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Communication Partners Supporting Children With Complex Communication Needs Who Use AAC: A Systematic Review
Abstract
Communication partners who efficiently use augmentative and alternative communication (AAC) are essential interaction partners for children learning to communicate using AAC. This systematic review examines studies targeting interventions designed to help communication partners support children with complex communication needs who use AAC. Overall, the 13 studies of moderate methodological quality rated using published rating scales reported positive findings for partners skills and childrens communication. Author-reported effect sizes and calculation of improvement rate difference indicated that multiple studies demonstrated large effects that were maintained 1 to 2 months post intervention. Delivery considerations for partner training including device training, enhancing partners understanding of communication targets, and the timing of partner training are discussed. The importance of supporting successful interactions across learning contexts and domains of communication as well as over time is highlighted. Furthermore, implications for dyads with unique characteristics including limited experience with AAC and children who are developmentally young are examined.
... Parents and caregivers are often the primary communication partners implementing some form of AAC, and the main context for evaluating the success of AAC intervention should always be the family (Granlund et al., 2008;Kent-Walsh & McNaughton, 2005;Pennington et al., 2004). A growing body of literature evidences the pivotal role of the family in supporting and enhancing a child's optimal use of AAC (see Biggs et al., 2018;Elmquist et al., 2023;Kent-Walsh et al., 2015;Shire & Jones, 2014). Recent systematic (Biggs et al., 2018;Pennington et al., 2018) and scoping reviews (Biggs et al., 2019;Elmquist et al., 2023;Shire & Jones, 2014), as well as a meta-analysis of singlecase experimental research studies (Kent-Walsh et al., 2015), have shown that caregivers can effectively implement AAC interventions, leading to improvements in their children's communication skills. ...
... A growing body of literature evidences the pivotal role of the family in supporting and enhancing a child's optimal use of AAC (see Biggs et al., 2018;Elmquist et al., 2023;Kent-Walsh et al., 2015;Shire & Jones, 2014). Recent systematic (Biggs et al., 2018;Pennington et al., 2018) and scoping reviews (Biggs et al., 2019;Elmquist et al., 2023;Shire & Jones, 2014), as well as a meta-analysis of singlecase experimental research studies (Kent-Walsh et al., 2015), have shown that caregivers can effectively implement AAC interventions, leading to improvements in their children's communication skills. Involving caregivers as intervention agents in AAC implementation has proven to increase the likelihood of generalizing new skills to natural environments, increase the number of responsive and motivated communication partners across the individual's life span, and provide more opportunities for children to acquire and maintain communication skills (Biggs et al., 2018(Biggs et al., , 2019Elmquist et al., 2023;Pennington et al., 2018;Shire & Jones, 2014). ...
... Recent systematic (Biggs et al., 2018;Pennington et al., 2018) and scoping reviews (Biggs et al., 2019;Elmquist et al., 2023;Shire & Jones, 2014), as well as a meta-analysis of singlecase experimental research studies (Kent-Walsh et al., 2015), have shown that caregivers can effectively implement AAC interventions, leading to improvements in their children's communication skills. Involving caregivers as intervention agents in AAC implementation has proven to increase the likelihood of generalizing new skills to natural environments, increase the number of responsive and motivated communication partners across the individual's life span, and provide more opportunities for children to acquire and maintain communication skills (Biggs et al., 2018(Biggs et al., , 2019Elmquist et al., 2023;Pennington et al., 2018;Shire & Jones, 2014). ...
Purpose
Caregivers play a critical role in their children's development and serve as their primary communication partners. Family interactions provide the most naturally occurring opportunities for children with complex communication needs to learn language in the context of family routines. A growing body of research suggests that caregivers can effectively support their children's use of augmentative and alternative communication (AAC) systems when provided with appropriate training and coaching through caregiver-implemented interventions (CIIs). However, the efficacy of these interventions remains untested among culturally and linguistically diverse caregivers. Given the increasing diversity in the United States, there is a pressing need to develop CIIs that align with the cultural and linguistic preferences of diverse families.
Method
Using the Ecological Validity Framework and the Checklist for Cultural Adaptations, this tutorial explores considerations for culturally adapting caregiver-implemented AAC interventions for Latinx caregivers of children with AAC needs. The aim is to ensure that interventions are relevant, meaningful, and respectful of cultural and linguistic practices. Through carefully crafted cultural adaptations, interventions can achieve greater acceptance by caregivers.
Results and Discussion
This tutorial suggests a series of cultural adaptations to ensure accessibility, sustainability, and success of caregiver-implemented AAC interventions for Latinx caregivers of children with AAC needs. By incorporating cultural and linguistic considerations into the intervention design, we can enhance its acceptability among Latinx caregivers. This, in turn, can lead to improved outcomes in AAC implementation within the home environment.
... In recognition of the important role partners play in conversations with children who use AAC technologies and in response to their proclivity to perpetuate problems in interaction, researchers have focused efforts on teaching communication partners to support children who use AAC technologies in conversations (Kent-Walsh et al., 2015;Kent-Walsh & McNaughton, 2005;Shire & Jones, 2015). This research has demonstrated that a variety of communication partners, including parents and educational assistants, can implement communication support strategies with fidelity and positively influence the communication skills of children who use AAC technologies Kent-Walsh et al., 2010;Kent-Walsh et al., 2015;Rosa-Lugo & Kent-Walsh, 2008;Shire & Jones, 2015). ...
... In recognition of the important role partners play in conversations with children who use AAC technologies and in response to their proclivity to perpetuate problems in interaction, researchers have focused efforts on teaching communication partners to support children who use AAC technologies in conversations (Kent-Walsh et al., 2015;Kent-Walsh & McNaughton, 2005;Shire & Jones, 2015). This research has demonstrated that a variety of communication partners, including parents and educational assistants, can implement communication support strategies with fidelity and positively influence the communication skills of children who use AAC technologies Kent-Walsh et al., 2010;Kent-Walsh et al., 2015;Rosa-Lugo & Kent-Walsh, 2008;Shire & Jones, 2015). However, this research has impact of highlighted the specific models of partner training rather than focusing more generally on understanding and describing the ways that effective partners support children who use AAC technologies in interactions that are dynamic and interpersonal. ...
... Furthermore, this research on communication partner training has focused on improving targeted child communication skills. This includes quantifying features of interactions including the total number of communicative turns a child takes, semantic concepts the child expresses, and multi-symbol messages the child constructs (Kent-Walsh et al., 2015;Shire & Jones, 2015). ...
Augmentative and alternative communication (AAC) technologies for children with complex communication needs (CCN) can improve communication skills, increase autonomy, promote social closeness, and enhance meaningful participation in a variety of social contexts. However, access to AAC technologies is insufficient. Successful use of AAC technologies also requires ongoing support from communication partners (i.e., parents, teachers, or speech and language pathologists [SLPs]) who are knowledgeable of AAC. Understanding what communication partners can do to support successful interactions in conversation is important for improving experiences and outcomes in communication for children who use AAC and their various communication partners.
One way to develop understandings of what comprises successful interactions with children who use AAC is to observe their interactions with highly skilled communication partners. The group of SLPs who are considered exemplary by their peers due to their expertise in AAC, communication, and language development includes many such highly skilled communication partners. Identifying the ways these exemplary partners support AAC-mediated interactions may improve understanding of how to promote successful interactions mediated by aided AAC technologies with a range of communication partners.
This study examined the nature of interactions between children who use aided AAC technologies and their exemplary AAC SLPs. Using a multi-case design, dyads (n = 3) of exemplary AAC SLPs and children who used robust AAC technologies were video recorded during typical speech therapy sessions that included a semi-structured collage-making activity designed to elicit conversation. Videos were transcribed and analyzed using microanalysis to examine how the interactions unfolded and the ways the SLPs supported each child's communication.
The results highlight the nuance in how the SLPs and children collaborated to make meaning and suggest that exemplary AAC SLPs individualize their intervention sessions, prioritize dynamic, dialogic interactions over mastery of targeted skills, and consistently use aided language modeling, without expecting specific responses. This study also highlights the importance of attuning for fostering relationships and shared meaning. This study adds to understanding of how SLPs can support children who use robust AAC technologies as communication partners in interactions that are meaningful and dynamic.
... They reported that, 1 year later, there was a positive relationship between adult input at home and child communication outcomes, but not between teacher input and child outcomes at school. Most research has been implemented in school or clinical settings (Biggs et al., 2019;Gevarter & Zamora, 2018;Holyfield et al., 2017;Logan et al., 2017; and infrequently in homes or other community settings (Shire & Jones, 2015). ...
... Whether the learner could imitate or alternatively was taught to imitate as part of the intervention has not often been addressed. A number of prompting and prompt-fading strategies have some evidence of promise (Ganz et al., 2017;Holyfield et al., 2017;Shire & Jones, 2015;. However, most existing systematic reviews have not statistically aggregated or compared results by instructional strategy. ...
... An important aspect of instructional strategies involves the general approach to implementation. Naturalistic intervention approaches, such as child-led instruction (Logan et al., 2017) and embedding AAC instruction within authentic activities (Gevarter & Zamora, 2018;Shire & Jones, 2015), are increasingly prevalent in AAC intervention. Although researchers and practitioners regularly call for implementing AAC in authentic environments, only a small proportion of studies have reported AAC implementation within authentic contexts and/or with natural communication partners (Biggs et al., 2019;Holyfield et al., 2017;Logan et al., 2017;Shire & Jones, 2015). ...
Purpose
This article provides a systematic review and analysis of group and single-case studies addressing augmentative and alternative communication (AAC) intervention with school-aged persons having autism spectrum disorder (ASD) and/or intellectual/developmental disabilities resulting in complex communication needs (CCNs). Specifically, we examined participant characteristics in group-design studies reporting AAC intervention outcomes and how these compared to those reported in single-case experimental designs (SCEDs). In addition, we compared the status of intervention features reported in group and SCED studies with respect to instructional strategies utilized.
Participants
Participants included school-aged individuals with CCNs who also experienced ASD or ASD with an intellectual delay who utilized aided or unaided AAC.
Method
A systematic review using descriptive statistics and effect sizes was implemented.
Results
Findings revealed that participant features such as race, ethnicity, and home language continue to be underreported in both SCED and group-design studies. Participants in SCED investigations more frequently used multiple communication modes when compared to participants in group studies. The status of pivotal skills such as imitation was sparsely reported in both types of studies. With respect to instructional features, group-design studies were more apt to utilize clinical rather than educational or home settings when compared with SCED studies. In addition, SCED studies were more apt to utilize instructional methods that closely adhered to instructional features more typically characterized as being associated with behavioral approaches.
Conclusion
The authors discuss future research needs, practice implications, and a more detailed specification of treatment intensity parameters for future research.
... It is theorized that novice communicators acquire language during social interactions with advanced communicators; therefore, individuals who rely on AAC (e.g., individuals with ID) can learn language, through observation, in an environment in which their communication partners model the language and AAC forms that are relevant to, or preferred by, them (Meuris et al., 2015;Shire & Jones, 2015). However, often, during AAC interventions, the language input of the communication partner (i.e., spoken language) is different from the language output of the individual who relies on AAC (i.e., graphic symbols and/or manual signs), which is problematic (Chadwick & Jolliffe, 2008;Meuris et al., 2015). ...
... However, often, during AAC interventions, the language input of the communication partner (i.e., spoken language) is different from the language output of the individual who relies on AAC (i.e., graphic symbols and/or manual signs), which is problematic (Chadwick & Jolliffe, 2008;Meuris et al., 2015). Communication partners must model the communication mode(s) used by individuals who rely on AAC by responding to their messages using the same language input or communication mode(s) (Shire & Jones, 2015;Smidt et al., 2019). ...
... Individuals with developmental disabilities require sufficient, ongoing opportunities to practice manual signs in their daily environments so that they learn to functionally use manual signs as well as generalize their manual sign use (Beukelman & Mirenda, 2013;Duker & Moonen, 1985;Fitzgerald et al., 1984;Spragale & Micucci, 1990) Along with using and modeling communication modes, communication partners must understand the communication modes used by individuals who rely on AAC. These communication modes may include verbal and nonverbal communication and unaided and aided AAC forms (Shire & Jones, 2015). For instance, if communication partners do not understand the unaided AAC form manual signs, then they may not comprehend the communications (i.e., communicative intent) of individuals who rely on AAC (or manual signs; Chadwick & Jolliffe, 2008). ...
This study examined the effect of a 1-day, 6-hour key word signing (KWS) workshop on in-service special education teachers’ and speech-language pathologists’ (SLPs) (a) skill identifying American Sign Language (ASL) signs; (b) skill producing ASL signs; (c) use of KWS in the classroom or therapy room; and (d) perceived changes from taking part in a KWS workshop. Participants included five special education teachers, three SLPs, and four students with complex communication needs (aged 3 to 14 years) participated in the study. All eight adult participants participated in a pretest-posttest design with repeated posttest measures over time, survey design, and phenomenological research to examine the effect of a KWS workshop on their skill identifying and producing manual signs as well as their perceived changes from taking part in the KWS workshop. Three of the eight adult participants and four students participated in an A-B single-case design, which was used to determine the effect of the KWS workshop on the in-service staff’s use of KWS in their classrooms or therapy rooms. The adult participants demonstrated an immediate increase in their ability to identify and produce the ASL signs taught during the KWS workshop, and they exhibited an increasing trend over the six postworkshop assessment sessions (across 11 or 12 weeks) in their ASL sign identification and production skills. The adult participants’ percentage of nonoverlapping data (PND) for the number of signed utterances, signs, and different signs they used in their classrooms or therapy rooms indicated a large effect. Two of the four students did not produce signed utterances during the classroom activities throughout the three preworkshop observations and five postworkshop observations. The PND for one student, who produced signed utterances, suggested a large effect and the PND for the other student, who used signed utterances, suggested a small effect. A majority of the participants reported that students, who relied on AAC and used natural speech, as well as classroom staff increased their production (i.e., imitation and spontaneous production) of ASL signs after the adult participants attended a workshop and began to use KWS in their classrooms and therapy rooms.
... skills (Allen et al., 2017;Biggs et al., 2018;Kent-Walsh et al., 2015;Shire & Jones, 2015). In the field of AAC, communication partner instruction involves a therapist teaching a communication partner to use an AAC system and language support strategies while interacting with an individual who uses AAC. ...
... In the field of AAC, communication partner instruction involves a therapist teaching a communication partner to use an AAC system and language support strategies while interacting with an individual who uses AAC. Communication partner instruction interventions support communication development by using language support strategies, such as modeling AAC systems and increasing child communication opportunities (Shire & Jones, 2015). Shire and Jones (2015) conducted a systematic review of communication partner interventions to examine the effects on communication partner fidelity and communication skills of children who used AAC. ...
... Communication partner instruction interventions support communication development by using language support strategies, such as modeling AAC systems and increasing child communication opportunities (Shire & Jones, 2015). Shire and Jones (2015) conducted a systematic review of communication partner interventions to examine the effects on communication partner fidelity and communication skills of children who used AAC. One randomized controlled trial (Romski et al., 2010) and 12 singlecase studies, which included 105 children with neurodevelopmental disabilities and their communication partners (parents, paraprofessionals, and therapists), met eligibility criteria. ...
Purpose
This study aimed to explore the feasibility of a telepractice communication partner intervention for children who use augmentative and alternative communication (AAC) and their parents.
Method
Five children (aged 3;4–12;9 [years;months]) with severe expressive communication impairments who use AAC and their parents enrolled in a randomized, multiple-probe design across participants. A speech-language pathologist taught parents to use a least-to-most prompting procedure, Read, Ask, Answer, Prompt (RAAP), during book reading with their children. Parent instruction was provided through telepractice during an initial 60-min workshop and five advanced practice sessions (M = 28.41 min). The primary outcome was parents' correct use of RAAP, measured by the percentage of turns parents applied the strategies correctly. Child communication turns were a secondary, exploratory outcome.
Results
There was a functional relation (intervention effect) between the RAAP instruction and parents' correct use of RAAP. All parents showed a large, immediate increase in the level of RAAP use with a stable, accelerating (therapeutic) trend to criterion after the intervention was applied. Increases in child communication turns were inconsistent. One child increased his communication turns. Four children demonstrated noneffects; their intervention responses overlapped with their baseline performance.
Conclusions
Telepractice RAAP strategy instruction is a promising service delivery for communication partner training and AAC interventions. Future research should examine alternate observation and data collection and ways to limit communication partner instruction barriers.
... The CP must also be skilled communicators so that the conversation or exchange of information is successful. To learn the specific skills to promote effective communication, CPs need to have explicit instruction in using the device to support individuals who have complex communication needs (Shire & Jones, 2015). However, many caregivers do not feel that they have adequate training and competencies to support the individual using AAC (IUA; McNaughton et al., 2008). ...
... Similarly, a systematic review of interventions for training CPs was completed by Shire and Jones (2015). Their study focused on children with complex communication needs who used AAC and included only studies in which CP training was provided. ...
... Maggie reported that, although she felt that the training increased her confidence using the device and supporting her son's communication, as well as improving her foundational skills using AAC, further training would be helpful, especially assisting in initiating and incorporating the AAC system as new communication situations or environments arise. Consistent with other studies (Shire & Jones, 2015), generalization and intervention across multiple contexts is needed so that IUAs and their CPs can engage in more varied communication opportunities within their day. ...
Purpose
The purpose of this clinical focus article was to assess the communication partner's (CP) perception regarding the effectiveness of a CP training model to support augmentative and alternative communication (AAC) use within a parent–adolescent dyad.
Method
This case study implements an adaptation of an 8-stage strategy instruction protocol for teaching aided language modeling across functional activities. Procedures for designing CP training to meet the specific needs of a particular CP and an individual using AAC (IUA) are offered. Pre- and posttraining questionnaires surveyed the CP's feelings and knowledge about using the AAC strategies and the IUA's AAC skill level.
Results
Quantitative and qualitative analyses of the CP's responses on the pre- and posttraining questionnaires revealed more confidence in supporting her son when using his device, increased knowledge of strategies to support AAC use, and increased understanding of the device operation. She also perceived that her son used his device more confidently and effectively in a variety of ways.
Conclusion
CP training that includes strategy instruction, along with practice and feedback, helps to increase the CP's and the IUA's understanding of the specific device and how to use it in more naturalistic, functional settings and situations. Since the CP's needs are similar across developmental and neurogenic groups, the direct strategy instruction described in this clinical focus article can be used by practicing clinicians working with pediatric or neurogenic populations to teach communication and operational skills. The results suggest that CP training should be included in treatment planning for speech-language pathologists working with individuals with complex communication needs who use AAC.
... Communication interventions often result in improved outcomes for individuals with ASD and/or intellectual and developmental disabilities (IDD; Paul, 1997). Instructional environments that emulate situations in which the learner is likely to use the new communicative behavior being taught have become increasingly prevalent in the intervention literature (Gevarter & Zamora, 2018;Logan et al., 2017;Shire & Jones, 2015). The implementation of augmentative and alternative communication (AAC) has proven effective for persons with ASD and/or IDD that results in complex communication needs (CCNs; Reichle et al., 2021) Positive outcomes of recent communication intervention research demonstrate the efficacy of a range of interventions including behavioral and naturalistic interventions, including AAC interventions in authentic settings (Holyfield et al., 2017;Logan et al., 2017). ...
... Further, most reviews of context as a potential moderator in communication interventions have not examined effect magnitude as a function of authentic compared to nonauthentic approaches to intervention (e.g., Gevarter & Zamora, 2018;Holyfield et al., 2017). Much of the extant research has been implemented in clinical settings, such as universities or schools (Biggs et al., 2018;Gevarter & Zamora, 2018;Holyfield et al., 2017;Logan et al., 2017;Therrien et al., 2016) rather than homes or other community settings (Shire & Jones, 2015). Consequently, there is a need to update and more systematically quantify the effects of instructional practices as moderators of intervention outcomes. ...
For children with autism or intellectual and developmental disabilities who also have complex communication needs, communication is a necessary skill set to increase independence and quality of life. Understanding the how, where, and communication style being taught is important for identifying deficits in the field as well as which interventions are most effective. This meta-analysis sought to identify effectiveness among different settings, behavioral strategies, and moderator variables. A systematic search and screening process identified 114 eligible studies with 330 participants; overall outcomes indicate that augmentative and alternative communication interventions were effective with Tau effects ranging from 0.53 to 1.03 and log response ratio effects ranging from 0.21 to 2.90. However, no instructional context variables systematically predicted differences in intervention effectiveness.
... A implementação bem-sucedida de qualquer sistema com saída de voz ou sistema de baixa tecnologia depende da experiência e eficácia do comunicador. Ambos os sistemas podem contribuir para o aumento das interações (CRESS; MARVIN, 2003;SHIRE;JONES, 2015). ...
... A implementação bem-sucedida de qualquer sistema com saída de voz ou sistema de baixa tecnologia depende da experiência e eficácia do comunicador. Ambos os sistemas podem contribuir para o aumento das interações (CRESS; MARVIN, 2003;SHIRE;JONES, 2015). ...
Resumo: a capacidade de comunicar permite criar oportunidades de interação, influenciar o comportamento de outros e através
disso exercer controlo sobre o meio ambiente da pessoa. Proporcionar uma forma aumentativa ou alternativa de comunicar potencia a autonomia e uma melhor qualidade de vida das crianças com perturbações da comunicação. Este facto, requere da parte dos
profissionais um conjunto de competências para intervir junto destas crianças. A implementação da Comunicação Aumentativa e
Alternativa (CAA) pode ser dificultada por preconceitos sobre a necessidade de uso, período mais adequado para iniciar a aprendizagem e competências precisas para o desenvolvimento da comunicação através destes recursos. Nesse sentido, este texto tem como
finalidade contribuir para uma compreensão acerca dos mitos e realidades em relação ao uso da CAA. Foram analisadas as produções científicas nacionais e internacionais acerca do uso da CAA em populações com problemas graves na comunicação. Para isso,
foi realizada uma busca em bases de dados de artigos, teses e dissertações, utilizando a combinação dos descritores, “Comunicação
Aumentativa” e “Perturbações da Comunicação”. Os cinco mitos apresentados, caso não sejam adequadamente esclarecidos, podem levar a problemas na adesão à CAA por parte das famílias e de alguns profissionais. Assim, surge a necessidade de desmistificar
estas questões de forma a promover o apoio adequado a crianças que podem beneficiar de CAA
... Overall, research suggests that communication partner instruction used within an AAC intervention program may result in improved communication outcomes for the individual who uses AAC (Kent-Walsh et al., 2015;Shire & Jones, 2015). Specifically, partner instruction has been shown to reduce the opportunity barriers of facilitator knowledge and skills resulting in improved communicative interactions between the AAC user and their respective communication partner. ...
AAC can enhance communication, improve academic achievement, and increase societal participation for individuals with complex communication needs. Unfortunately, many students lack access to effective interventions due to a lack of
experienced professionals and stakeholders. Research suggests educational
assistants can be trained to support the communication of these children, but there
is a notable gap regarding adolescent students. This investigation used a single subject, multiple-baseline design to examine the effects of an educational-assistant delivered intervention on the morpho-syntactical productions of adolescents who
require AAC. Analyses indicated that an effective communication partner-delivered
intervention program can lead to gains for adolescents who use aided communication.
... Both the individual and their communication partners are fundamental to the success of AAC (Kent-Walsh et al. 2015). Communication partners must become familiar with the AAC system , model AAC and respond to the individual using AAC (Shire & Jones 2015). Moreover, they must listen to the individual (McCormack, Baker, and Crowe 2018). ...
Background
This study explores communication partners' perceptions of their roles and responsibilities in the design, planning and use of augmentative and alternative communication (AAC) with individuals with severe/profound intellectual disability.
Methods
A qualitative descriptive approach was used. Purposive sampling, data collection and qualitative content analysis were undertaken simultaneously. Data were collected from nine participants, four parents and five professionals over 4 months through audio or video‐recorded, semi‐structured, open‐ended interviews.
Findings
An overarching theme ‘Maximising Communication through AAC’ emerged, capturing participants' unanimous agreement that their shared goal was to optimise individuals' communication through AAC. This was influenced by three themes: ‘Developing a Communicative Environment’, ‘The Act of Communicating; Attempting to Realise the Individuals' Ability’ and ‘Living with Uncertainty’.
Conclusions
These findings contribute to enhancing understanding of AAC use with individuals with severe/profound intellectual disability and their communication partners.
... Moreover, communication partners are required to have skills to understand how the child communicates, verbally or nonverbally. They must also appropriately model communication and respond to the child via this same array of modes of communication (Shire & Jones, 2015). ...
Objectives
Rett syndrome, a rare genetic disorder, may impact language development and be associated with severe communication deficits. Communication partners, such as parents and health professionals involved in children’s daily lives with RTT, are the most relevant for understanding their communication needs. This article aimed to provide an overview of the identification of communication abilities in children with RTT in their daily routine from the perspectives of communication partners who interact with individuals diagnosed with RTT.
Methods
A scoping review was used to comprehensively search and gather evidence from existing literature on how communication partners understand, define, and classify the communication abilities of children with RTT in their daily routines. The quality of each selected study was assessed using the modified critical appraisal skills program (CASP) checklist.
Results
This scoping review revealed specific communication abilities in children with RTT as described by the communication partners interacting with them daily. Accurate assessment outcomes rely on the communication partners’ perspectives on the communication skills of children with RTT.
Conclusions
This review highlights the need for future studies to support and identify preassigned communicative acts in the communication assessment of children with RTT.
... A cursory review of the literature shows children with DD have frequently been the subject of AAC research with positive impacts on communication (Binger et al. , 2019Binger, Kent-Walsh, King, Webb, et al. 2017;Light, McNaughton, and Caron 2019). Previous systematic reviews were dedicated to children and focused on specific topics such as aided language stimulation (Biggs, Carter, and Gilson 2018) and communication partner training (Shire and Jones 2015;Therrien, Light, and Pope 2016). While the quality of the studies did vary in these reviews, positive results were found for these intervention techniques for children. ...
The purpose of the study was to review available literature on aided AAC intervention for adults with developmental disabilities excluding autism. Nineteen studies were included with 43 participants in a 30-year period. Most studies were single-subject design and interventions varied widely. Most interventions focused on social or linguistic skills. Relatively limited research has addressed aided AAC interventions for adults with DD. It is necessary to further investigate intervention techniques for this population.
... Remedial actions by the National Department of Education have included the provision of training programs for care center staff (Sekatane & Orlandi, 2021). Various ad hoc workshops and training events have been initiated; however, not all semantic and morpho-syntactic outcomes (Biggs et al., 2019;Kent-Walsh et al., 2015;Muttiah et al., 2022;Shire & Jones, 2015). A strategy instruction model (Kent-Walsh & McNaughton, 2005) has been used in many AAC partner training studies (e.g., Douglas, 2012;Timpe et al., 2021). ...
In South Africa, many children with extensive support needs-including children who require AAC-are accommodated in care centers rather than the public schooling system. Caregivers employed at these centers need training in order to support children's communication using augmentative and alternative methods. A total of 29 center-based caregivers took part in this study. A single group pretest-posttest design was used to evaluate the effect of a 5-day training workshop on caregivers' ability to demonstrate and implement five AAC strategies. The effect of the workshop on caregivers' perceptions of their own skills as well as the social validity of the training were also evaluated. Results suggest that the workshop effectively taught caregivers to demonstrate the skills in a simulated roleplay situation. A proportion of caregivers also supplied video footage after the workshop that suggests the ability to implement the strategies in the care center contexts. Caregivers also perceived their own skills to have improved post workshop, and evaluated the training positively.
... Pessoas com necessidades complexas de comunicação necessitam de maior engajamento e utilização de estratégias específicas por parte de seus interlocutores para conseguirem atingir ampla participação nas atividades comunicativas (13) , portanto é fundamental que seus parceiros de comunicação, especialmente os do meio familiar, sejam capacitados, considerando que são estes atores sociais os que exercem a mais profunda e potente influência no desenvolvimento e/ou recuperação da linguagem dessas pessoas. Outrossim, devem estar aptos a modelar adequadamente a comunicação alternativa e responder à criança por meio desse mesmo conjunto de tipos ou modos de comunicação (14) . A modelagem no uso da CAA é uma estratégia utilizada pelo parceiro de comunicação quando este tem a intenção de ser modelo de interlocutor para que o usuário de CAA aprenda a utilizar o seu sistema de CAA, inicialmente imitando e, em seguida, utilizando de forma independente. ...
Purpose
To validate the appearance and content of the DHACA method to develop communication skills in autism.
Methods
This qualitative and quantitative validation study included 10 speech-language-hearing judges with expertise in alternative communication. The judges received the communication book, the description of the principles, skills, and strategies in the DHACA method, and a form with items for them to appraise the appearance and content of the method. The validity was calculated with the content validity index.
Results
The response analysis made it possible to calculate the degree of agreement between judges and develop the new instrument version. The calculation of the content validity index revealed excellent content validity. The judges made suggestions regarding the content of the communication book, texts regarding the participation of communication partners and modeling, using cues, and communicative skills.
Conclusion
The degree of agreement between judges ensured the validation of the appearance and content of the DHACA method, considering the items alone and the whole instrument. Hence, its use can be recommended for speech-language-hearing clinical practice.
Keywords:
Autism; Communication; Speech; Language and Hearing Sciences; Assistive Technology; Alternative and Augmentative Communication Systems
... The significant gap between these two rates restricts individuals with communication difficulties from effective participation in multiparty interactions with minimal delay [22]. Overall, current assistive technologies cannot enable AAC users to participate successfully in multiparty interactions due to large time delays and a lack of expressivity, naturalness and personalisation [46,17,48]. ...
Over 70 million people worldwide face communication difficulties, with many using augmentative and alternative communication (AAC) technology. While AAC systems help improve interaction, the communication rate gap between individuals with and without speaking difficulties remains significant, and this has led to a low sustained use of AAC systems. The study reported here combines human computer interaction (HCI) and language modelling techniques to improve the ease of use, user satisfaction, and communication rates of AAC technology in open-domain interactions. A text input interface utilising word prediction based on BERT and RoBERTa language models has been investigated with a view to improving communication rates. Three interface layouts were implemented, and it was found that a radial configuration was the most efficient. RoBERTa models fine-tuned on conversational AAC corpora led to the highest communication rates of 25.75 words per minute (WPM), with alphabetical ordering preferred over probabilistic ordering. It was also found that training on conversational corpora such as TV and Reddit outperformed training based on generic corpora such as COCA or Wikipedia. Hence, it is concluded that the limited availability of large-scale conversational AAC corpora represent a key challenge for improving communication rates and robust AAC systems.
Index Terms: Text Input Prediction, Language Modelling, Augmentative and Alternative Communication (AAC), Speech Synthesis
... While ample research supports the benefits of partner training on communication support strategies (Biggs et al., 2019;Kent-Walsh et al., 2015;Shire & Jones, 2015), less attention has been given to training that develops operational competencies and technical skills. Heavy technical demands are placed on educational professionals providing AAC services, especially when teaching in classrooms with multiple students who use AAC, each with a different device and system organization. ...
Purpose
This qualitative study explores classroom contextual factors influencing augmentative and alternative communication (AAC) use in early childhood classrooms.
Method
Semistructured interviews were conducted with six special education teachers, 13 speech-language pathologists (SLPs), and one SLP assistant. Interviews were analyzed inductively in a systematic, multistep coding process using the constant comparative method with member checking.
Results
Seven themes were identified that affected AAC use in the classroom. Each theme was organized into three categories: individual-, classroom-, or school-level factors. Three themes were categorized as individual-level factors: Students' AAC systems are unavailable, professionals face challenges obtaining AAC knowledge and skills, and students' disruptive behaviors reduce access to AAC. One theme was a classroom-level factor: Classroom demands prevent AAC use. Finally, three themes were considered school-level factors: The culture of AAC influences AAC acceptance, team collaboration is essential for successful implementation, and teams need administrative support to deliver AAC interventions effectively.
Conclusions
Teachers and SLPs felt that collaborative teams with AAC expertise, a school culture that endorsed AAC, and solid administrative support accelerated AAC adoption by normalizing AAC use in the classroom. Due to classroom demands, they struggled to use strategies such as aided AAC modeling and responsiveness during group instruction. Finally, participants emphasized that while it was necessary to customize AAC systems for each student, this individualization makes it harder for staff to learn each system and integrate them into classroom activities.
Supplemental Material
https://doi.org/10.23641/asha.23681718
... Empirical research in AAC and telepractice is growing and there is mounting support for using telepractice to train and coach interventionists (caregivers, staff, and clinicians) who work with children who use AAC in early intervention contexts and school settings. Communication partner training is a fundamental aspect of AAC intervention (Kent-Walsh et al., 2015;Shire & Jones, 2015). Furthermore, gaining caregiver buy-in for AAC and incorporating AAC into naturalistic settings such as home and school is critical to successful communication outcomes (Fäldt et al., 2020;Romski et al., 2015). ...
Purpose
The purpose of this project was to examine the effect of the COVID-19 pandemic on speech-language pathologist (SLP) service provision for emergent bilinguals who use augmentative and alternative communication (AAC). One prominent issue in AAC service delivery is the efficacy and feasibility of providing AAC services via telepractice. The COVID-19 pandemic intensified this issue as most providers, clients, and families adjusted to remote service delivery models. While emerging evidence supports telepractice in AAC, little is known about the potential benefits and challenges of telepractice for emergent bilinguals who use AAC and their families.
Method
Data were collected via a nationwide survey. Licensed SLPs (N = 160) completed an online questionnaire with Likert-type, multiple-choice, and open-ended questions, analyzed using mixed methods.
Results
Findings illustrated a shift in service delivery from in-person to telepractice and hybrid (both telepractice and in-person) models. Overall, child intervention outcomes declined for emergent bilinguals who used AAC during the COVID-19 pandemic, regardless of service delivery format. However, collaboration increased for many providers and families. Qualitative analyses highlighted barriers to AAC service provision for emergent bilinguals who use AAC that were exacerbated by the COVID-19 pandemic, as well as factors that facilitated collaboration and family engagement.
Conclusion
These findings suggest that, despite challenges, telepractice or hybrid services may be a promising approach to provide more culturally responsive, family-centered care for emergent bilinguals who use AAC.
Supplemental Material
https://doi.org/10.23641/asha.20405673
... Actuellement, la façon dont la formation du partenaire de communication influence les habiletés réceptives des enfants n'est pas encore bien comprise. Pour avancer sur cette question, il serait important de documenter plus précisément l'évolution des capacités réceptives des enfants suite à l'entraînement de leurs partenaires de communication (Shire & Jones 2015). ...
Communication partner instruction of indi viduals using augmentative and alternative communication (AAC) is a huge challenge for speech and language therapists. The purpose of this article was to identify the active ingredients of AAC communication partner interventions based on available data. In a first step, we identified targets and implementation strategies that have been sh own as effective in parent implemented communication interventions with young child ren. In a second step, these data were supplemented by studies on the training of communication partners in the context of the use of AAC. Taken together, these studies point out that the most effective targets to improve the interaction style of partners consist in training their responsiveness and use of language models. Pragmatic outcomes (e.g., tu rn-taking), the access to spontaneous communication and a support for understanding have to be added for AAC interventions. To achieve this, the instructional methods employed with communication partners should include various combinations of implementation modalities (e.g., information sharing, modeling, guided practice, verbal rehearsal and feedback). Verbal rehearsal was shown to have a key role for the efficacy of the implementation. Finally, the communication partner's proficiency level with the AAC device should also be considered.
... CPT for people with primary progressive aphasia (PPA) and their CPs is a new field of research (Volkmer et al., 2021, although speech and language therapists/pathologists (henceforth SLTs) report that they have been adapting stroke-aphasia CPT programs for use in PPA for some time (Volkmer et al., 2019. A systematic review by Shire & Jones (2015) of 13 studies (of moderate methodological quality) of CP interventions to support children who use AAC concludes that there is evidence that parents and educational assistants adopt beneficial interactional strategies after CPT and that these positively influence children's AAC use. Similarly, Thiessen & Buekelman (2013) report that adults who rely on AAC benefit from a trained CP, and they encourage SLTs to consider principles of adult learning, CPT delivery mode including remote training, and cultural issues when providing CPT. ...
Purpose
This case report provides an overview of telehealth delivery of our Better Conversations approach to communication partner training (CPT) for people with primary progressive aphasia (PPA) and their communication partner (CP). The purpose is to advance the knowledge of speech and language therapists/pathologists (SLTs) on this type of CPT and empower them to deliver teleCPT as part of their clinical practice.
Method
We provide a case report describing therapy delivery, outcomes, and self-reflections from our clinical practice, which represents a collaboration between a UK National Health Service CPT clinic and the Better Conversations Research Lab at University College London, UK. A man with PPA and his CP (a dyad) video-recorded everyday conversations at home using a video conferencing platform. These formed the basis of an evaluation of conversation barriers and facilitators, which led to four weekly 1-hr therapy sessions covering the mechanics of conversation, identification of barriers and facilitators, goal setting, and practice of positive conversation strategies.
Results
Dyad self-rating of goal attainment revealed that three of four conversation strategies were achieved much more than expected, a positive outcome given the progressive nature of F.F.'s condition. SLT access to the dyad at home via teleCPT facilitated the carryover of strategies from the session to everyday conversations in the home environment. TeleCPT was acceptable to this couple during a global pandemic, with benefits including no travel, ease of therapy scheduling around the CP's work and family commitments, and access to a specialist CPT clinic outside their geographical area.
Conclusions
TeleCPT is feasible and acceptable to clients, improving access to therapy in a way that should not just be the preserve of service delivery during a global pandemic. SLTs can enable clients and their families to have better conversations despite communication difficulties by offering teleCPT. We have shared practical suggestions for delivering teleCPT.
... Several studies have explored ways to offer coaching to paraeducators to increase their knowledge and skills in supporting students who use AAC (Biggs et al., 2019;Douglas, 2012;Kent-Walsh et al., 2015;Shire & Jones, 2015). Key components of successful coaching interventions for communication partners have included description of the skill to be practiced, demonstration of the target skill by the coach to the partner, and the communication partner practicing with feedback from the coach (Binger et al., 2010;Kent-Walsh & McNaughton, 2005) as well as role-play, provision of printed materials, explanation of rationales for targeted skills, and individualized instructional plans for communication partners (Biggs et al., 2019). ...
Paraeducators are the most frequent communication partners during the school day for students who use augmentative and alternative communication (AAC), yet they often lack training in AAC best practices. This intervention study examined the effect of an in-class, coaching intervention on the aided language modeling (ALM) skills of paraeducators who work with students who use AAC. An intervention protocol using evidence-based coaching strategies was used to support paraeducator implementation of ALM in typical classroom activities. The multiple-baseline single-subject design measured the use of ALM by four paraeducators. Data were analyzed visually and by calculating Tau- U and gain scores. Results suggest a strong effect from the coaching intervention on ALM skills for each of the paraeducators. Challenges and benefits of paraeducator-focused interventions in classroom settings are presented.
... There is a strong and growing evidence base supporting the benefits of providing aided language input during natural communication interactions (e.g., Brady, Thiemann-Bourque, Fleming, & Mathews, 2013;O'Neill et al., 2018;Romski & Sevcik, 1996;Sennott, Light, & McNaughton, 2016). Similar to the benefits of spoken models for students who use speech to communicate, students learning to use graphic symbols benefit from others demonstrating their use (Shire & Jones, 2014). In its simplest form, aided language input involves pointing to symbols on an aided AAC system while speaking to students, using succinct language and holding the point long enough for students to see it and have a chance to make a meaningful connection between the symbol and the context in which the spoken word is used (O'Neill et al., 2018). ...
Many students with significant disabilities have complex communication needs and are not yet able to express themselves using speech, sign language, or other symbolic forms. These students rely on nonsymbolic forms of communication like facial expressions, body movements, and vocalizations. They benefit from responsive partners who interpret and honour these forms and teach symbolic alternatives. The purpose of this article is to describe ways in which classroom teachers and other classroom staff can be responsive partners using three targeted teaching practices: (a) attributing meaning and honouring early communication behaviours, (b) giving students personal access to aided augmentative and alternative communication (AAC) systems with a core vocabulary, and (c) using aided language input strategies to show students what is possible and how to use graphic symbols on aided AAC systems. These teaching practices are discussed using scenarios to illustrate how each can be integrated into typical academic and non-academic classroom activities.
... Educating significant communication partners (e.g., parents, teachers) can be of great benefit in increasing participation in daily interactions by individuals using speech-generating devices (SGD) [8,9]. Recent analyses of communication partner training programs suggest that there is consistent evidence that communication partner instruction improves both the skills of partners and of people who use AAC [10,11]. Furthermore, research suggests that communication partner training can be used effectively as an intervention strategy for individuals using AAC [10]. ...
BACKGROUND
Lack of parental knowledge about augmentative and alternative communication (AAC) systems and how to incorporate them into daily life can be a barrier to AAC use. To support children who are learning an AAC system, parents must understand how to model communication during naturally occurring activities.
OBJECTIVE
The objective of the study was to examine the effects of parent instruction on modeling AAC use in naturally occurring activities.
METHODS
An eight-step instruction model was used to teach four parents of children who use AAC to provide partner-augmented input (PAI) using the core vocabularies on their children’s speech-generating devices (SGDs) during core family leisure activities. Communication Sampling and Analysis (CSA) was used to compare parent and child language at pretest and post-test.
RESULTS
All parents demonstrated the ability to perform all of the components of successful PAI (slow rate, model, respect and reflect, repeat, expand, stop) as determined by review of an observation checklist completed during coaching sessions. Parents significantly increased percentage of utterances modeled on their children’s SGDs between pretest and post-test measures. The percentage of unique words modeled (i.e., type-token ratios) by each parent suggests variety in models at post-test. Three of four child participants demonstrated increases in unique words used following parent instruction.
CONCLUSIONS
Parent instruction can increase parent modeling and child SGD use.
... For example, ideally, the implementer should be able to quickly take a photo within a communication app and rapidly and intuitively add the photo to the device, program hotspots, and/or add voice-output to capture novel communication needs when they occur. Parents should also be taught specific strategies to encourage communication in their children, such as prompting and prompt fading for independent responding, addressing numerous communicative functions, and implementing AAC within naturalistic activities (Shire & Jones, 2015). ...
Augmentative and alternative communication (AAC) systems can support communication skills for people with significant developmental disabilities who experience complex communication needs (CCNs). There is a need to tailor best practices in AAC assessment and intervention to create individualized communication systems with this population. In this article, we outline the important components of AAC systems that can be implemented in authentic settings. However, given the limited evidence on AAC interventions specific to people with CCNs, we also identify some priority areas for future inquiry. Among these involve strategies to enhance decision making regarding (a) matching communication mode(s) to learner skills and contextual demands, (b) identifying communicative opportunities and obligations, (c) individualizing aided communication display features, (d) selection of vocabulary specificity, and (e) considering dosage parameters needed to acquire and maintain a communicative repertoire. In addition, we briefly discuss the use of telehealth to enhance intervention capability.
... Altruistic attitudes were prominent characteristics among peers with supportive roles (Anderson et al., 2011;Kent-Walsh & Light, 2003). In their systematic review of interventions directed to help children who use AAC, Shire and Jones (2015) highlighted support from communication partners. Furthermore, support from fellow students was one among several criteria for inclusion of students using AAC in a study involving staff of students using AAC in elementary to high school programs (Soto et al., 2001). ...
Purpose: This paper investigates the perceptions among parents and staff of how relational aspects among students who use AAC, fellow students, and staff may affect the students’ social relationships.
Methods: The study included semi-structured interviews of 6 parents and 18 staff to 7 students using AAC. The interviews were audio-recorded, transcribed verbatim, and analyzed by using a constructivist grounded theory approach.
Results: The analysis identified several interactional facilitators and barriers to social relationships between students using AAC and fellow students.
Conclusions: The results demonstrated the importance of considering personal as well as environmental facilitators and barriers to the student using AAC’s social relationships. The complexities in how these interactional facilitators and barriers interact with each other are discussed in relation to previous research. Of special importance for the development of the students’ social relationships was shared experiences between students using AAC and fellow students, environmental adaption and support provided by staff and fellow students, staff’s efforts in building goodwill for students using AAC, and fellow students’ confidence in using AAC. As confidence in communicating was associated with reduction of the consequences of challenging communication with students using AAC, the results indicated the importance of providing communication training to fellow students.
The article can be downloaded from https://www.tandfonline.com/doi/full/10.1080/20021518.2018.1438692.
... However, limited research has focused on parent training for children with ASD who require AAC (Patterson et al., 2011). Within two literature reviews examining communication partner training for children with CCN (Shire & Jones, 2015) and AAC interventions for children with ASD (Nunes, 2008), only five studies addressed parent training for children with ASD who required AAC. Yet, initial findings show that parent training can improve parent supports and increase child communication. ...
Parent training is an essential part of quality programming for children with autism spectrum disorder (ASD). However, limited research exists exploring online training approaches to support parents of children with both ASD and complex communication needs (CCN; e.g., limited verbal ability), despite the many benefits that online training might have for these parents and the overall sustainability and scalability of such approaches. This study utilized a single-subject multiple probe design with three parents and their children to explore the impact of online parent training for parents and their children with ASD and CCN. Training included online interactive components to teach parents a communication strategy, as well as live practice sessions during which parents implemented the strategy, had an opportunity to ask questions, and engaged in self-reflection. Results indicated that training increased communication opportunities and responses provided by parents, and communication by the child. Limitations and future research directions are discussed.
... Of particular significance is a line of research that has found that mothers who use cognitive reframing to react more positively to the stresses related to their child's autism and associated challenging behaviors have less depression and a higher level of general well-being than mothers who use other coping strategies (Benson 2010). Therefore, similar to communication interventions that are more efficacious when communication partners are trained (Schneider et al. 2008;Shire and Jones 2015), interventions developing coping strategies in children with ASD may be more efficacious if caregivers are simultaneously trained in the use of positive cognitive strategies to manage their own responses to the child's behavior. ...
Data from the Autism Inpatient Collection was used to examine the relationship between problem behaviors and verbal ability, which have generally, though not universally, been highly associated. In a comparison of 169 minimally-verbal and 177 fluently-verbal 4 to 20-year-old psychiatric inpatients with ASD, the severity of self-injurious behavior, stereotyped behavior, and irritability (including aggression and tantrums) did not significantly differ, when controlling for age and NVIQ. Verbal ability was not strongly related to the severity of problem behaviors. However, lower adapting/coping scores were significantly associated with increasing severity of each type of problem behavior, even when accounting for verbal ability. Interventions to develop adapting/coping mechanisms may be important for mitigation of problem behaviors across the spectrum of individuals with ASD.
... Recent analyses of communication partner training programs suggest that there is consistent evidence that communication partner instruction has a positive impact on the communication of PWUAAC and the skills of their partners (Kent-Walsh, Murza, Malani, & Binger, 2015;Shire & Jones, 2015). Furthermore, Kent-Walsh et al. (2015) suggested that communication partner training can be used effectively as an intervention strategy for individuals using AAC. ...
The article is designed to provide speech-language pathologists with information they can use in designing hands-on augmentative & alternative communication (AAC) partner training programs directed toward speech-language pathology graduate students and instructional staff working in schools. First, the article develops a rationale for the need for such instruction. Next, it details necessary elements of such training programs described in the literature. Then, the authors detail the increases in instructional staff use of partner-augmented input following their implementation of a program based upon one of these training approaches. Last, the authors present the lessons they learned that can be applied to the design and implementation of graduate training opportunities in AAC.
... Previous investigations have examined the nature of joint attention interactions shared between children using sign language, their adult communication partners, and objects [10]. Findings suggest that the complexity of the interaction hindered children's abilities to process referential language because children had to shift their focus away from the objects to attend to what the adult was signing [11]. Although akin, the aforementioned scenario would be even more complex with the introduction of a computerized system into the interaction [9]. ...
Seven preschool children ( M age=3;11; range=2;10–5;7) with autism or related pragmatic difficulties participated in two structured interactions with an AAC system. In the aligned interaction, the system was placed at the chest level of the experimenter with the actual book to the side. In the divided interaction, the system was placed to one side of the experimenter and the book was placed to the other side. Based on states of joint attention (JA) engagement during the AAC interactions, two subgroups emerged: beginning coordinators and active coordinators. JA engagement states with the caregiver, performance on the Early Social Communication Scales, and caregiver report of language and communication skills supported the observations during the AAC interactions. Future research directions and implications for therapy are discussed.
Keywords: Autism; Joint attention; Augmentative and alternative communication
Low-tech core boards with attached fringe vocabulary are increasingly popular as an entry-level AAC system in New Zealand and beyond, but they require skilled support from communication partners to be used successfully. This article describes the results of a year-long multiple case study carried out in New Zealand, which involved the provision of a 77-cell core board with extensive fringe vocabulary for six preschool children, alongside a training and coaching intervention for one of their parents. This intervention combined group workshops with in-home coaching and provided ongoing maintenance coaching. Quantitative and qualitative data was collected throughout the year, which provided information on the progress of both the parents and the children, as well as exploring each parent's journey with implementing AAC. All the parents learned to use the supportive AAC strategies with consistency and skill and maintained these over the year and their children made significant gains in their communication skills. The parents reported on a range of barriers and supports around implementing AAC; all six parents felt that the training and coaching intervention was essential for the successful implementation of the core board.
The relationship between children and their caregivers is essential for the development of social, emotional, cognitive, and linguistic skills. This is especially critical for children with complex communication needs who use augmentative and alternative communication (AAC), as parents play a crucial role in supporting AAC integration within the home. However, communicating with a child who uses AAC does not come naturally and requires the learning of several specific skills. Various training programs have shown that, with appropriate training, parents and caregivers can develop the skills necessary to become effective communication partners and support the use of AAC at home. This paper analyzes the overlap between existing parent training programs in AAC to identify the core competencies essential for parents and caregivers to become effective communication partners. By extracting these fundamental skills, this paper aims to guide practitioners in the design of effective parent training sessions. Key strategies include responsivity, environmental arrangements, wait time, aided modeling, prompting, and appropriate feedback.
A multiple-probe across participants design was used to examine whether three young children diagnosed with autism spectrum disorder (ASD) could learn to use verb symbols presented on an AAC application to request actions. Using researcher coaching (involving joint planning, descriptive instructions, and guided practice) parents of participants were taught to (a) embed opportunities for children to request actions in daily home routines, (b) model AAC responses, (c) use a prompt hierarchy with a time delay, and (d) contingently reinforce correct aided AAC responses. Following intervention delivered by parents, all three participants increased their use of verb symbols to request actions and parents implemented procedures with high fidelity. There were, however, individualized differences in rate of acquisition, variability of responding, readiness for fading supports, and moving to more advanced skills. One of the three participants was able to master two-step responses involving navigation to a category folder. Generalization of requesting actions to labeling actions was limited.
Purpose
To validate the appearance and content of the DHACA method to develop communication skills in autism.
Methods
This qualitative and quantitative validation study included 10 speech-language-hearing judges with expertise in alternative communication. The judges received the communication book, the description of the principles, skills, and strategies in the DHACA method, and a form with items for them to appraise the appearance and content of the method. The validity was calculated with the content validity index.
Results
The response analysis made it possible to calculate the degree of agreement between judges and develop the new instrument version. The calculation of the content validity index revealed excellent content validity. The judges made suggestions regarding the content of the communication book, texts regarding the participation of communication partners and modeling, using cues, and communicative skills.
Conclusion
The degree of agreement between judges ensured the validation of the appearance and content of the DHACA method, considering the items alone and the whole instrument. Hence, its use can be recommended for speech-language-hearing clinical practice.
Keywords:
Autism; Communication; Speech; Language and Hearing Sciences; Assistive Technology; Alternative and Augmentative Communication Systems
Purpose: Language learning, including on a speech-generating device (SGD), relies on having communication opportunities to use language. Yet, children who use SGDs do not consistently use their devices throughout the day. As a first step towards increasing device use, it is important to determine how the numerous contexts (e.g. recess, lunch, academic) that exist throughout the school day impact the frequency and type of communication opportunities that children have. Within this study, we used complex adaptive systems theory to investigate whether there were differences in how frequently nonspeaking autistic children classified as emerging communicators (i.e. children who do not consistently produce two-word utterances independently and do not communicate for a variety of communicative functions) used their SGDs to communicate and the type of communication they produced (i.e. spontaneous, prompted, or imitation) across different classroom contexts.Method: Fourteen autistic children who use an SGD as their primary mode of communication were videotaped up to nine times throughout different school days. The videos were coded for the type of device use (i.e. whether the child's use of the device was spontaneous, prompted, or imitation) and classroom context, which were categorised by the inherent level of support and directiveness.Result: There was a significant difference in SGD use across classroom contexts. Overall, the children communicated more and engaged in more spontaneous, prompted, and imitated communication in classroom contexts with high levels of structure (e.g. tabletop work) compared to contexts with low levels of structure and directiveness (e.g. free play).Conclusion: This study highlights the need to increase communication opportunities across all school contexts. Creating appropriate communication opportunities in all contexts, especially those with less structure, will help ensure that communication does not become context-bound.
The aim of this pilot study was to explore the feasibility and language outcomes of coaching parents to implement an aided language stimulation intervention using Pragmatic Organisation Dynamic Display (PODD) communication books. Two parent–child dyads, with children aged 4 years 6 months and 4 years 8 months participated in a home-based intervention. An AB design was used. Data were collected in mealtime and play activities. Dependent variables were frequency of parent use of AAC symbols and speech and frequency of child symbol use (speech, signs or graphic symbols). The intervention was feasible as parents reported they were confident in implementing it and the timeframes were appropriate for single-case research designs. An increase in parent AAC symbol use was associated with PODD book use in mealtime and for one parent in play. Both children increased their symbol use, with the clearest association in the mealtime activity. Overall, the encouraging results suggest that this approach warrants further research using stronger designs.
Purpose: Individuals with autism spectrum disorders (ASD) and Complex Communication Needs (CCN) require additional support from communication partners in order to communicate effectively. This study aimed to address a current gap in the literature by exploring communication partners' perspectives of their role. Method: A qualitative multiple case study design was used. The sample consisted of four participants who represented a diverse range of relationships with adults with ASD and CCN. Individual, in-depth, semi-structured interviews were conducted. Interview transcripts were analysed using the Framework Method of thematic analysis. Result: Four key themes were identified: (1) respecting the individual (2) flexibility (3) reaching beyond the dyad and (4) underlying beliefs. Due to the diverse range of relationships represented in this study, each case provided a unique perspective and therefore the results of each individual case were contrasted within each theme. Conclusion: The findings of this study highlight the crucial role that communication partners play in enabling interactions with adults who have ASD and CCN. Additionally, these findings provide preliminary evidence to support an expansion of the existing framework of communicative competence for individuals with CCN. Future research should aim to expand on these findings in order to investigate their generalisability.
Establishing evidence- and research-based practices relies upon research synthesis of individual studies in reviews and meta analyses. Further summarizing scientific evidence about a specific topic by synthesizing reviews is an area of need to determine practices that have a strong evidence base and to identify areas of methodological weakness and gaps in the literature. A mega-review of literature reviews, systematic reviews, and meta-analyses on interventions using aided augmentative and alternative communication (AAC) interventions for children with intellectual and developmental disabilities from 2000 to mid-2020 was conducted. Participant and interventionist demographics, interventions, settings, outcomes, and recommendations of each review were reported and summarized. A MeaSurement Tool to Assess systematic Reviews Revised (AMSTAR 2; Shea et al., 2017) was used to examine the methodological rigor of 84 included reviews. Over the past 20 years, published reviews have increased slightly in methodological rigor but demonstrate a number of methodological weaknesses that detract from the strength of evidence for AAC interventions with this population. Suggestions for improving the methodological rigor of literature reviews and areas for future research specific to AAC interventions are discussed.
This paper describes the benefits of Visual Scene Display (VSD)
technology during shared storybook reading activities to support the
literacy instruction of children with a diverse range of disabilities,
particularly students with complex communication needs. VSDs are a
novel technology that allows practitioners to transform traditional books and photographs into interactive images that have been proven to increase communication and participation opportunities for students with speech impairments and support the vocabulary development and sight word learning of students with a variety of disabilities. Readers will learn about Billy, a young boy with down syndrome, and how his teachers, Ms. Allen and Ms. Jones, were able to incorporate VSD technology into their classroom to increase Billy’s engagement with books during shared storybook reading.
Autism spectrum disorders (ASDs) are complex neuro-developmental disorders. They demonstrate pervasive deficits in social communication, restricted and repetitive behaviors, cognitive impairments, etc. Most often individuals with ASDs are often considered “non-verbal” and they require comprehensive intervention to improve their functional communication skills. Augmentative and alternative communication (AAC) was always viewed as a “last resort” for people with complex communication needs when all other interventions failed to achieve the potential benefit. However, with growing evidence, AAC has been implemented even in children with communication difficulties to augment spoken language development. Thus, this chapter aims to discuss the characteristics of ASD, to describe the need for AAC intervention in children with ASD, challenges and practices of AAC in ASD, to review implementation of aided AAC systems for children with ASD in different contexts, to indicate the gaps and future prospective in AAC intervention for people with ASDs.
Intelligibility of spoken languages is a widely discussed construct; however, intelligibility, as it pertains to signed languages, has rarely been considered. This study provides an initial investigation of the construct of intelligibility in American Sign Language (ASL) and evaluates potential measures for self-report and expert ratings of sign intelligibility that examined the frequency of understanding, amount of understanding, and ease of understanding. Participants were 66 college students (42 Deaf, 24 hearing) who had self-rated ASL skills ranging from poor to excellent. Participants rated their own intelligibility in ASL and then provided a signed language sample through a picture description task. Language samples were reviewed by an expert rater and measures of intelligibility were completed. Results indicated that expert ratings of sign intelligibility across all measures were significantly and positively correlated. Understanding of the signer was predicted by the amount of understanding, frequency of understanding, and ASL production skills, while understanding the picture being described was predicted by ease of understanding and ASL grammar skills. Self- and expert ratings of sign intelligibility using the ASL version of the Intelligibility in Context Scale were not significantly different. Self-report of sign intelligibility for viewers of different familiarity using the ICS-ASL was found not to be feasible due to many participants not being in contact with ASL users in the relationships defined by the measure. In conclusion, this preliminary investigation suggests that sign intelligibility is a construct worthy of further investigation.
Aufgrund des aktuellen Forschungsstandes zur Effektivität von Methoden der Unterstützte Kommunikation (UK) kann festgehalten werden, dass sich der Einsatz von körpereigenen und externen Methoden in der Mehrheit positiv auf die kommunikativen Fähigkeiten von Kindern, Jugendlichen und Erwachsenen mit erheblichen Beeinträchtigungen in diesem Bereich auswirkt. Darüber hinaus führt der Einsatz von Methoden der UK nicht zu einer Abnahme lautsprachlicher Fähigkeiten, sondern wirkt sich im Gegenteil vielfach sogar positiv auf diese aus. Das Modeling (die modellhafte Mitbenutzung der UK-Methode) sowie das Prompting (die Aufforderung zur Nutzung der UK-Methode) innerhalb natürlicher Interaktionen haben sich als förderliche Vorgehensweisen bei der Vermittlung der Verwendung von Methoden der UK gezeigt. Eine Ausnahme von diesen positiven Effekten von Methoden der UK stellt die Gestützte Kommunikation dar. Diese Methode hat sich eindeutig als nicht valide erwiesen und sollte daher keine weitere Verwendung finden.
In this study, a computer-aided listening comprehension intervention package supported both listening comprehension and communication goals for three students with autism spectrum disorder (ASD) and intellectual disability (ID). The package consisted of systematic instruction (i.e., system of least prompts [SLP] procedure) to teach listening comprehension, an iPad-supported electronic communication book, and a peer support arrangement. The students with ASD and ID who participated in the study increased both listening comprehension and communication skills, while showing an increase in generalizing communication turns to interactions with their peers without disabilities. The researchers found a functional relation between the SLP procedure and both dependent variables. All three participants experienced concurrent growth between the dependent variables, implying a connection between text-based listening comprehension and communication outcomes. Further implications for academic instruction for students with ASD who use augmentative and alternative communication as well as for future inquiry concerning cross-modal generalization to social communication discourse are discussed.
An eight-step instruction model was used to train a self-contained classroom teacher, speech-language pathologist, and two instructional assistants in partner-augmented input, a modeling strategy for teaching augmentative and alternative communication use. With the exception of a 2-hr training session, instruction primarily was conducted during naturally occurring lessons in a self-contained classroom. All staff increased modeling on students’ speech-generating devices between pre- and post-test measures across activities.
Abstract There is a growing research literature on the potential benefits of augmentative and alternative communication (AAC) for individuals with autism; however few studies have investigated implementation of AAC within real-life contexts. Thus, the purpose of this study was to investigate the impact of training for practitioners in implementation of aided AAC, and to examine implementation of Picture Exchange Communication System (PECS) in real-life contexts. In particular, this study involved the implementation of instructional coaching to increase opportunities offered by behavioral therapists for their preschool-aged clients to use PECS to make requests. Results indicated increases in therapist implementation of AAC and client use of AAC in trained contexts, with limited generalization to untrained contexts.
The effects of a parent‐implemented naturalistic intervention on the communication skills of a 4‐year‐old boy with autism using an alternative and augmentative communication (AAC) system were investigated. The child’s mother was taught to use 4 naturalistic teaching strategies that incorporated a picture communication system during 2 typical home routines. Generalisation probes to assess the caregiver’s use of the intervention techniques and generalisation of the child’s communication outcomes were conducted in 2 similar interactions. A multiple baseline design was used to evaluate the effects of the intervention. Data indicated an increase in the use of 2 caregiver–teaching strategies across two routines following treatment. No consistent changes were observed in the use of the other caregiver strategies across the routines. An increase in the child’s frequency of initiations and responses and the use of the communication system also were observed.
Current research indicates that children who use augmentative and alternative communication (AAC) often are not given opportunities to participate in supportive early storybook-reading experiences in home environments. This investigation employed a single-subject, multiple-baseline-across-subjects design to investigate the effects of a parent instructional program on the communication of two participating Latino parents and their Latino children using AAC (ages = 6 years 8 months and 6 years 10 months). Both parents reached criterion for implementation of the targeted interaction strategy during storybook reading and evidenced generalized and maintained strategy use. In addition, both participating children demonstrated robust increases in communicative turns taken and novel semantic concepts expressed.
The success of communicative interaction is dependent on the communication skills of each individual participating in the exchange. Accordingly, in the case of an interaction involving an individual using augmentative and alternative communication (AAC), the success of the interaction depends not only on the skills of this individual, but also on those of the communication partner. Current literature indicates that communication partner instruction is a critical intervention component. Furthermore, there is evidence that, with instruction, communication partners can learn to use facilitative interaction skills and strategies to better support the communication of individuals using AAC. To date, however, little attention has been paid to the most effective and efficient instructional methods for communication partner intervention programs. Therefore, in this paper, we propose an eight-step strategic model for use in communication partner instruction programs, and identify future research directions related to this model.
Many individuals with autism are candidates for augmentative and alternative communication (AAC) systems, either to supplement (i.e., augment) their existing speech or to act as their primary (i.e., alternative) method of expressive communication. The purpose of this article is to summarize research and directions for future research with regard to two questions related to the delivery of AAC supports to these individuals: (a) What AAC modality is preferable to use? and (b) What do we know about the use of voice output communication aids with people with autism?
Aim
The purpose of this systematic review was to examine research utilizing single subject research designs (SSRD) to explore the effectiveness of interventions designed to increase parents’ ability to support communication and social development in children with autism spectrum disorders (ASDs).
Method
Included studies were systematically assessed for methodological quality (Logan et al., 2008; Smith et al., 2007) and intervention effects. Data examining participant characteristics, study methodology, outcomes, and analysis were systematically extracted.
Results
Eleven SSRD parent-training intervention studies examining 44 participants with ASD were included. Overall, the studies were of moderate quality and reported increases in parent skills and child language and communication outcomes.
Interpretation
The results supported by improvement rate difference (IRD) analysis indicated several interventions demonstrated positive effects for both parent and child outcomes. However, limited generalization and follow-up data suggested only one intervention demonstrated parents’ accurate and ongoing intervention implementation beyond training.
Purpose
The purpose of this meta-analysis was to systematically evaluate the effects of parent-implemented language interventions on the language skills of children between 18 and 60 months of age with primary and secondary language impairments.
Method
A systematic literature search yielded 18 studies that met the predetermined inclusion and exclusion criteria. Effect sizes for each study were calculated for 7 language outcome variables and analyzed using a random effects model. Separate analyses were conducted for each language outcome and for each comparison group. Outcomes were compared for children with and without intellectual disabilities and for parent report and direct observational language measures.
Results
The results indicate that parent-implemented language interventions have a significant, positive impact on receptive and expressive language skills of children with and without intellectual disabilities. Effect sizes (g) for child measures ranged from −0.15 to 0.82 depending on the outcome measure and comparison group.
Conclusion
The results of this review indicate that parent-implemented language interventions are an effective approach to early language intervention for young children with language impairments. Critical features of parent-implemented interventions are discussed in terms of implications for practice and future research.
This study reports on the communication produced by 30 children learning to communicate with AAC in their preschool classrooms, as well as the communication input provided by educators. All of the children were communicating with less than 20 different words, symbols, or signs at the time of observation. Characteristics of participants' preschool classrooms were also measured with the ECERS-R. Relationships between ECERS-R scores, communication input to children, and child communication rate were explored through correlation analyses. Results indicated that child communication rates in their classrooms were low and that the majority of child communication was in response to educators' initiations. Only the amount of adult input to children was significantly related to child communication rates. ECERS-R scores were not related to any observed communication variables. Results provide a base of comparison for future studies as well as demonstrating need to provide more communication input within preschool classrooms.
One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for 8 standard statistical tests: (1) the difference between independent means, (2) the significance of a product-moment correlation, (3) the difference between independent rs, (4) the sign test, (5) the difference between independent proportions, (6) chi-square tests for goodness of fit and contingency tables, (7) 1-way analysis of variance (ANOVA), and (8) the significance of a multiple or multiple partial correlation.
Purpose
This study compared the language performance of young children with developmental delays who were randomly assigned to 1 of 3 parent-coached language interventions. Differences in performance on augmented and spoken word size and use, vocabulary size, and communication interaction skills were examined.
Method
Sixty-eight toddlers with fewer than 10 spoken words were randomly assigned to augmented communication input (AC-I), augmented communication output (AC-O), or spoken communication (SC) interventions; 62 children completed the intervention. This trial assessed the children’s symbolic language performance using communication measures from the language transcripts of the 18th and 24th intervention sessions and coding of target vocabulary use.
Results
All children in the AC-O and AC-I intervention groups used augmented and spoken words for the target vocabulary items, whereas children in the SC intervention produced a very small number of spoken words. Vocabulary size was substantially larger for AC-O and AC-I than for SC groups.
Conclusions
This study found that augmented language interventions that include parent coaching have a positive communication effect on young children with developmental delays who begin with fewer than 10 spoken words. Clinical implications suggest that augmented communication does not hinder, and actually aids, speech production abilities in young children with developmental delays.
Purpose
This study investigated the effects of a communication partner instruction strategy for parents of children using augmentative and alternative communication (AAC) on the communicative turn taking of their children. Instruction was provided within storybook-reading contexts.
Method
Two single-subject multiple-probe-across-participants designs were used to evaluate the effects of parent instruction on (a) 3 European American parents and (b) 3 African American parents. Changes in turn-taking rates and the expression of different semantic concepts in children using AAC were assessed in storybook-reading activities.
Results
All 6 parents learned to implement the communication partner interaction strategy accurately. All 6 children who used AAC increased their communicative turn taking and their language use as reflected by different semantic concepts expressed.
Conclusions
Results provide evidence that the communication partner instruction program applied within storybook-reading contexts holds significant promise in improving parent–child interaction patterns and facilitating communicative expression and turn taking in children who use AAC.
Purpose
Many classroom educational assistants (EAs) have a significant amount of responsibility in carrying out educational plans for children who use augmentative and alternative communication (AAC), but they receive little instruction on how to do so (Kent-Walsh & Light, 2003). This study investigates the impact of using a communication partner instructional program to teach EAs how to teach their students to produce symbol combinations on their speech-generating devices.
Method
A single-subject multiple-probe-across-participants design was used to evaluate the effectiveness of the instructional program on (a) the EAs' implementation of an interaction strategy with their students who used AAC and (b) the rates of multisymbol message productions for the students who used AAC.
Results
All 3 participating EAs learned to use the interaction strategy appropriately, and all 3 participating students who used AAC increased their multisymbol message production rates.
Conclusions
Results provide further evidence (a) of the viability of using a communication partner instructional program for teaching partners how to facilitate the communication skills of children who use AAC and (b) that the interaction strategy can be an effective tool for increasing expressive multisymbol message rates for children who use AAC.
Much controversy exists regarding the clinical efficacy of behavioural and developmental interventions for improving the core symptoms of autism spectrum disorders (ASD). We conducted a systematic review to summarize the evidence on the effectiveness of behavioural and developmental interventions for ASD.
Comprehensive searches were conducted in 22 electronic databases through May 2007. Further information was obtained through hand searching journals, searching reference lists, databases of theses and dissertations, and contacting experts in the field. Experimental and observational analytic studies were included if they were written in English and reported the efficacy of any behavioural or developmental intervention for individuals with ASD. Two independent reviewers made the final study selection, extracted data, and reached consensus on study quality. Results were summarized descriptively and, where possible, meta-analyses of the study results were conducted. One-hundred-and-one studies at predominantly high risk of bias that reported inconsistent results across various interventions were included in the review. Meta-analyses of three controlled clinical trials showed that Lovaas treatment was superior to special education on measures of adaptive behaviour, communication and interaction, comprehensive language, daily living skills, expressive language, overall intellectual functioning and socialization. High-intensity Lovaas was superior to low-intensity Lovaas on measures of intellectual functioning in two retrospective cohort studies. Pooling the results of two randomized controlled trials favoured developmental approaches based on initiative interaction compared to contingency interaction in the amount of time spent in stereotyped behaviours and distal social behaviour, but the effect sizes were not clinically significant. No statistically significant differences were found for: Lovaas versus special education for non-verbal intellectual functioning; Lovaas versus Developmental Individual-difference relationship-based intervention for communication skills; computer assisted instruction versus no treatment for facial expression recognition; and TEACCH versus standard care for imitation skills and eye-hand integration.
While this review suggests that Lovaas may improve some core symptoms of ASD compared to special education, these findings are based on pooling of a few, methodologically weak studies with few participants and relatively short-term follow-up. As no definitive behavioural or developmental intervention improves all symptoms for all individuals with ASD, it is recommended that clinical management be guided by individual needs and availability of resources.
It has been suggested that the quality of clinical trials should be assessed by blinded raters to limit the risk of introducing bias into meta-analyses and systematic reviews, and into the peer-review process. There is very little evidence in the literature to substantiate this. This study describes the development of an instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research and its use to determine the effect of rater blinding on the assessments of quality. A multidisciplinary panel of six judges produced an initial version of the instrument. Fourteen raters from three different backgrounds assessed the quality of 36 research reports in pain research, selected from three different samples. Seven were allocated randomly to perform the assessments under blind conditions. The final version of the instrument included three items. These items were scored consistently by all the raters regardless of background and could discriminate between reports from the different samples. Blind assessments produced significantly lower and more consistent scores than open assessments. The implications of this finding for systematic reviews, meta-analytic research and the peer-review process are discussed.
To address methodological challenges in research on psychosocial interventions for autism spectrum disorder (ASD), a model was developed for systematically validating and disseminating interventions in a sequence of steps. First, initial efficacy studies are conducted to establish interventions as promising. Next, promising interventions are assembled into a manual, which undergoes pilot-testing. Then, randomized clinical trials test efficacy under controlled conditions. Finally, effectiveness studies evaluate outcomes in community settings. Guidelines for research designs at each step are presented. Based on the model, current priorities in ASD research include (a) preparation for efficacy and effectiveness trials by developing manuals for interventions that have shown promise and (b) initial efficacy studies on interventions for core features of ASD such as social reciprocity.
To assess the effectiveness of expert training and consultancy for teachers of children with autism spectrum disorder in the use of the Picture Exchange Communication System (PECS).
Design: Group randomised, controlled trial (3 groups: immediate treatment, delayed treatment, no treatment). Participants: 84 elementary school children, mean age 6.8 years. Treatment: A 2-day PECS workshop for teachers plus 6 half-day, school-based training sessions with expert consultants over 5 months. Outcome measures: Rates of: communicative initiations, use of PECS, and speech in the classroom; Autism Diagnostic Observation Schedule-Generic (ADOS-G) domain scores for Communication and Reciprocal Social Interaction; scores on formal language tests.
Controlling for baseline age, developmental quotient (DQ) and language; rates of initiations and PECS usage increased significantly immediately post-treatment (Odds Ratio (OR) of being in a higher ordinal rate category 2.72, 95% confidence interval 1.22-6.09, p < .05 and OR 3.90 (95%CI 1.75-8.68), p < .001, respectively). There were no increases in frequency of speech, or improvements in ADOS-G ratings or language test scores.
The results indicate modest effectiveness of PECS teacher training/consultancy. Rates of pupils' initiations and use of symbols in the classroom increased, although there was no evidence of improvement in other areas of communication. Treatment effects were not maintained once active intervention ceased.
The aim of this article is to present a set of evidence levels, accompanied by 14 quality or rigor questions, to foster a critical review of published single-subject research articles. In developing these guidelines, we reviewed levels of evidence and quality/rigor criteria that are in wide use for group research designs, e.g. randomized controlled trials, such as those developed by the Treatment Outcomes Committee of the American Academy for Cerebral Palsy and Developmental Medicine. We also reviewed methodological articles on how to conduct and critically evaluate single-subject research designs (SSRDs). We then subjected the quality questions to interrater agreement testing and refined them until acceptable agreement was reached. We recommend that these guidelines be implemented by clinical researchers who plan to conduct single-subject research or who incorporate SSRD studies into systematic reviews, and by clinicians who aim to practise evidence-based medicine and who wish to critically review pediatric single-subject research.
Many children who require augmentative and alternative communication (AAC) have difficulties shifting from the single- to multi-symbol stage of language development. Ensuring that children who use AAC receive evidence-based interventions to address this problem is critical. Furthermore, there has been little AAC treatment efficacy research to date that addresses the needs of multicultural populations, particularly those of Latino children who use AAC and their families. To address these issues, the current investigation used a mixed methodology, which included a focus group to determine if any changes needed to be made to an existing instructional program; and a single subject, multiple probe, across participants design to evaluate the effects of a caregiver instructional program on the multi-symbol utterance productions of Latino children who used AAC. Specifically, a cognitive strategy instructional approach that has been used to teach turn-taking skills to both Caucasian and African American children who use AAC was modified and used to teach caregivers how to support the production of their children's multi-symbol messages. In order to foster emergent literacy skills, caregivers implemented the strategy during book reading activities. Focus group results revealed that changes to the instructional program may be required for some Latino families. With regard to the instructional program, all caregivers successfully learned to use the instructional strategy, and all children increased their use of multi-symbol messages. Research and clinical implications of the findings are discussed.
The purpose of this study was to determine the impact of training paraeducators on (a) paraeducator prompting use of augmentative communication (AAC) systems, (b) paraeducator responding to student requests, (c) student use of AAC, and (d) student problem behavior via a series of multiple probe designs. Participants were three paraeducators and students. Paraeducators were trained on (a) importance of communication, (b) relationship between behavior and communication, (c) use of AAC, (d) how to prompt students to use AAC and respond to communications, and (e) how to self evaluate their behavior. All paraeducators increased the number of times they prompted student use of AAC and responded to student requests. All students increased use of AAC and exhibited fewer problem behaviors.
This article describes and field-tests the improvement rate difference (IRD), a new effect size for summarizing single-case research data. Termed "risk difference" in medical research, IRD expresses the difference in successful performance between baseline and intervention phases. IRD can be calculated from visual analysis of nonoverlapping data, and is easily explained to most educators. IRD entails few data assumptions and has confidence intervals. The article applies IRD to 166 published data series, correlates results with three other effect sizes: R2, Kruskal-Wallis W, and percent of nonoverlapping data (PND), and reports interrater reliability of the IRD hand scoring. The major finding is that IRD is a promising effect size for single-case research.
When characterizing the social communication skills of children with developmental and physical disabilities, researchers may need to account for special considerations, particularly if the children have severe communication disabilities. These children may require means other than spoken language to communicate their needs and thoughts to others if their communication needs are unmet through natural speech production. These means or forms of communication are known as augmentative and alternative communication (AAC). This article discusses aided symbol‐infused joint engagement, a form of joint attention that might be useful when characterizing the joint engagement states of children with communication difficulties who require the use of AAC. The theoretical, empirical, and clinical implications of aided symbol‐infused joint engagement are discussed.
Objective:
This study tested the effect of beginning treatment with a speech-generating device (SGD) in the context of a blended, adaptive treatment design for improving spontaneous, communicative utterances in school-aged, minimally verbal children with autism.
Method:
A total of 61 minimally verbal children with autism, aged 5 to 8 years, were randomized to a blended developmental/behavioral intervention (JASP+EMT) with or without the augmentation of a SGD for 6 months with a 3-month follow-up. The intervention consisted of 2 stages. In stage 1, all children received 2 sessions per week for 3 months. Stage 2 intervention was adapted (by increased sessions or adding the SGD) based on the child's early response. The primary outcome was the total number of spontaneous communicative utterances; secondary measures were the total number of novel words and total comments from a natural language sample.
Results:
Primary aim results found improvements in spontaneous communicative utterances, novel words, and comments that all favored the blended behavioral intervention that began by including an SGD (JASP+EMT+SGD) as opposed to spoken words alone (JASP+EMT). Secondary aim results suggest that the adaptive intervention beginning with JASP+EMT+SGD and intensifying JASP+EMT+SGD for children who were slow responders led to better posttreatment outcomes.
Conclusion:
Minimally verbal school-aged children can make significant and rapid gains in spoken spontaneous language with a novel, blended intervention that focuses on joint engagement and play skills and incorporates an SGD. Future studies should further explore the tailoring design used in this study to better understand children's response to treatment. Clinical trial registration information-Developmental and Augmented Intervention for Facilitating Expressive Language (CCNIA); http://clinicaltrials.gov/; NCT01013545.
Paraeducators are frequent communication partners for young children with complex communication needs (CCN) in early childhood settings. This study examined the impact of instruction to paraeducators in two communication interaction strategies (IPLAN [Identify activities for communication, Provide means for communication, Locate and provide vocabulary, Arrange environment, use iNteraction strategies] and MORE [Model AAC, Offer opportunities for communication, Respond to communication, Extend communication]) on the number of communication opportunities provided by paraeducators during play activities with young children with CCN. Results of the study provide evidence that after 2 hr of one-on-one training, paraeducators increased the number of communication opportunities they provided for children with CCN, and children with CCN took an increased number of communication turns. In addition, paraeducators reported that they found the training beneficial, and the supervising teachers noted improvements in the communication support provided by the paraeducators. Limitations and future research directions are discussed.
It is currently estimated that about 30% of children with autism spectrum disorder remain minimally verbal, even after receiving years of interventions and a range of educational opportunities. Very little is known about the individuals at this end of the autism spectrum, in part because this is a highly variable population with no single set of defining characteristics or patterns of skills or deficits, and in part because it is extremely challenging to provide reliable or valid assessments of their developmental functioning. In this paper, we summarize current knowledge based on research including minimally verbal children. We review promising new novel methods for assessing the verbal and nonverbal abilities of minimally verbal school-aged children, including eye-tracking and brain-imaging methods that do not require overt responses. We then review what is known about interventions that may be effective in improving language and communication skills, including discussion of both nonaugmentative and augmentative methods. In the final section of the paper, we discuss the gaps in the literature and needs for future research. Autism Res 2013, ●●: ●●-●●. © 2013 International Society for Autism Research, Wiley Periodicals, Inc.
The Cochrane Handbook for Systematic Reviews of Interventions (the Handbook) has undergone a substantial update, and Version 5 of the Handbook is now available online at www.cochrane-handbook.org and in RevMan 5. In addition, for the first time, the Handbook will soon be available as a printed volume, published by Wiley-Blackwell. We are anticipating release of this at the Colloquium in Freiburg. Version 5 of the Handbook describes the new methods available in RevMan 5, as well as containing extensive guidance on all aspects of Cochrane review methodology. It has a new structure, with 22 chapters divided into three parts. Part 1, relevant to all reviews, introduces Cochrane reviews, covering their planning and preparation, and their maintenance and updating, and ends with a guide to the contents of a Cochrane protocol and review. Part 2, relevant to all reviews, provides general methodological guidance on preparing reviews, covering question development, eligibility criteria, searching, collecting data, within-study bias (including completion of the Risk of Bias table), analysing data, reporting bias, presenting and interpreting results (including Summary of Findings tables). Part 3 addresses special topics that will be relevant to some, but not all, reviews, including particular considerations in addressing adverse effects, meta-analysis with non-standard study designs and using individual participant data. This part has new chapters on incorporating economic evaluations, non-randomized studies, qualitative research, patient-reported outcomes in reviews, prospective meta-analysis, reviews in health promotion and public health, and the new review type of overviews of reviews.
Abstract: The field of augmentative and alternative communication (AAC) continues to struggle with issues relating to generalization and maintenance. Current methods of modifying instructional practices and teaching skills directly to the communication partner have contributed to developing successful treatment outcomes. However, few studies have examined AAC in the home setting during daily routines with parents. This study examined whether teaching parents a problem-solving intervention that considered the family's lifestyle would promote child spontaneous picture card use and parent-provided communication opportunities during daily routines. Data were collected in the context of a multiple baseline design across child and parent behavior. The results showed increases in the child's use of cards and in the parent's use of communication opportunities across multiple routines, parent and child behavior maintenance over time, and increases in the parent's perception of their child's communication skill and of their own ability to promote communication. The findings support the use of a problem-solving intervention that incorporates the family's lifestyle as a method to promote augmentative communication during daily routines.
In this study mother-child storybook reading was explored as a context within which to support early symbolic communication of girls with Rett syndrome. Baseline measures of mother-daughter interaction were gathered as mothers read familiar and unfamiliar storybooks with their daughters. Then three experimental interventions were studied in the homes of four girls: (a) resting hand splints, (b) light tech augmentative communication systems such as voice-output devices and symbols, and (c) very basic parent training. Access to devices, symbols, and training increased the frequency of each of the four girls, labeling and symbolic communication during storybook reading. Parent training was particularly useful in increasing the percentage of appropriate switch use by three of the four girls. The study suggests that parents can provide substantial support to early communication development in girls with Rett syndrome, if they are provided with basic information and materials.
This paper provides results of a descriptive analysis of peer-reviewed, single subject design, intervention research on augmentative and alternative communication (AAC) for individuals with severe disabilities, from birth to 21 years, published in English between 1997 and 2003. A database of 40 studies was found that met seven specified criteria. The descriptive analysis showed that a variety of antecedent, both adult and child directed, and consequent intervention components, typically used in combination, were effective in improving communication. Most research contexts were rated as less natural. Parents, teachers, and siblings or peers were infrequently involved in intervention. When problem behavior and communication were targeted, functional communication training (FCT) was the method of choice. Treatment integrity was infrequently measured. When measured, generalization and maintenance of treatment effects were good but were reported less than half of the time. Implications for interventionists and researchers are discussed.
Recent years have seen a revolution in our knowledge of how children learn to think and speak. In this volume, leading scholars from these rapidly evolving fields of research examine the relationship between child language acquisition and cognitive development. At first sight, advances in the two areas seem to have moved in opposing directions: the study of language acquisition has been especially concerned with diversity, explaining how children learn languages of widely different types, while the study of cognitive development has focused on uniformity, clarifying how children build on fundamental, presumably universal concepts. This book brings these two vital strands of investigation into close dialogue, suggesting a synthesis in which the process of language acquisition may interact with early cognitive development. It provides empirical contributions based on a variety of languages, populations and ages, and theoretical discussions that cut across the disciplines of psychology, linguistics and anthropology.
Typescript. Thesis (Ph. D.)--University of Toledo. "A dissertation [submitted] as partial fulfillment of the requirements of the Doctor of Philosophy degree in Curriculum and Instruction." Includes bibliographical references (leaves 198-213). Photocopy. s
Interventions that focus on implementing augmentative and alternative communication (AAC) strategies and methods have been available to children in need of AAC and their families for at least 30 years. To date, most of the research that has considered AAC in family settings has been focused on gathering evidence of the effects of AAC interventions, rather than on implementing evidence-based strategies in everyday practice to improve outcomes. The purpose of this article is to discuss the research that has focused on parents as AAC interventionists, the family as a context for AAC intervention, and the effects of AAC interventions on children and other family members. The discussion is framed within the four steps associated with the process of knowledge translation: (a) deciding on desired outcomes of interventions, (b) evaluating evidence of the effectiveness of different AAC methods to obtain the desired outcomes, (c) translating the research evidence into everyday practice, and (d) implementing knowledge in practice.
To facilitate early identification of children at risk for development of behavioral or emotional disturbance, the Parenting Stress Index (PSI) is designed as a screening and diagnostic instrument that measures the relative magnitude of stress in the parent-child system. For this study, the most recent revision of the PSI, Form 6, was evaluated for reliability and factorial validity using a sample of 534 parents. Form 6 of the PSI was found to have even higher reliability than previous forms, supporting its continued usefulness both for preliminary screening and for pretest/posttest measurement of the effectiveness of counseling programs and intervention techniques. Form 6 of the PSI was also found to have high factorial validity, suggesting that the domain scores and subscale scores may be confidently utilized to provide information about specific sources of stress in the parent-child system which should be the focus of further attention and professional assistance.
A group of five preschool children with developmental disability and their mothers participated in a study into the efficacy of a parent-implemented language intervention. Each parent was included in the team as a consultee, with a speech pathologist and special educator acting as consultants within a collaborative consultation process. Treatment for each child was developed using this process, with specific strategies to increase language production skills decided by the team. Strategies were used within an interactive model of early language intervention. The effectiveness of treatment was determined within a multiple baseline design. For three children, the impact of treatment was evident, but the results were not replicated for the other two children. Descriptive analysis of mothers' communicative behaviours indicated that, following treatment, they tended to direct more utterances to their children, used more models, fewer questions and directives, and more (although limited) teaching strategies.
Augmentative and alternative communication (AAC) technologies offer the potential to provide children who have complex communication needs with access to the magic and power of communication. This paper is intended to (a) summarize the research related to AAC technologies for young children who have complex communication needs; and (b) define priorities for future research to improve AAC technologies and interventions for children with complex communication needs. With the realization of improved AAC technologies, young children with complex communication needs will have better tools to maximize their development of communication, language, and literacy skills, and attain their full potential.
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A visually based naturalistic communication intervention for nonverbal persons with autism (Unpublished doctoral dissertation)
- G T M Chang
*Chang, G. T. M. (2009). A visually based naturalistic communication intervention for nonverbal persons with autism
(Unpublished doctoral dissertation). Claremont Graduate
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