ArticleLiterature Review

A Systematic Review of Research on Augmentative and Alternative Communication Interventions for Children Aged 6–10 in the Last Decade

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Abstract Purpose The purpose of this systematic review was to identify, appraise, and critically synthesize the latest available evidence on the effects of augmentative and alternative communication (AAC)-based interventions on communication skills in children aged between 6 and 10 years with mixed diagnoses. Method MEDLINE (OVID), PsycINFO (EBSCO), ERIC (ProQuest), SCIELO (WOS), Teacher Reference Center (EBSCO), and Education Database (ProQuest) were searched. The studies were independently selected by two reviewers for the purposes of the review. The methodological quality of the included studies was assessed, and characteristics and results of the studies were extracted. Results This review included 14 studies from a total of 1,204 found through an electronic search. The AAC interventions studied were effective at improving various outcomes in children with mixed diagnoses. Interventions that focused on narrative skills were the most common type. When considering the quality of the studies, the independence of assessors, data analysis, replication, and generalization of interventions were the weaker areas. Conclusions Interventions analyzed in this review improve communication skills, including phonological awareness, vocabulary, requesting, and developing narrative skills in children aged between 6 and 10 years with mixed diagnoses. The results of one study also indicate that the acquisition of skills using an AAC method is superior when the child prefers the method.

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An evidence-based practice (EBP) approach to clinical and educational practice emphasizes the importance of integrating sound research evidence into the decision-making process. This paper provides a discussion of the relevance of EBP to the field of augmentative and alternative communication (AAC). Included is an examination of what is currently known about decision-making in AAC, as well as a brief history of EBP and its application in other fields. A definition of EBP in AAC is proposed and a schematic of the EBP process is described, including proposed design hierarchies of evidence. This process is then illustrated with a case example. Finally, key factors for the adoption of EBP in AAC are discussed.
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Narrative abilities have been linked to literacy, communicative competence and development of identity. Children who use augmentative and alternative communication (AAC) may be at risk for difficulties in the development of narrative skills due to differences in their language learning opportunities and limitations of their AAC systems. The structural dimensions of the narrative discourse produced by children who use AAC have been observed to be poorly organized, limited in coherence and severely impoverished in both vocabulary and grammar. In addition, the children usually rely heavily on narrative co-construction and may not be given sufficient opportunities by their communication partners to provide narrative features. This study describes the process used to support the development of autonomous narrative skills of an eight-year old child who uses a voice output communication aid (VOCA) to communicate and who demonstrates significant delays in narrative formation. Results indicate that narratives produced with her VOCA improved in both linguistic and story complexity following intervention that targeted understanding and use of story structures.
Article
This review integrates cognitive, socioemotional, and neuroimaging perspectives on self-development. Neural correlates of key processes implicated in personal and social identity are reported from studies of children, adolescents, and adults, including autobiographical memory, direct and reflected self-appraisals, and social exclusion. While cortical midline structures of medial prefrontal cortex and medial posterior parietal cortex are consistently identified in neuroimaging studies considering personal identity from a primarily cognitive perspective ("who am I?"), additional regions are implicated by studies considering personal and social identity from a more socioemotional perspective ("what do others think about me, where do I fit in?"), especially in child or adolescent samples. The involvement of these additional regions (including tempo-parietal junction and posterior superior temporal sulcus, temporal poles, anterior insula, ventral striatum, anterior cingulate cortex, middle cingulate cortex, and ventrolateral prefrontal cortex) suggests mentalizing, emotion, and emotion regulation are central to self-development. In addition, these regions appear to function atypically during personal and social identity tasks in autism and depression, exhibiting a broad pattern of hypoactivation and hyperactivation, respectively.
Article
We compared speed of acquisition and preference for using a speech-generating device (SGD) versus manual signing (MS) as augmentative and alternative communication (AAC) options. Four children with developmental disabilities (DD), aged 5-10 years, were taught to request preferred objects using an iPod(®)-based SGD and MS. Intervention was introduced in a multiple-probe across participants design and SGD and MS conditions were compared in an alternating treatments design. A systematic choice-making paradigm was implemented to determine if the children showed a preference for using SGD or MS. All participants showed increased use of SGD when intervention was introduced, but only three learned under the MS condition. Three participants exhibited a preference for the SGD while the remaining participant demonstrated a preference for using MS. Results support previous studies showing that individuals with DD often show a preference for different AAC options and extend previous data by suggesting that acquisition and maintenance was better for the preferred option.
Article
An augmentative communication system is a blend of technology and language. The technology can be very light — a sheet of cardboard accessed by head stick or very complex — a computerized speech-generating device (SGD) accessed by infrared pointing. The language system, however, whether simply or intricately implemented, must be linguistically sophisticated from the beginning to allow the learner to become familiar with the distributional regularities of the language and give him/her the ability to construct utterances and have the chance to test them in his/her linguistic environment and adjust them to environmental requirements. A language system in AAC must include and join five aspects of language: the sound system (intonation/tone/pitch, stress, rhythm, homonymy), the grammatical structures (closed classes, word order, morphology, parts of speech, syntagmatic axis, paradigmatic axes), the vocabulary organization (word phrase definitions, word boundaries, semantic primitives and networks), the writing system (pinyin, simplified and traditional ideograms/logograms and their radicals, language representation methods), and the cultural outlook (form, meaning, and distribution of popular metaphors, pragmatics, folk metalinguistics, teaching practices, teaching materials). To this must be added concerns from theories of language growth and development including aphasias and learning disabilities. This paper is an overview of foundational issues involved in the development of a Mandarin language system for augmentative communication.
Article
A fundamental understanding of the underlying clinical intervention and acquisition process of an Augmentative and Alternative Communication (AAC) system is crucial in its development. In this paper, we attempt to document the beginning stages of teaching, intervention methods and outcomes of a Mandarin Chinese (MC) and an English speaker as they acquire communicative competence of their AAC system. The system for the MC speaker comprised a low tech communication chart and a notepad for writing. The English speaker used a high tech voice output device based on semantic compaction. Preliminary data on outcomes of the first three months of training was gathered, and interpreted. This paper attempts to analyze these two outcomes and discuss potential issues arising from this experience. It will also address implications for further training and the development of a high tech voice output MC AAC system.
Article
Social participation becomes particularly important in middle childhood, as it contributes towards the acquisition and development of critical life skills such as developing friendships and a sense of belonging. However, only limited literature is available on the impact of communication difficulties on social participation in middle childhood. This study compared the participation patterns of school-age children with and without physical disabilities and complex communication needs in extracurricular activities. Participants included five children between 6-9 years of age with moderate-severe physical disability and complex communication needs, and five matched peers. Findings showed that children with physical disability and complex communication needs engaged in activities with reduced variety, lower frequency, fewer partners and in limited venues, but reported higher levels of enjoyment and preference for activity participation, than their matched peers. These children also had fewer same-aged friends, but more paid workers in their social circle. This small-scale descriptive study provides some preliminary evidence about the impact of severe communication difficulties on participation and socialization.
Article
Students with developmental disabilities and limited or no functional speech often use speech-generating devices. While the speech-output function of such devices is considered to have potential advantages, it is unclear whether the length of synthetic speech output influences augmented communication and natural speech production. To this end, we describe a two-phase study involving an adolescent with Klinefelter syndrome. In Phase 1, the frequency of augmented requests and natural speech were compared under three speech-output conditions (no-output, short-output, and long-output). In Phase 2, augmented requests in the long-output condition were no longer reinforced to determine if this would increase natural speech production. The presence and length of speech output did not influence the frequency of augmented requesting or natural speech production in Phase 1, but extinction of augmented requesting under the long-output condition in Phase 2 was associated with a significant increase in natural speech production under that condition, relative to the two other conditions. The implications of these findings for using speech-generating devices are discussed.
Article
Children who have poor expressive vocabularies are at risk of further language delays and reading comprehension difficulties, which will significantly impact their educational achievement. The role of shared book reading in supporting vocabulary growth continues to receive empirical attention in the field of communication disorders. This single-subject study analyzes the effect of an intervention program based on shared book reading in a girl with no functional speech who used augmentative and alternative communication. The study included three literacy activities, a prereading activity to stimulate the girl's prior knowledge about the topic, a shared reading activity, and a postreading activity to assess and support language comprehension. Our findings suggest that the activities and elicitation techniques used by the clinician had a positive effect on the participant's expressive vocabulary.
Article
Literacy skills provide numerous benefits to individuals who require augmentative and alternative communication (AAC), including new opportunities for education, work, and social interaction. Literacy skills also have a powerful impact on communication and language development. This paper describes the components of effective evidence-based literacy instruction, including skills to target for instruction, effective instructional procedures to teach these skills, and adaptations to accommodate the needs of individuals with significant speech, motor, and other disabilities. The paper also presents a case study that describes ongoing intervention with an 8-year-old girl with multiple disabilities who required AAC. Evidence-based instruction was provided in phonologic awareness, letter-sound correspondences, decoding, sight-word recognition, reading connected text, reading comprehension skills, and early writing and keyboarding skills. During the 16 months of intervention, a total of 55 hours of instruction, the student acquired 20 letter-sound correspondences, learned to use decoding and sight-word skills to read 60 words, and began to read simple texts both in shared reading activities and independently. She also began to type simple short messages and stories using spelling approximations. The acquisition of these new literacy skills resulted in increased educational opportunities for the learner and also enhanced her language and communication skills.
Article
The present study investigated the effectiveness of prompted nonspoken language production using two low-tech AAC strategies (i.e., picture symbols and sign language) at indirectly facilitating speech productions in a young child with expressive language delays ("late talker"). A single subject, multiple baseline design was used. Results indicated that prompting either sign or picture-symbol production improved the child's speech output for target words without any direct prompts to speak, but that the two AAC strategies did not differ from one another in effectiveness at indirectly eliciting speech. The improvements associated with both strategies suggest that AAC can be a viable intervention tool to address improved speech in children with expressive delays. The AAC intervention had a clear and rapid effect on the child's spoken word productions, although the child did not produce signs or symbols to criterion for most of the target words before producing them in speech.
Article
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. 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. 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. 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.
Article
This investigation examined the extent to which a set of 98 best practices in AAC, previously agreed upon by a panel of experts in AAC and inclusive education, reflected the actual preferences of 32 parents of children diagnosed with Angelman Syndrome. Parents' responses were examined in relation to whether their children were currently in mostly integrated (MI) settings with children without disabilities, or mostly segregated settings with other children with disabilities. With two exceptions, both groups, regardless of their children's current placements, viewed the practices favorably. When asked to prioritize the most important communication skills they wished their children to attain, all of the most frequently cited priorities were reflected in items contained in the questionnaire, supporting the social validity of the questionnaire as truly reflecting parents' priorities for AAC instruction. Implications of this investigation are discussed, along with next steps.
Article
The purpose of this study was to evaluate the feasibility of teaching an integrated requesting-rejecting sequence. Four children with developmental disabilities were taught to request missing items and reject wrong items using either speech-generating devices (SGD) or picture-exchange (PE) communication. Data showed that the introduction of the teaching procedures were associated with acquisition of the targeted requesting and rejecting responses. The newly acquired rejecting responses generalized across two untrained activities and were maintained for up to four weeks following intervention for three of the four participants. The missing-item and wrong-item formats can be successfully combined to teach an integrated sequence of requesting and rejecting to students with developmental disabilities who use speech-generating devices (SGD) or picture-exchange (PE) communication.
Article
Picture-book reading provides an effective intervention context for young children learning spoken language and may also be appropriate for teaching the use of augmentative and alternative communication to children with severe intellectual disabilities. This study reports on a group intervention using a semiscripted book reading routine implemented by a teacher in a classroom for students with severe intellectual disabilities. Student use of line drawings was observed over the course of the intervention. Students' abilities to match words, line drawings, book illustrations, and real objects were assessed weekly. There were differences between baseline and intervention performances for all students, and these differences were particularly noticeable for one student.
Article
This review sought to determine the evidence base of augmentative and alternative communication (AAC) use with infants and toddlers with disabilities. The review identified 12 studies, involving 190 participants aged 36 months or younger. The majority of the studies investigated unaided AAC methods (e.g., gestures or sign language), with 42% of the studies also including aided AAC methods. Although all studies reported improvement in child communication following AAC intervention, in-depth analyses of study methodology indicated that only 7 out of 12 provided conclusive evidence. Implications for early intervention AAC practice and suggestions for future research are proposed.