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AAC narrative intervention for children with autism
Abstract
In research, augmentative and alternative communication (AAC) interventions have primarily focused on teaching children to make requests; however, AAC intervention should not stop there. There is a dearth of AAC intervention research targeting other communicative functions, despite there being a significant need to enhance children's communication competence in a variety of social and educational contexts. The purpose of this study was to examine the initial efficacy and feasibility of an AAC narrative intervention on the picture-supported retelling skills of three children with autism, aged 6-9 years old. This multiple baseline across participants design study was preregistered at Open Science Framework (https://doi.org/10.17605/OSF.IO/29SFP). We measured the effect of the intervention on children's inclusion and complexity of story grammar elements and the variety of symbols used to retell untrained stories during a baseline condition, just before each intervention session, immediately following each intervention session, and three weeks after the last intervention session. Parents completed a feasibility questionnaire and documented their children's generalized use of AAC. The AAC narrative intervention improved children's AAC retells, with ascending trends in the intervention condition and scores elevated above baseline after 3 weeks. Parents reported that they perceived the intervention to be appropriate, effective, enjoyable, and planned to use it themselves after the study. Generalized use of AAC outside of intervention sessions was documented for all three participants.
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Purpose
Language sampling is a critical component of language assessments. However, there are many ways to elicit language samples that likely impact the results. The purpose of this study was to examine how different discourse types and elicitation tasks affect various language sampling outcomes.
Method
A diverse group of K–3 students (N = 1,037) contributed eight spoken language samples in four elicitation conditions: (a) expository generation, (b) expository retell, (c) narrative generation, and (d) narrative retell. Samples were audio-recorded, transcribed, and coded for number of total words, number of different words, mean length of utterance in words (MLUW), and number of clauses per communication unit (i.e., Subordination Index [SI]).
Results
Narrative retell and expository generation conditions yielded the largest samples with the greatest lexical diversity when compared to narrative generation and expository retell. MLUW was higher in expository conditions, but mean SI was higher in narrative conditions. For both measures of syntax, narrative retell and expository generation yielded the highest mean scores. For each outcome, there were expected increases corresponding to grades; however, the differences faded between second and third grade.
Conclusion
As a component of language assessments, clinicians' selection of language sampling procedures will impact the sample length, lexical diversity, utterance length, and syntactical complexity of the samples.
Supplemental Material
https://doi.org/10.23641/asha.24185649
This study examined whether particular practices in story retelling improve children’s comprehension of story structure and enables them to further comment on the story content. Eighty-three (83) kindergarten children (M = 5.4) years old composed the experimental (N = 43) and the control (N = 40) groups. For 6 weeks, one time per week, six well-structured books were read to the experimental group as follows: Before reading there was a brief discussion, while after reading children were trained in story retelling. The intervention programme in retelling consisted of five levels, which began from total teacher assistance to the point where children were able to retell the story freely and completely. The same six books were simply read to the control group and after the reading the children discussed the interesting parts and made drawings based on the story. Children’s retellings were taped and analysed by a series of measures. Results confirmed the experimental group children’s achievements in almost all measurements indicating that the multilevel training programme in retelling enhanced children’s ability for deeper comprehension and further commentary.
Purpose
The purpose of this randomized controlled trial was to examine the effects of a multitiered system of language support (MTSLS) on kindergarteners' narrative retelling, personal stories, writing, and expository language.
Method
Participants were 686 kindergarten students from four school districts in the United States. Twenty-eight classrooms were randomly assigned to treatment (n = 337 students) or control (n = 349 students) conditions. The treatment group received 14 weeks of oral narrative language instruction using Story Champs, a multitiered language program. Classroom teachers delivered large group (Tier 1) instruction for 15–20 min a day for 4 weeks. After this short-duration whole-class instruction, speech-language pathologists began small group Story Champs (Tier 2) intervention with a random sample of students who did not make adequate progress from the large group instruction (n = 49). These students received Tier 2 intervention for 20 min twice a week in addition to continued Tier 1 instruction.
Results
Results indicated that the students in the treatment group had significantly higher scores on all outcome measures compared to the students in the control group. Analyses of outcomes from the 49 students who received Tier 2 intervention compared to a matching sample of at-risk control students revealed that the treatment group had significantly higher scores on narrative retells, personal stories, and expository retells. When compared to matched average-performing and advanced-performing control peers, the students who received Tier 2 intervention had significantly higher narrative retell scores and no longer had significantly lower personal story, expository, or writing scores.
Conclusion
This effectiveness study demonstrated that MTSLS can lead to meaningful improvements in kindergarteners' oral and written language skills, even helping at-risk students catch up to high-achieving peers.
Purpose
The purpose of this systematic review with meta-analyses was to examine interventions that aimed to improve narrative language outcomes for preschool and elementary school–age children in the United States. Our goal was to examine peer-reviewed publications to describe the characteristics of these interventions and synthesize their overall effectiveness on narrative comprehension and production via meta-analysis.
Method
We searched electronic databases, examined previously published reviews, and consulted experts in the field to identify published studies that employed robust experimental and quasi-experimental designs. We included randomized controlled trials, studies with nonrandomized comparison groups, and single-case design (SCD) studies. We completed a qualitative synthesis of study factors for all identified studies and calculated meta-analyses for the studies that had sufficient data. All included studies were analyzed for risk of bias.
Results
Our systematic search yielded 40 studies that included one or more narrative language outcomes as part of their assessment battery. Twenty-four of the included studies were group design studies, including randomized controlled trials and quasi-experimental designs, and the other 16 were SCD studies. Effect sizes were analyzed based on narrative production and comprehension outcomes. The meta-analyses of 26 studies indicated overall positive effects of the interventions, with effect sizes of d = 0.51 and 0.54 in the group design studies and d = 1.24 in the SCD studies.
Conclusions
A variety of effective interventions were found that improve narrative production and comprehension outcomes in children with diverse learner characteristics. Some common characteristics across these interventions include manualized curricula, opportunities to produce narrative language, verbal and visual supports, direct instruction of story grammar, and use of authentic children's literature.
Supplemental Material
https://doi.org/10.23641/asha.15079173
Communication deficits are one of the core symptoms of autism spectrum disorder (ASD), and augmentative and alternative communication (AAC) systems are utilized to facilitate the communication and language development of children with ASD. This review examines the research literature on the use of aided and unaided AAC systems in interventions for children with ASD, and investigates their effectiveness in enhancing language and communication skills in this population. Systematic review methodology was used to limit bias in the search of electronic databases, and relevant studies were selected, 20 of which met the inclusion criteria for the review. The findings of these studies indicate that AAC systems are able to facilitate and enhance communication skills in children with ASD. It is apparent that this is a method that will be used increasingly in the future, and it is imperative that meticulous research is conducted on the effects of the applications. Refinements in the study methodology are recommended, and additional questions that might be addressed in future research are discussed.
Writing is a critical literacy skill that emerges in kindergarten. The research literature has only addressed transcription skills of kindergarteners and has failed to address text generation. The purpose of this action-research study was to investigate the effect of oral language instruction that focused on narrative text structures on kindergarten students’ ability to generate written narrative text. We conducted a concurrent multiple baseline design across three groups of students with two participants in each group. Students received six instructional sessions that involved the teacher modeling a story and supporting the students while they retold and generated oral stories. Pictures and icons were used to represent story grammar elements, but were faded within session to facilitate independent storytelling. The oral language instruction had an immediate positive effect on the narrative quality of students’ writing. Individual and overall effects were significant and maintained three to four weeks later. Findings suggest an efficient causal relation between oral language instruction and writing quality.
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.
Purpose
The purpose of the current study was to evaluate the effect of bilingual narrative intervention on vocabulary gains in Hebrew (school language) and English (home language) among English–Hebrew bilinguals, using a block design (one language at a time), and to determine whether there was cross-linguistic transfer to the language that was not receiving intervention.
Method
Sixteen English–Hebrew bilingual children participated in the study using an adaptation of the Puente de Cuentos intervention. Vocabulary was examined using a word definition task before the intervention, post English intervention, post Hebrew intervention, and 4 weeks after the interventions ended to examine maintenance of skills.
Results
Repeated-measures analyses of variance revealed that children made significant gains in vocabulary in the language of intervention as expected. In addition, children made cross-linguistic gains in Hebrew during the English intervention, but made no gains in English following Hebrew intervention.
Conclusion
These results underscore the need to provide language support in the home language to ensure growth and that intervention in the home language does not hinder growth in the school language.
This systematic review provides an examination of the quality, efficacy, and common features of oral narrative interventions on the narratives of children with language disorder. Searches of electronic data bases, ancestral searches and database alerts identified studies that addressed oral narrative intervention in children with language disorder. Structured inclusion procedures were used to select and examine the quality, efficacy and common features of the included studies. Twenty-four research articles published between 1993 and 2018 were included for review. Apart from measures of social validity, the single case research studies were generally of good quality and results can be interpreted with confidence. The group studies were generally of low quality and only four included comparison groups. Single case effects sizes for macrostructure were moderate with lower effect sizes for microstructure. The results for group studies were variable. Successful interventions included the use of icons, visuals, clinician modelling and the participants being provided with an opportunity to state an entire narrative each intervention session. Oral narrative intervention to develop the narratives of children with language disorder may be effective. Areas for future research were identified and include more robust research designs, intervention being delivered to participants in groups, conducting intervention with participants with more significant disabilities, more research conducted with personal narrative, and including more generalization measures.
Purpose
Narrative interventions are a class of language interventions that involve the use of telling or retelling stories. Narrative intervention can be an efficient and versatile means of promoting a large array of academically and socially important language targets that improve children's access to general education curriculum and enhance their peer relations. The purpose of this tutorial is to supply foundational information about the importance of narratives and to offer recommendations about how to maximize the potential of narrative interventions in school-based clinical practice.
Method
Drawing from decades of cognitive and linguistic research, a tutorial on narratives and narrative language is presented first. Ten principles that support the design and implementation of narrative interventions are described.
Results
Clinicians can use narrative intervention to teach story grammar, complex language, vocabulary, inferencing, and social pragmatics. Storytelling, as an active intervention ingredient, promotes the comprehension and production of complex language.
Conclusion
When narrative intervention is implemented following a set of principles drawn from research and extensive clinical experience, speech-language pathologists can efficiently and effectively teach a broad set of academically and socially meaningful skills to diverse students.
In Brazil, it is estimated that there are approximately 2 million youngsters and children diagnosed with autism and other cases of learning disabilities, a factor that has led to an increase on the demand for treatment aimed at the development of basic and academic skills, such as reading, writing, fluency in interpreting texts, recalling and retelling a story dictated by a teacher. The purpose of the present investigation was to assess the efficacy of a procedure to teach intraverbal storytelling to four Brazilian children (two autistic and two with language delays). Three stories were taught to each participant and each story comprised four segments represented by pictures and written scripts. The participants had opportunities to read the scripts with help from the experimenter if necessary and, after an interval, they had to retell the stories. During training, echoic and visual prompts were administered as corrections whenever a given child was unable to retell a given segment appropriately. Correct responses free from prompts resulted in praise and a token. After gathering a given number of tokens, the participants could exchange them for a preferred item like a toy or a favorite activity. As result, the participants were able to retell the stories correctly when compared to baseline levels. Only one was unable to retell all the segments of the third story, probably because she did not have more time to be exposed to the programming contingencies due to the period of recess from school. The results provide education professionals with specific directions for advocacy and service delivery that aim to enhance school outcomes for students with ASD.
Purpose
This study extends the research on narrative intervention by evaluating the effect of a standard treatment protocol, Story Champs (Petersen & Spencer, 2012), on personal narrative generations of school-age children with specific language impairment (SLI).
Method
Four second-grade, 8- to 9-year-old boys with SLI participated in this multiple baseline across behaviors, single-case design study that was repeated across participants. Each one-on-one intervention session involved eight steps across two intervention segments: story retell and personal story generation. The interventionist provided systematic scaffolding (visual and verbal supports) that was faded within each session. Three individualized story grammar elements per participant were targeted sequentially across the weeks of intervention based on each participant's needs identified in baseline. The dependent variable probe (personal narrative generation) was administered at the beginning of each twice-weekly session, and individualized story grammar elements were scored on a 4-point rubric (dependent variable).
Results
In this single-case research design study, a functional relation was evaluated for each participant (i.e., replication of an effect across three story grammar elements). A functional relation between Story Champs intervention and the dependent variable was observed for two participants.
Conclusion
Results provide preliminary evidence for the efficacy of individually administered Story Champs intervention for children with SLI.
The purpose of this cluster randomized group study was to investigate the effect of multitiered, dual-language instruction on children’s oral language skills, including vocabulary, narrative retell, receptive and expressive language, and listening comprehension. The participants were 3- to 5-year-old children (n = 81) who were learning English and whose home language was Spanish. Across the school year, classroom teachers in the treatment group delivered large-group lessons in English to the whole class twice per week. For a Tier 2 intervention, the teachers delivered small-group lessons 4 days a week, alternating the language of intervention daily (first Spanish, then English). Group posttest differences were statistically significant, with moderate to large effect sizes favoring the treatment group on all the English proximal measures and on three of the four Spanish proximal measures. Treatment group advantages were observed on Spanish and English norm-referenced standardized measures of language (except vocabulary) and a distal measure of language comprehension.
A multiple baseline with probe across participants design was used to investigate the effects of an oral narrative intervention on early developing personal narratives of four children aged 6 and 7 with autism spectrum disorder and severe language disorder. The individual intervention targeted the narrative macrostructure elements of where, who with, what happened and feelings. Intervention involved the use of individual photographs to support each narrative, macrostructure icons, participants telling the entire narrative each session, and modeling. Using variations of the intervention, an intervention and maintenance effect using untaught narratives was demonstrated for three participants, and some evidence for generalization across settings, people, and stimuli was demonstrated for one participant. Social validity measures indicated that an objective naïve observer rated post-intervention narratives as better. Areas for future research include implementing intervention to better provide for generalization of skills, delivering intervention to small groups, and classroom teachers implementing the intervention.
A multiple baseline across participants design was used in this pilot study to investigate the effect of an oral narrative intervention on the macrostructure of short fictional narrative retells in children with a diagnosis of autism spectrum disorder (ASD) and severe communication impairment. Four children aged between 6 and 9 years of age took part in the 1:1 intervention that targeted the narrative macrostructure elements of character (who), setting (where+what), problem, internal response (feelings), attempt at a resolution (do), consequence (next) and end. Intervention involved the use of macrostructure icons, modeling, and participants telling the entire narrative each session. An intervention and maintenance effect was demonstrated for three participants using untaught stories but generalization to storybooks typical of classroom use did not occur. In addition, social validity measures indicated that naive observers rated retells as better following intervention. Areas for future research include investigation of generalization to more complex stories, and implementation of the intervention with small groups.
Purpose
Despite literature showing a correlation between oral language and written language ability, there is little evidence documenting a causal connection between oral and written language skills. The current study examines the extent to which oral language instruction using narratives impacts students' writing skills.
Method
Following multiple baseline design conventions to minimize threats to internal validity, 3 groups of 1st-grade students were exposed to staggered baseline, intervention, and maintenance conditions. During the intervention condition, groups received 6 sessions of small-group oral narrative instruction over 2 weeks. Separated in the school day from the instruction, students wrote their own stories, forming the dependent variable across baseline, intervention, and maintenance conditions. Written stories were analyzed for story structure and language complexity using a narrative scoring flow chart based on current academic standards.
Results
Corresponding to the onset of oral narrative instruction, all but 1 student showed meaningful improvements in story writing. All 4 students, for whom improvements were observed and maintenance data were available, continued to produce written narratives above baseline levels once the instruction was withdrawn.
Conclusions
Results suggest that narrative instruction delivered exclusively in an oral modality had a positive effect on students' writing. Implications include the efficiency and inclusiveness of oral language instruction to improve writing quality, especially for young students.
Purpose
This study investigated the early rule-based sentence productions of 3- and 4-year-old children with severe speech disorders who used single-meaning graphic symbols to communicate.
Method
Ten 3- and 4-year-olds requiring the use of augmentative and alternative communication, who had largely intact receptive language skills, received instruction in producing up to four different semantic–syntactic targets using an Apple iPad with a communication app. A single-case, multiple-probe, across-targets design was used to assess the progress of each participant and target. Generalization to new vocabulary was assessed, and a subgroup also was taught to produce sentences using grammatical markers.
Results
Some targets (primarily possessor-entity) were mastered in the baseline phase, and the majority of the remaining targets were mastered during intervention. All four children who completed intervention for grammatical markers quickly learned to use the markers accurately.
Conclusions
Expressive language potential for preschoolers using graphic symbol–based augmentative and alternative communication systems should not be underestimated. With appropriate presentation and intervention techniques, some preschoolers with profound speech disorders can readily learn to produce rule-based messages via graphic symbols.
Skinner (1957) described the tact as the most important verbal operant; however, there remains a disproportionate amount of research evaluating mand training compared to tact training for young children with autism. The current study sought to alleviate some of this disparity by evaluating the effectiveness of the iPad® and application Proloquo2Go™ as a speech-generating device, using a multiple baseline design, on the acquisition of a tact repertoire in three preschool aged children with autism. The procedures employed a time delay with full physical prompts, during a “circle time” routine. During the circle time routine, the classroom teacher would read the lift-the-flap children’s book “Where’s Spot?” and pause for five-seconds upon reaching the targeted animal for each respective student. During this time delay if the student independently selected the picture that corresponded to the animal, evoking the SGD’s digitized output, the teacher provided verbal praise. If the child did not respond or responded incorrectly, a full physical prompt was used to evoke the tact of the animal. Results indicated that all three participants acquired the ability to tact at least one animal at 100% independence, across three consecutive sessions, after an average of four training sessions. This skill was also found to maintain for those two participants for whom maintenance data were taken. These results extend the evidence base on the use of the iPad® and application Proloquo2Go™ as a SGD, as well as, the research based on tacting acquisition.
Purpose
In this study, we investigated the efficacy of a least-to-most (LTM) prompting procedure (Ault & Griffen, 2013; MacDuff, Krantz, & McClannahan, 2001; Neitzel & Wolery, 2009) for increasing use of multisymbol messages in school-age children with autism spectrum disorder (ASD) who use augmentative and alternative communication (AAC) during a storybook reading activity.
Method
In the study, we used a single-subject, multiple-probe research design across participants (Kazdin, 1982) with 6 children (ages 8–12) with ASD and who used AAC systems for communication. There were 4 phases in this investigation: (a) baseline, (b) intervention, (c) generalization, and (d) maintenance.
Results
All participants exhibited a positive increase in multisymbol message production almost immediately upon introduction of the LTM prompting procedure.
Conclusions
The results of the investigation contribute important information on the efficacy of the LTM prompting procedure for teaching use of multisymbol messages to school-age children with ASD who use AAC.
A disproportionate percentage of culturally and linguistically diverse students have difficulties with language-related skills that affect their academic success. Early and intensive language instruction may greatly improve these students' language skills, yet there is not sufficient research available to assist educators and school psychologists in distinguishing between language disabilities and language differences. Because of this, culturally and linguistically diverse children often receive special education services several years later than other children. The purpose of the study was to investigate the effect of a multitiered intervention on the narrative language skills of seven culturally diverse preschool students. We also examined the preventive impact the narrative language intervention had on special education referrals. Results of the multiple baseline design across participants revealed that a positive trend emerged in retells and personal stories from baseline to intervention for all seven participants. At follow-up, scores remained consistently above baseline. The intervention had a preventive impact for six preschoolers, and only one preschooler was referred for a psychoeducational evaluation. These findings support the use of narrative intervention to prevent erroneous referrals of culturally and linguistically diverse students.
The purpose of this study was to conduct a systematic review and meta-analysis of the augmentative and alternative communication (AAC) partner instruction intervention literature to determine (a) the overall effects of partner interventions on the communication of individuals using AAC, and (b) any possible moderating variables relating to participant, intervention, or outcome characteristics. Seventeen single-case experimental design studies (53 participants) met the inclusion criteria and were advanced to the full coding and analysis phase of the investigation. Descriptive analyses and effect size estimations using the Improvement Rate Difference (IRD) metric were conducted. Overall, communication partner interventions were found to be highly effective across a range of participants using AAC, intervention approaches, and outcome measure characteristics, with more evidence available for participants less than 12 years of age, most of whom had a diagnosis of autism spectrum disorder or intellectual/developmental disability. Aided AAC modeling, expectant delay, and open-ended question asking were the most frequently targeted communication partner interaction skills. Providing a descriptive overview, instructor modeling, guided practice, and role plays were the most frequently incorporated communication partner intervention activities within the included studies.
The aim of this study was to compare the efficacy with which the use of a speech generating device (Apple iPadTM with GoTalk NowTM application) versus a communication board promoted the production of two-symbols combinations (agent-action and attribute-entity combinations) by children limited speech within a shared story reading context. Four children between the ages of 6;8 (years; months) and 11;4 with severe motor speech disorders and a variety of developmental disabilities participated in the study. An adapted alternating treatment design was used. All four participants showed increased production of two-symbol combinations in both intervention conditions. The Wilcoxon ranked pairs test did not show differences between the conditions for any participant. The results suggest that symbol combination skills can effectively be taught using either AAC system. A preference assessment indicated that all participants preferred to use the speech generating device during shared story reading.
Personal narratives are a critical aspect of functional discourse. The purpose of this article is to describe the impairments of personal narrative discourse in children with language learning disorders. The authors also consider cultural aspects of narrative discourse, present assessment and intervention guidelines, and delineate cultural considerations.
Purpose
This study was conducted to determine whether a narrative intervention program that targeted the use of mental state and causal language resulted in positive gains in narrative production for children with autism spectrum disorder (ASD).
Method
Five children (2 girls and 3 boys) who had been diagnosed with ASD participated in the study. Children ranged in age from 8 to 12 years and were recruited through an autism clinic. Intervention was provided for two 50-min individual sessions per week for a total of 21–33 sessions (depending on the student). Children's spontaneous stories, collected weekly, were analyzed for overall story complexity, story structure, and the use of mental state and causal language. Following a multiple-baseline across-participants design, data were collected for lagged baseline and intervention phases over a 6-month period.
Results
All of the children made gains on all 3 measures of narration after participating in the instruction, with clear changes in level for all 5 children and changes in trend for 4 of the 5 children. The gains were maintained after intervention was discontinued.
Conclusion
The results demonstrate the efficacy of the 3-phase narrative instruction program for improving the fictional narration abilities of children with ASD.
Supplemental Material
https://doi.org/10.23641/asha.6170315
This study investigated the effect of a large group narrative intervention on diverse preschoolers’ narrative language skills with aims to explore questions of treatment efficacy and differential response to intervention. A quasi-experimental, pretest/posttest comparison group research design was employed with 71 preschool children. Classrooms were randomly assigned to treatment and comparison conditions. Intervention consisted of explicit teaching of narrative structure via repeated story retell practice, illustrations and icons, and peer mediation. Children’s narrative language and comprehension were assessed at Pretest, Posttest, and 4 weeks after treatment. Statistically significant differences between treatment and comparison groups were found on retell and story comprehension measures. A priori classification criteria resulted in 28 percent of the participants identified as Minimal Responders on the story retell measure and 19 percent as Minimal Responders on the story comprehension measure. Children who were dual-language learners did not have a different pattern of response than monolingual English speakers. Low-intensity narrative intervention delivered to a large group of children was efficacious and can serve as a targeted language intervention for use within preschool classrooms. A culturally and linguistically appropriate, dynamic approach to assessment identified children for whom intensified intervention would be recommended.
Narrative skills that are important for preschoolers include retelling stories, telling personal stories, and answering questions about stories. Narrative abilities form the foundation of reading comprehension. The purpose of this study was to investigate the effect of an individually delivered language intervention on the narrative skills of preschoolers with developmental disabilities. Five preschoolers attending Head Start and participating in special education received 24 sessions of intervention each lasting 10 to 15 min. A multiple baseline, multiple probe experimental design was used to investigate the effects of the intervention, which incorporated visual supports (e.g., icons and pictures) and retell and personal storytelling practice, on story retells, personal stories, and story comprehension. Improvements on all three measures were related to the intervention. Parents and teachers reported that the storytelling activities were engaging, enjoyable, and produced improvements in the children’s language skills.
The aim of this study was to determine the effect of an intervention strategy on the production of graphic symbol combinations in children with limited speech. Four children between the ages of 6;5 and 10;8 (years;months) with limited speech participated in the study. A single-subject, multiple probe design across three different types of semantic relations was used. Generalization to untrained exemplars was also monitored. Results were mixed across the four participants: two participants learned to combine symbols across different types of relations, maintained these skills post intervention, and generalized their skills to untrained combinations; and two participants showed less consistent evidence of learning. The effects, as measured during structured probes, were strong for one participant, moderate for another, and inconclusive for the two others. Responses during shared story reading suggested that the measurement probes might have underestimated participants' ability to combine symbols.
Purpose
The purpose of this study was to investigate the effect of an individualized, systematic language intervention on the personal narratives of children with autism.
Method
A single-subject, multiple-baseline design across participants and behaviors was used to examine the effect of the intervention on language features of personal narratives. Three 6- to 8-year-old boys with autism participated in 12 individual intervention sessions that targeted 2–3 story grammar elements (e.g., problem, plan) and 3–4 linguistic complexity elements (e.g., causal subordination, adverbs) selected from each participant's baseline performance. Intervention involved repeated retellings of customized model narratives and the generation of personal narratives with a systematic reduction of visual and verbal scaffolding. Independent personal narratives generated at the end of each baseline, intervention, and maintenance session were analyzed for presence and sophistication of targeted features.
Results
Graphical and statistical results showed immediate improvement in targeted language features as a function of intervention. There was mixed evidence of maintenance 2 and 7 weeks after intervention.
Conclusion
Children with autism can benefit from an individualized, systematic intervention targeting specific narrative language features. Greater intensity of intervention may be needed to gain enduring effects for some language features.
Purpose
This nonrandomized feasibility study was designed to provide a preliminary assessment of the impact of a narrative and vocabulary instruction program provided by a speech-language pathologist (SLP) in a regular classroom setting.
Method
Forty-three children attending 2 first-grade classrooms participated in the study. Children in each classroom were divided into high- and low-risk subgroups on the basis of their performance on a narrative test. Narrative and vocabulary instruction was provided by an SLP in 1 classroom for three 30-min periods per week for 6 weeks.
Results
The children in the experimental classroom made clinically significant improvements on narrative and vocabulary measures; children in the comparison classroom did not. Within the experimental classroom, children in the high-risk subgroup demonstrated greater gains in narration and fewer gains in vocabulary than children in the low-risk subgroup. There were no subgroup differences in the comparison classroom.
Conclusion
These preliminary results provide early evidence of the feasibility of implementing a narrative instruction program in a classroom setting. Children at a high risk for language difficulties appeared to profit more from the narrative instruction than from the embedded vocabulary instruction. More extensive research on this instructional program is warranted.
Supplemental Material
https://doi.org/10.23641/asha.6170276
Narration, or storytelling, is an important aspect of language. Narrative skills have academic and social importance. This study evaluated the effects of a narrative intervention on story retelling and personal story generation skills of preschoolers with risk factors and narrative language delays. Narrative intervention was delivered in a small group arrangement, and materials, activities, and assistance were systematically adjusted within sessions to facilitate increasingly independent practice of oral narration. Participants were 5 preschoolers enrolled in a Head Start classroom who performed below average on two narrative language tasks. Participants made substantial gains in narrative retelling, demonstrated improved preintervention to postintervention scores for personal story generations, and maintained improvements when assessed following a 2-week break. These results have several implications for practice, including narrative intervention’s versatility with a range of children from diverse backgrounds and its use of economic and efficient classroom-based small group formats for intervention.
This systematic review focuses on research articles published since 1980 that assess outcomes of narrative-based language intervention for preschool and school-age children with language impairment. The author conducted a comprehensive search of electronic databases and hand searches of other sources for studies using all research designs except nonexperimental case studies. The results of the studies were converted to a common metric using effect sizes. The review yielded nine studies that met inclusion criteria. The majority of studies reported moderate to large effect sizes for narrative macrostructure and microstructure. Although the results of the studies were generally positive, each of the studies had a limited number of participants, limited experimental control, and considerable variation in the procedures and materials used. Clinicians should be cautious when interpreting the results of these studies. Narrative intervention is at an emerging stage of evidence and needs further investigation.
The correspondence between direct observation and informant ratings of preschool children with specific language impairment (SLI) was investigated. Preschoolers with and without SLI were observed during free play using the Social Interactive Coding System (SICS; Rice, Sell, & Hadley, 1990). In addition, teachers and parents completed the Social Competence Behavior Evaluation Scale (La Freniere & Dumas, 1995), Teacher—Child Rating Scale (Perkins & Hightower, 2002), and Parent—Child Rating Scale (Primary Mental Health Project, 1999). SICS observations were compared with the results of each rating scale. Results indicated low to moderate correlations between the SICS and teacher ratings and between the SICS and the parent ratings. Differences between children with and without SLI were observed, including differences in communication style and preferred audience (adults versus peers), responsiveness to social initiations, and play style. Problems of task orientation, peer social skills, assertiveness, isolation, and behavioral control were also noted. A multi-method, multisource assessment was recommended.
This early-stage feasibility study investigated the effects of a multitiered oral narrative language intervention on oral language, reading comprehension, and writing. Twenty-eight second-grade students participated in this quasi-experimental control group study with assignment at the classroom level. The independent variable was large- and small-group oral narrative language intervention that required students to retell increasingly complex stories that were strategically crafted to include academic language typically found in grade-level reading material. Story grammar, causal adverbial subordinate clauses, elaborated noun phrases, adverbs, and the acquisition of word meanings through context were explicitly taught. Students' performance on proximal measures of oral narrative retells, as well as distal measures of reading comprehension and writing, was assessed at pretest and posttest. Statistically significant differences between the treatment and control groups were found on all outcome measures using nonparametric analyses. Large- and small-group multitiered oral narrative instruction improved not only oral narrative language but also reading comprehension and written composition.
Skinner’s (1957) book Verbal Behavior is a critical tool in designing effective communication programs for individuals with limited speech. The purpose of this systematic review was to analyze the speech generating device (SGD) research literature from Skinner’s taxonomy of primary verbal operants. An extraction procedure yielded 56 studies published between 1995 and 2018, with a total of 221 participants, most of whom had autism spectrum disorder (ASD) or an intellectual and developmental disability (IDD). The large majority of SGD studies (42) targeted multiply controlled mands, whereas only a handful of studies targeted verbal operants that were not mands. Few studies employed procedures for fading contrived sources of stimulus control to promote spontaneous responding, and few studies targeted more sophisticated, topography-based responses (e.g., typing, speech). Results of the review highlight the need for better dissemination of Skinner’s Verbal Behavior, the need for research to evaluate effects of SGD in teaching a greater variety of spontaneous verbal operants, and the need to focus on application of SGD with populations beyond individuals with ASD and IDD.
Previous research suggests that (a) individual differences in reading and language development are stable across childhood, (b) reading and vocabulary are intertwined, and (c) children's oral narrative skill contributes to later reading comprehension. Each of these three phenomena is assessed using a longitudinal design spanning 15 years, from when children were 19 months old until they were 16 years old. Alongside measures for maternal vocabulary, a host of language and (early) reading measures, including vocabulary, early literacy development, oral narrative skill, and reading comprehension, were administered across eight time points to a sample of 58 children. Specific early language and reading skills were generally strongly correlated over time. Reading comprehension at age 12 was predicted by vocabulary at 19 months and emergent literacy at school entry. Vocabulary at 19 months of age predicted early literacy skills prior to school entry and reading comprehension at age 12 years, as did school entry literacy skills. Controlling for maternal and infant vocabulary, children's oral narrative skill around school entry related uniquely to reading comprehension 10 years later. Findings provide new evidence for the long-term interplay between early language, literacy, and later reading and vocabulary development .
When working with individuals with little or no functional speech, clinicians often recommend that communication partners use the client’s augmentative and alternative communication (AAC) device when speaking to the client. This is broadly known as “augmented input” and is thought to enhance the client’s learning of language form and content. The purpose of this systematic review was to determine the effects of augmented input on communication outcomes in persons with developmental disabilities and persons with childhood apraxia of speech who use aided AAC. Nineteen studies met the inclusion criteria. Each included study was reviewed in terms of participant characteristics, terminology used, symbol format, augmented input characteristics, outcomes measured, effectiveness, and study quality. Results indicate that augmented input can improve single-word vocabulary skills and expression of multi-symbol utterances; however, comprehension beyond the single word level has not been explored. Additionally, it is difficult to form conclusions about the effect of augmented input on specific diagnostic populations. Directions for future research are posited.
Augmentative and alternative communication (AAC) interventions have been shown to be effective in supporting children with autism spectrum disorder (ASD) to communicate, particularly to request preferred items and activities. The aim of this systematic review was to examine the effectiveness of AAC interventions in supporting children to produce a broader range of communicative functions and determine the extent to which these interventions have been evaluated beyond immediate effectiveness to address maintenance, generalization, and social validity. A systematic search and application of inclusion criteria yielded 30 interventions that focused on communication functions beyond object requests. In many of the studies, flaws detracted from the certainty of evidence, and maintenance, generalization, and/or social validity were not addressed. Further research is needed to evaluate the extent to which AAC interventions can support children with ASD to communicate using a variety of communication functions, as well as to demonstrate sustained, transferable, and meaningful change.
Background:
Estimates of the proportion of children with autism spectrum disorder (ASD) who are minimally verbal vary from 25%to 35%. However, there is a lack of consensus in defining minimally verbal and few detailed reports of communication outcomes for these children following intervention. The aim of this study was to explore how minimally verbal children have been defined and to document the proportion of minimally verbal children in a group of children with ASD receiving a community based early intervention programme.
Method:
A longitudinal cohort design was used to examine the proportion of children who met criteria for minimally verbal in 246 children with ASD when they entered and exited an early intervention programme.
Results:
Overall, 26.3% of the children in this study exited the programme using 'fewer than five spontaneous and functional words' and 36.4% exited not using 'two word phrases' as indicated by direct assessment. However, our findings were mixed depending on measures and definitions used, with parent report indicating that as many as 29.4% of children were not 'naming at least three objects' consistently, and 43.3% not using 'phrases with a noun and verb' consistently at exit. More than half of the children who entered the programme with minimal speech exited the programme with a similar language profile. A small percentage of children (1.2%-4.7%) regressed in their language level over time.
Conclusions:
Despite advances in early intervention, and access to services at a younger age, around a quarter of individuals with ASD in this study exited early intervention with significant communication needs. Our findings are considered in relation to the literature and clinical implications, and future research directions are discussed.
Echoic, tact, and textual transfer procedures have been proven successful in establishing simple intraverbals (Braam and Poling Applied Research in Mental Retardation, 4, 279-302, 1983; Luciano Applied Research in Mental Retardation, 102, 346-357, 1986; Watkins et al. The Analysis of Verbal Behavior, 7, 69-81, 1989). However, these strategies may be ineffective for some children due to the complexity of the targeted intraverbals. The current study investigated the use of a novel procedure which included a modified chaining procedure and textual prompts to establish intraverbal behavior in the form of telling short stories. Visual prompts and rule statements were used with some of the participants in order to produce the desired behavior change. Results indicated that the procedure was effective for teaching retelling of short stories in three children with autism.
In an effort to responsibly incorporate evidence based on single-case designs (SCDs) into the What Works Clearinghouse (WWC) evidence base, the WWC assembled a panel of individuals with expertise in quantitative methods and SCD methodology to draft SCD standards. In this article, the panel provides an overview of the SCD standards recommended by the panel (henceforth referred to as the Standards) and adopted in Version 1.0 of the WWC's official pilot standards. The Standards are sequentially applied to research studies that incorporate SCDs. The design standards focus on the methodological soundness of SCDs, whereby reviewers assign the categories of Meets Standards, Meets Standards With Reservations, and Does Not Meet Standards to each study. Evidence criteria focus on the credibility of the reported evidence, whereby the outcome measures that meet the design standards (with or without reservations) are examined by reviewers trained in visual analysis and categorized as demonstrating Strong Evidence, Moderate Evidence, or No Evidence. An illustration of an actual research application of the Standards is provided. Issues that the panel did not address are presented as priorities for future consideration. Implications for research and the evidence-based practice movement in psychology and education are discussed. The WWC's Version 1.0 SCD standards are currently being piloted in systematic reviews conducted by the WWC. This document reflects the initial standards recommended by the authors as well as the underlying rationale for those standards. It should be noted that the WWC may revise the Version 1.0 standards based on the results of the pilot; future versions of the WWC standards can be found at http://www.whatworks.ed.gov.
The effects of children's story retelling on early literacy and language development was examined in a meta-analysis of 11 studies including 687 toddlers and preschoolers. Results indicated that children's story retelling influenced both story-related comprehension and expressive vocabulary as well as nonstory-related receptive language and early literacy development. Findings also showed that the use of the characteristics that experts consider the important features of retelling practices was associated with positive child outcomes. Implications for practice are described. CELLreviews are publications of the Center for Early Lit-eracy Learning (CELL) funded by the U.S. Department of Education, Office of Special Education Programs (Grant #H326B060010). CELL is a collaboration among the Orelena Hawks Puckett Institute, the American In-stitutes for Research, and the PACER Center. Copy-right © 2012 Orelena Hawks Puckett Institute. All rights reserved. Engaging young children in retelling stories read to them by parents or teachers is a strategy that is often used to promote story-related comprehension and expressive vocabulary (e.g., Gambrell & Dromsky, 2000; Geva & Ol-son, 1983; Soundy, 1993). When used with toddlers and preschoolers, a child or group of children is asked to retell, rehearse, or recall different parts of a story read to them by adults or older children (Koskinen, Gambrell, Kapinus, & Heathington, 1988). According to Isbell (2002), "Retelling stories encourages children to use their imagination, expand their ideas, and create visual images as they transfer the plot [of the story] to new settings, including different characters or new voices" (p. 28). A retelling episode typically includes a teacher or par-ent scaffolding child engagement in storybook reading. This often includes asking open-ended questions, asking a child to make predictions, and engaging a child in verbal elabora-tions. Story retelling is characterized by actively involving a child in the reading episode, retelling the story to the child, promoting additional child elaborations and expansions, and asking the child to retell the story (in his or her own words) (Cliatt & Shaw, 1988). The purpose of the meta-analysis reported in this CELL-review was to investigate the effectiveness of children's story retelling on the children's story-related comprehension and expressive vocabulary. The goal was to identify the character-istics of and conditions under which children's story retell-ing has the largest sizes of effect on the study outcomes, and especially comprehension and expressive vocabulary consis-tent with the hypothesis that children's story retelling should influence these particular outcomes (Gambrell & Dromsky, 2000; Isbell, 2002; Koskinen et al., 1988).
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.
Traditionally, discrimination has been understood as an active process, and a technology of its procedures has been developed and practiced extensively. Generalization, by contrast, has been considered the natural result of failing to practice a discrimination technology adequately, and thus has remained a passive concept almost devoid of a technology. But, generalization is equally deserving of an active conceptualization and technology. This review summarizes the structure of the generalization literature and its implicit embryonic technology, categorizing studies designed to assess or program generalization according to nine general headings: Train and Hope; Sequential Modification; Introduce to Natural Maintaining Contingencies; Train Sufficient Exemplars; Train Loosely; Use Indiscriminable Contingencies; Program Common Stimuli; Mediate Generalization; and Train “To Generalize”.