Demographics of Preschoolers Who Require AAC

Communication challenges and use of communication apps among individuals with cerebral palsy

PURPOSE

Verbal communication is the most immediate way of expressing oneself and the fastest way to make a first impression on others. However, for individuals with cerebral palsy (CP), which is generally accompanied by speech impediments, verbal communication can present a major hurdle to social interactions.

MATERIALS AND METHODS

In this study, 10 individuals with CP (four men and six women) and speech impediments were surveyed using questionnaires and semistructured interviews to explore the following four points: (1) communication difficulties in life, (2) communication methods and related problems, (3) application of existing AAC methods, and (4) predicaments using existing communication technologies.

RESULTS

The study found that individuals with CP and speech impediments speak slowly and generally choose to avoid conversations or engage passively, relying on written words, simplified phrases, and physical gestures to compensate for their language impediments. Family education and educational attainment influence their communication strategies.

CONCLUSION

Following advancements in technology, individuals with CP have become more reliant on text communications via phone apps such as Line and Facebook Messenger, and use text and stickers to express themselves. Despite the many problems with the usability of assistive devices and tech products for individuals with CP, reducing the number of operational steps and time constraints can improve the convenience of these products for individuals with CP.

Designing Cultural Adaptations of Caregiver-Implemented Interventions for Latinx Caregivers of Children Who Use Augmentative and Alternative Communication: Key Considerations

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.

Supporting Emergent Bilinguals Who Use Augmentative and Alternative Communication and Their Families: Lessons in Telepractice From the COVID-19 Pandemic

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.

Black Children With Developmental Disabilities Receive Less Augmentative and Alternative Communication Intervention Than Their White Peers: Preliminary Evidence of Racial Disparities From a Secondary Data Analysis

PURPOSE

Ensuring equitable access to augmentative and alternative communication (AAC) intervention services for children with complex communication needs (CCN) is crucial. Evidence suggests that racial disparities exist in access to communication interventions, disadvantaging Black children. However, no research has investigated specifically the evidence for racial disparities in AAC services for children with developmental disabilities and CCN.

METHOD

The current study applied post hoc data analysis methods within a preexisting, open-access data set to explore preliminary evidence of racial disparities in AAC intervention. Amount of AAC intervention was compared for Black versus white 1 preschool students at study initiation (M age = 3;8 [years;months]) and 2 years later at study completion (M age = 5;10).

RESULTS

Black preschool students were reported to receive significantly less AAC intervention per week as compared to their white peers, both at study initiation and 2 years later. By study end, 75% of the Black children were receiving less than 60 min of AAC intervention per week, an inadequate amount to achieve meaningful gains given their significant disabilities.

CONCLUSIONS

It is unclear what mechanisms may contribute to the observed disparities; however, it is critical that concrete steps are taken by individual speech-language pathologists, school districts, preservice preparation programs, and researchers to identify inequities in AAC services and take actions to rectify them. Future research is essential to investigate the potential factors contributing to inequalities and determine effective interventions to address them.

A Systematic Review of Augmentative and Alternative Communication Interventions for Children Aged From 0 to 6 Years

PURPOSE

This systematic review evaluates the latest available evidence regarding augmentative and alternative communication (AAC) interventions in children from 0 to 6 years old diagnosed with various disabilities.

METHOD

A systematic search was conducted in MEDLINE (OVID), PsycINFO (EBSCO), ERIC (ProQuest), SCIELO (WOS), Teacher Reference Center (EBSCO), and Education Database (ProQuest), and studies on AAC interventions in children from 0 to 6 years old diagnosed with various disabilities were selected independently by two reviewers (A.L.-R. and N.I.M.) according to the purpose of the review.

RESULTS

Twenty-nine of 1,709 studies met the inclusion criteria for this review. The methodological quality of the included studies was assessed, and the characteristics and results of the studies were extracted by a descriptive analysis (O.L.S. and M.O.-V.).

CONCLUSION

This analysis revealed that children with different diagnoses show improvements in expressive and receptive communication, functional communication behaviors, communication participation skills, interaction strategies, and symbol and multisymbol production and comprehension by using various AAC systems.

Speech-language pathologists’ practices in augmentative and alternative communication during early intervention

This survey study examined augmentative and alternative communication (AAC) practices reported by early intervention speech-language pathologists (SLPs) across the United States (N = 376). The study examined (a) types of AAC that SLPs reported using (i.e., sign language, photographs, pictures, symbols, talking switches, and iPad apps or dedicated speech-generating devices); (b) SLPs' perspectives on the influence of child spoken language ability on AAC recommendations; (c) factors that influenced AAC decision-making within early intervention; and (d) perceived barriers associated with AAC implementation. SLPs reported that they were significantly more likely to introduce all types of AAC to children without spoken language abilities compared to children in later stages of language development. On average, they were most likely to report using or recommending sign language and photographs, and least likely to report using or recommending talking switches or speech-generating devices. Of the options provided, child expressive and receptive language abilities were rated as the most important factors to consider when determining AAC use, followed by cognitive ability, diagnosis, and chronological age. SLPs identified caregiver buy-in and carryover across providers as the most significant barriers to AAC implementation. Recommendations for future research and current AAC practices within early intervention are discussed.

A survey of school-age children with highly unintelligible speech

Prevalence studies in the AAC discipline are fundamental to establishing funding, instructional, and research priorities. These data inform policy-makers on the allocation of clinical and educational services, help prioritize AAC pre-service and in-service trainings, and support AAC research grant applications. A survey study was designed to (a) provide prevalence estimates of school-age students who have highly unintelligible speech, (b) describe the demographic makeup of these students, and (c) describe their access to AAC. Rigorous web-based survey development and distribution procedures were followed. Special education administrators in New Mexico, USA were recruited to distribute the surveys to speech-language pathologists (SLPs) in their respective school districts. The majority of school districts in the state participated, and the overall SLP response rate for participating districts was high (65%). Based on the results, the best estimate indicates that approximately 1 in 89 school-age students in New Mexico has severely unintelligible speech. SLPs averaged 5.4 students per caseload with severely unintelligible speech, with 86% of SLPs providing services to at least one of these students. Only 22% of students with highly unintelligible speech had been seen by an AAC specialist. The findings highlight the substantial number of school-age students with highly unintelligible speech and the ongoing need for high quality AAC service provision for these students.

Caregiver burden and proxy-reported outcomes of people without natural speech: a cross-sectional survey study

OBJECTIVE

To examine interrelations between care-related burden on informal caregivers and their proxy assessments of outcomes in people without natural speech.

DESIGN

A cross-sectional survey.

SETTING

Data were collected in January 2019 from a postal survey of informal caregivers of people without natural speech who are insured by a large regional health insurance company in the German federal state of Lower Saxony.

PARTICIPANTS

n=714 informal caregivers of people without natural speech of all ages and with various underlying disabilities were identified and contacted via the health insurance company. Data from n=165 informal caregivers (26.4%) were obtained.

MAIN OUTCOME MEASURES

Caregiver burden (self-reported, Burden Scale for Family Caregivers), pragmatic communication skills of people without natural speech (proxy report, self-developed), health-related quality of life of people without natural speech (proxy report, DISABKIDS Chronic Generic Measure - DCGM-12) and functioning of people without natural speech (proxy report, WHO Disability Assessment Schedule 2.0).

RESULTS

The analyses revealed significant associations between caregiver burden on the one hand and both proxy-reported health-related quality of life (b=-0.422; p≤0.001) and functioning (b=0.521; p≤0.001) on the other. Adding caregiver burden to the regression model leads to a substantial increase in explained variance in functioning (R² Model 1=0.349; R² Model 2=0.575) as well as in health-related quality of life (R² Model 1=0.292; R² Model 2=0.460).

CONCLUSIONS

Caregiver burden should be considered an important determinant when informal caregivers report outcomes on behalf of people without natural speech. Longitudinal studies are recommended to better understand the burdens experienced by caregivers when supporting people without natural speech.

TRIAL REGISTRATION NUMBER

DRKS00013628.

Augmentative and Alternative Communication Supports for Language and Literacy in Preschool: Considerations for Down Syndrome and Autism Spectrum Disorder

Children with Down syndrome and children with autism spectrum disorder have a range of speech abilities during preschool that impacts access to both language and literacy instruction. It is the responsibility of the speech-language pathologist to advocate for and provide intervention using augmentative and alternative communication (AAC) through individualized assessment. This article provides a review of the literature supporting the use of AAC during preschool for both language and literacy development in children with Down syndrome and children with autism spectrum disorder who have limited speech. A small scale exploratory report is discussed to highlight differences in early literacy skills found in children in each group. Implications for AAC intervention during preschool to support both language and literacy are discussed.

Language Differentiation Using Augmentative and Alternative Communication: An Investigation of Spanish-English Bilingual Children With and Without Language Impairments

Purpose Children with severe speech and language impairments growing up in dual language environments may communicate in more than one language using augmentative and alternative communication (AAC). This study investigated predictors of bilingual children's ability to differentiate between Spanish and English using an AAC iPad app during a cued language-switching task and examined whether switching between languages using AAC incurred a cognitive cost. Method Participants were 58 Spanish-English bilingual children ages 4;0-6;11 (years;months; 23 with language impairments). Children received standardized language and cognitive assessments and completed an experimental language-switching task in which they were asked to differentiate between languages using an AAC iPad app containing English and Spanish vocabulary layouts paired with voice output. Results Results of a binary logistic regression indicated that, when controlling for age, processing speed significantly predicted whether children were classified as high or low performers on the experimental task. Nonparametric tests indicated that switching between languages did not incur a cognitive cost as evidenced by similar response times on trials where participants were required to switch between languages compared to trials where they did not switch. Conclusion This study contributes to the understanding of how young bilingual children with and without language impairments conceptualize and discriminate between languages represented in a visual-graphic modality paired with speech output. Supplemental Material https://doi.org/10.23641/asha.13289330.

How to Recruit, Support, and Retain Speech-Language Pathologists in Public Schools

Over the past two decades, there has been a persistent shortage of qualified speech-language pathologists (SLPs) across the United States. This shortage is predicted to continue, as data reported by the American Speech Language Hearing Association (ASHA) from the US Bureau of Labor Statistics indicates that there will be a 27% increase in job openings through the year 2028. In some states, the shortage has led to service provision from individuals without a background in speech-language pathology and/or without speech-language pathology certification and licensure. Speech and language services that are delivered by unqualified personnel may lead to inadequate time devoted to therapy—either too much, or too little—which is ultimately unethical, illegal, and expensive. However, there is a real issue at hand for school leadership—and that is: How to recruit, support, and retain highly qualified SLPs? In the current tutorial, we will provide evidence-based action steps for how and why to recruit, support, and retain certified and licensed SLPs. Specifically, we discuss the qualifications of the SLP, roles and responsibilities of school-based SLPs, caseload versus workload considerations, various service delivery models, and a review of SLP job satisfaction research. Throughout the tutorial, we will provide concrete and evidence-based ideas for school leadership to consider when recruiting, supporting, and retaining SLPs.

Augmentative and Alternative Communication (AAC) Use Among Patients Followed by a Multidisciplinary Cleft and Craniofacial Team

OBJECTIVE

To establish preliminary data describing the number of patients who visit a multidisciplinary cleft and craniofacial team who use augmentative and alternative communication (AAC) supports.

DESIGN

This retrospective study consisted of chart reviews for all patients who visited a single site's multidisciplinary cleft and craniofacial team for 1 calendar year.

SETTING

A single multidisciplinary craniofacial team at a tertiary teaching hospital.

PARTICIPANTS

Four hundred sixty-four patients met the inclusion criteria for this study. Of these, 59.9% (n = 278) were male and 40.1% (n = 186) were female.

RESULTS

Of the sample population, 6.9% (n = 32) were AAC users as they received AAC intervention in a therapeutic context, while 93.1% (n = 432) were not. The AAC group had a mean age of 5.1 years (standard deviation [SD]: 4.2) and was 68.8% (n = 22) male. The non-AAC group had a mean age of 6.3 (SD: 4.9) and was 59.3% (n = 256) male. Within the AAC group, 40.6% (n = 13) were found to have an identified syndromic diagnosis in comparison to 17.6% (n = 76) of the non-AAC group (P = .003).

CONCLUSIONS

This is the first study to report the prevalence of AAC use among patients in the care of multidisciplinary cleft and craniofacial teams. Our findings suggest that a subset of craniofacial team patients may have complex communication disorders that require AAC supports. Craniofacial teams should be aware of resources available for these patients so that the patients' communication needs are met in the hospital, in school, and in the community.

Teaching Preschoolers With Autism to Use Different Speech-Generating Device Display Formats During Play: Intervention and Secondary Factors

Purpose

Children with autism spectrum disorder (ASD) and complex communication needs are increasingly taught to use tablet-based speech-generating devices (SGDs). An important issue in designing such interventions is the selection of an appropriate format for displaying vocabulary. The purpose of this study was to determine (a) whether young children with ASD can be taught to use different SGD vocabulary display formats and (b) whether there are differences across the formats on a range of secondary measures (e.g., preference and generalization).

Method

Five preschoolers with ASD (and prior experience with simpler aided augmentative and alternative communication) were taught to use grid and visual scene display SGDs during a play-based intervention. Acquisition of functional responding was assessed using a single-case experimental design. Secondary variables included error types, antecedents for communication, preference, and generalization.

Results

All participants increased their use of functional target vocabulary using both the grid and the simple visual scene display. Of the five participants, three showed similar performance with both formats, whereas two had slightly higher rates of functional responding with the grid. Individualized differences across participants and formats were apparent across secondary variables (e.g., preference, error types, generalization).

Conclusions

Both simple grid and visual scene displays may be viable options when teaching functional use of SGDs to children with ASD who have prior aided augmentative and alternative communication experience. Analyzing secondary variables beyond device acquisition (e.g., generalization, preference) may have implications for individualizing intervention.

Adaptation to Technology Use in Families of Children With Complex Communication Needs: An Integrative Review and Family Theory Application

Families with children who have developmental disabilities and complex communication needs (CCNs) face challenging demands affecting family adaptation. Many children with CCNs use augmentative and alternative communication (AAC) devices to support communication, yet little is known about family adaptation to such technology. To fill this gap, an integrative review, guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation was conducted to assess conceptual foundations and the state of the science of family adaptation among children utilizing AAC. Web-based searches were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Mixed Methods Appraisal Tool. Thirty-three studies met eligibility. Findings demonstrated that to enhance the science underpinning family adaptation to AAC use, future research should be grounded conceptually and address important components of the Resiliency Model. Work in this emerging area will identify and facilitate nursing efforts to assist families as they adapt to communication technology.

Complex intervention in augmentative and alternative communication (AAC) care in Germany: a study protocol of an evaluation study with a controlled mixed-methods design

INTRODUCTION

The current practice of service delivery in Germany for people with complex communication needs (CCN) who are in need of augmentative and alternative communication (AAC) is characterised by diverse problems, including a lack of clarity in the responsibilities of the service providers involved. To address these issues a new service delivery model has been put in place, implemented in three AAC counselling centres for patients with a particular health insurance across Germany. The implementation of a new service delivery model aims to improve individualised service delivery. The model goes beyond standard care by adding case management, counselling, AAC training and, if needed, AAC therapy. This study aims to evaluate the effectiveness of this complex intervention.

METHODS AND ANALYSIS

In consideration of the complexity of the new service delivery model, formative and summative evaluation will be conducted. The formative evaluation will provide data based on qualitative and quantitative assessments of the competences and perspectives of all involved stakeholders, including a proxy measurement of persons with CCN. The summative evaluation will include a controlled study design as the new service delivery model will be compared against the service delivery in an existing contract and against data gathered from caregivers of AAC users provided with standard care. With the exception of the individual interviews the data will be collected from proxies-that is, informal and formal caregivers.

ETHICS AND DISSEMINATION

Data collection, storage and evaluation meet the currently valid data protection regulations. Consultation by the responsible data protection officer of the Oldenburg Medical School and a positive vote from its Ethics Committee were obtained prior to the start of the study. Dissemination strategies include the presentation of the obtained data and results in the form of publications and at conferences.

TRIAL REGISTRATION NUMBER

DRKS00013628.

National survey describing and quantifying students with communication needs

PURPOSE

Research literature has yet to quantify and describe how students with complex communication needs are supported in the classroom and how special educators are being prepared to offer support. This study sought out special educators to complete a survey about their students with complex communication needs.

METHOD

Over 4,000 teachers representing 50 states reported on the communicative and behavioral characteristics of 15,643 students. Teachers described the training they have received and instructional approaches they used.

RESULTS

The majority of students were reported to use speech as their primary communication mode. Over half of students utilizing alternative and augmentative communication (AAC) were reported to have non-proficient communication. Teacher training varied across respondents as well as the supports they used to support these students in the classroom.

CONCLUSION

The majority of students with disabilities using AAC when communicating across the nation are not proficiently communicating. Implications and recommendations will be discussed.

Early Sentence Productions of 3- and 4-Year-Old Children Who Use Augmentative and Alternative Communication

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.

A Synthesis of Relevant Literature on the Development of Emotional Competence: Implications for Design of Augmentative and Alternative Communication Systems

PURPOSE

Emotional competence refers to the ability to identify, respond to, and manage one's own and others' emotions. Emotional competence is critical to many functional outcomes, including making and maintaining friends, academic success, and community integration. There appears to be a link between the development of language and the development of emotional competence in children who use speech. Little information is available about these issues in children who rely on augmentative and alternative communication (AAC). In this article, we consider how AAC systems can be designed to support communication about emotions and the development of emotional competence.

METHOD

Because limited research exists on communication about emotions in a context of aided AAC, theory and research from other fields (e.g., psychology, linguistics, child development) is reviewed to identify key features of emotional competence and their possible implications for AAC design and intervention.

RESULTS

The reviewed literature indicated that the research and clinical attention to emotional competence in children with disabilities is encouraging. However, the ideas have not been considered specifically in the context of aided AAC. On the basis of the reviewed literature, we offer practical suggestions for system design and AAC use for communication about emotions with children who have significant disabilities. Three key elements of discussing emotions (i.e., emotion name, reason, and solution) are suggested for inclusion in order to provide these children with opportunities for a full range of discussion about emotions.

CONCLUSIONS

We argue that supporting communication about emotions is as important for children who use AAC as it is for children who are learning speech. This article offers a means to integrate information from other fields for the purpose of enriching AAC supports.

Conducting an Augmentative and Alternative Communication Assessment as a School-Based Speech-Language Pathologist: A Collaborative Experience

In addition to providing services to children who demonstrate speech and language impairments, it is within a speech-language pathologist's (SLP's) scope of practice to “recognize and hold paramount the needs and interests of individuals who may benefit from AAC [Augmentative and Alternative Communication]” (American Speech-Language-Hearing Association (ASHA), 2005, Position Statement section, para. 3). However, in spite of nearly one-half of all school-based SLPs reporting they provide services to nonverbal students who utilize AAC systems (ASHA 2012; Kent-Walsh, Stark, & Binger, 2008; Proctor & Oswalt, 2008) many SLPs across the country still do not feel adequately trained to assess and provide therapy services to these children (Costigan & Light, 2010; Kent-Walsh et al., 2008; Light, Drager, Currall, & Roberts, 2012). It is becoming increasingly necessary for all SLPs to assume responsibilities in the AAC process. The case study presented in this article illustrates the collaborative process of conducting an AAC assessment for a preschool-aged child.

A comparison of two approaches for representing AAC vocabulary for young children

PURPOSE

Young children with complex communication needs often experience difficulty in using currently available graphic symbol systems as a method of augmentative and alternative communication (AAC). Information on young children's performance with graphic representations based on this population's conceptualizations of these vocabulary items may assist in the development of more effective AAC systems.

METHOD

This study developed Developmentally Appropriate Symbols (DAS) for 10 early emerging vocabulary concepts using procedures designed to address both conceptual and appeal issues for graphic representations for young children. Using a post-test only, between-subjects comparison group design, 40 typically-developing 2.5-3.5-year-old children were randomly assigned to receive a brief training in either of two different types of graphic symbol sets: (a) DAS or (b) Picture Communication Symbols (PCS), a, commercially available graphic symbol system.

RESULT

Results of a two sample independent t-test provide evidence that children in the DAS condition correctly identified more symbols than children trained with the PCS symbols. There was no evidence of a preference between the symbol sets.

CONCLUSION

The results provide support for careful consideration of children's use and understanding of language in developing AAC systems for young children.

Language Intervention via Text-Based Tele-AAC: A Case Study Comparing On-site and Telepractice Services

There is a shortage of qualified speech and language pathologists (SLPs) to not only meet the needs of students with a variety of communicative disabilities, but also the needs of those students with severe impairments who use augmentative and alternative communication (AAC). Special education administrators need to consider additional methods of service delivery, such as telepractice. However, there is limited evidence regarding the efficacy of services delivered to students using AAC via telepractice as opposed to face-to-face services. This study examines the effectiveness of services provided using both methodologies, and aims to provide some validation of telepractice as an alternative treatment method. Using a single-subject design to compare performance outcomes, a 7 year-old male participant, who used a Vantage Plus™ device with an 84-sequenced overlay, was studied over an eight-week period, with four weeks of on-site therapy immediately followed by four weeks of telepractice therapy. Student progress was measured by comparing outcomes in both conditions to baseline data with respect to short-term goals focused on grammatical morphemes. The results indicate that the performance outcomes were comparable in both conditions. The authors discuss the implications of using telepractice to deliver direct intervention and future applications of telepractice as a service delivery model for individuals using AAC.

Resourcing speech-language pathologists to work with multilingual children

Speech-language pathologists play important roles in supporting people to be competent communicators in the languages of their communities. However, with over 7000 languages spoken throughout the world and the majority of the global population being multilingual, there is often a mismatch between the languages spoken by children and families and their speech-language pathologists. This paper provides insights into service provision for multilingual children within an English-dominant country by viewing Australia's multilingual population as a microcosm of ethnolinguistic minorities. Recent population studies of Australian pre-school children show that their most common languages other than English are: Arabic, Cantonese, Vietnamese, Italian, Mandarin, Spanish, and Greek. Although 20.2% of services by Speech Pathology Australia members are offered in languages other than English, there is a mismatch between the language of the services and the languages of children within similar geographical communities. Australian speech-language pathologists typically use informal or English-based assessments and intervention tools with multilingual children. Thus, there is a need for accessible culturally and linguistically appropriate resources for working with multilingual children. Recent international collaborations have resulted in practical strategies to support speech-language pathologists during assessment, intervention, and collaboration with families, communities, and other professionals. The International Expert Panel on Multilingual Children's Speech was assembled to prepare a position paper to address issues faced by speech-language pathologists when working with multilingual populations. The Multilingual Children's Speech website ( http://www.csu.edu.au/research/multilingual-speech ) addresses one of the aims of the position paper by providing free resources and information for speech-language pathologists about more than 45 languages. These international collaborations have been framed around the World Health Organization's International Classification of Functioning, Disability and Health (ICF-CY) and have been established with the goal of supporting multilingual children to participate in society.

Comparing communication systems for individuals with developmental disabilities: a review of single-case research studies

Studies that have compared different communication systems for individuals with developmental disabilities were systematically reviewed in an effort to provide information useful for clinical decision making and directions for future research. Specifically, 28 studies that compared (a) non-electronic picture systems to speech generating devices, (b) aided AAC (e.g. picture exchange systems and SGDs) to unaided AAC systems (manual sign), or (c) AAC to speech-language interventions were included in this review. Dependent variables forming the basis for comparison included: (a) effectiveness (e.g. acquisition of systems and/or rate of use), (b) efficiency or rate of skill acquisition (c) participants' preference for systems, (d) occurrence of vocalizations and problem behavior, and (e) generalization across communication partners, settings, and time (i.e. maintenance). Results suggest that clear and consistent differences between communication systems are rare, precluding definitive statements regarding a universal best approach for all people with developmental disabilities. Instead, findings of this review support the consideration of an individual's existing skills, goals and preferences as part of the process of selecting an approach to communication.

Predicting language outcomes for children learning augmentative and alternative communication: child and environmental factors

PURPOSE

To investigate a model of language development for nonverbal preschool-age children learning to communicate with augmentative or alternative communication.

METHOD

Ninety-three preschool children with intellectual disabilities were assessed at Time 1, and 82 of these children were assessed 1 year later, at Time 2. The outcome variable was the number of different words the children produced (with speech, sign, or speech-generating devices). Children's intrinsic predictor for language was modeled as a latent variable consisting of cognitive development, comprehension, play, and nonverbal communication complexity. Adult input at school and home, and amount of augmentative or alternative communication instruction, were proposed mediators of vocabulary acquisition.

RESULTS

A confirmatory factor analysis revealed that measures converged as a coherent construct, and a structural equation model indicated that the intrinsic child predictor construct predicted different words children produced. The amount of input received at home, but not at school, was a significant mediator.

CONCLUSIONS

The hypothesized model accurately reflects a latent construct of Intrinsic Symbolic Factor (ISF). Children who evidenced higher initial levels of ISF and more adult input at home produced more words 1 year later. The findings support the need to assess multiple child variables and suggest interventions directed to the indicators of ISF and input.

The Multi-faceted Implementation of Telepractice to Service Individuals with Autism

Telepractice is a method of service delivery in which professionals provide intervention, assessment and consultation services to individuals through the use of telecommunication technologies. In response to the nationwide school-based shortage of speech-language pathologists, telepractice has emerged as a viable way to reach underserved clients. Telepractice has the potential to extend to populations in need of services, including those diagnosed with autism. This paper examines an evidence-based clinical model for the delivery of telepractice services and describes the policies and procedures required for assessing individual need, confidentiality, technology, training and documentation within a telepractice program. Two clinical case studies involving individuals diagnosed with autism are described and provide initial evidence for the use of telepractice as a practical method for direct and consultative service delivery. Results indicated that both the student receiving direct services, and the treating clinician receiving consultative services via telepractice, demonstrated an increased skill level in target domains.

Tele-AAC Resolution

Approximately 1.3% of all people, or about 4 million Americans, cannot rely on their natural speech to meet their daily communication needs. Telepractice offers a potentially cost-effective service delivery mechanism to provide clinical AAC services at a distance to the benefit of underserved populations in the United States and worldwide. Tele-AAC is a unique cross-disciplinary clinical service delivery model that requires expertise in both telepractice and augmentative and alternative communication (AAC) systems. The Tele-AAC Working Group of the 2012 ISAAC Research Symposium therefore drafted a resolution underscoring the importance of identifying and characterizing the unique opportunities and constraints of Tele-AAC in all aspects of service delivery. These include, but are not limited to: needs assessments; implementation planning; device/system procurement, set-up and training; quality assurance, client progress monitoring, and follow-up service delivery. Tele-AAC, like other telepractice applications, requires adherence to the ASHA Code of Ethics and other policy documents, and state, federal, and international laws, as well as a competent technological infrastructure. The Working Group recommends that institutions of higher education and professional organizations provide training in Tele-AAC service provision. In addition, research and development are needed to create validity measures across Tele-AAC practices (i.e., assessment, implementation, and consultation); determine the communication competence levels achieved by Tele-AAC users; discern stakeholders’ perceptions of Tele-AAC services (e.g., acceptability and viability); maximize Tele-AAC’s capacity to engage multiple team members in AAC assessment and ongoing service; identify the limitations and barriers of Tele-AAC provision; and develop potential solutions.

Discurso de fisioterapeutas acerca da comunicação com sujeitos com encefalopatia crônica não progressiva

INTRODUÇÃO: A Encefalopatia Crônica Não Progressiva (ECNP) refere-se ao prejuízo motor não evolutivo, adquirido antes dos dois primeiros anos de vida, que manifesta desordem do movimento e da postura. Além do atraso nas aquisições motoras, o sujeito acometido por essa patologia pode apresentar problemas de visão, cognição, comunicação e comportamento, dependendo da gravidade do comprometimento neurológico. Para tanto, há a necessidade de uma equipe de profissionais da área da saúde para auxiliá-lo e de uma visão humanista em seu atendimento. OBJETIVO: Analisar as formas de comunicação utilizadas entre fisioterapeutas e sujeitos com encefalopatia crônica não progressiva (ECNP). MATERIAIS E MÉTODOS: Foram realizadas entrevistas individuais com perguntas abertas pertinentes à temática. A análise dos dados ocorreu com a seleção e o agrupamento das ideias mais relevantes sobre o tema a partir de análise crítica e relacional. RESULTADOS: A forma de comunicação não verbal mais referida pelos fisioterapeutas foi a cinésica (expressão facial e corporal), enfatizada como importante e presente na sessão de fisioterapia com o sujeito com ECNP. O grupo investigado afirma ter dificuldades na interpretação da leitura corporal desses sujeitos. A abordagem de tal tema demonstrou-se deficitária na vida acadêmica de grande parte dos fisioterapeutas investigados. Do mesmo modo, há quase um desconhecimento dos benefícios de outras formas de comunicação, como a comunicação aumentativa alternativa (CAA). CONCLUSÃO: Os resultados sugerem a necessidade de se ampliar a formação de fisioterapeutas em relação à comunicação dentro de uma perspectiva de maior humanização do atendimento a sujeitos com ECNP.

Synthesized speech intelligibility and early preschool-age children: comparing accuracy for single-word repetition with repeated exposure

PURPOSE

This investigation examined the effect of repeated exposure to novel and repeated spoken words in typical environments on the intelligibility of 2 synthesized voices and human recorded speech in preschools.

METHOD

Eighteen preschoolers listened to and repeated single words presented in human-recorded speech, DECtalk Paul, and AT&T Voice Michael during 5 experimental sessions. Stimuli consisted of repeated and novel words presented in each speech output condition during each session. Sessions took place in the presence of typically occurring noise in classroom or home settings.

RESULTS

There was a significant main effect for voice as participants accurately identified significantly more words in the human-recorded speech and AT&T Voice than in the DECtalk speech output condition. When averaged across speech output conditions, children increased their accuracy as they participated in additional sessions. There was a statistically significant interaction between session and voice. DECtalk had a slightly larger effect of session than did AT&T Voice and human-recorded speech.

A Comunicação Suplementar e/ou alternativa na sessão de fisioterapia

OBJETIVO: analisar o que fisioterapeutas referem no discurso sobre o uso da Comunicação Suplementar e/ou Alternativa (CSA) durante a sessão de fisioterapia com sujeitos com Encefalopatia Crônica Não Evolutiva (ECNE). MÉTODO: foram efetuadas entrevistas individuais com cinco profissionais, por meio de questionamentos pertinentes à temática em forma de perguntas abertas. A análise dos dados ocorreu com o agrupamento de ideias e a seleção das ideias mais relevantes sobre o tema. RESULTADOS: os cinco fisioterapeutas entrevistados referem que conhecem e ressaltam a importância da utilização da CAA em suas sessões, mas não tiveram formação teórica sobre o tema. O contato e a utilização de tal abordagem ocorreram por meio da troca interdisciplinar com o profissional de Fonoaudiologia da instituição na qual trabalham. Tal fato, somado às demandas específicas da sessão de fisioterapia, limita a incorporação de tal abordagem na prática diária por quatro profissionais entrevistadas. Apenas um incorporou o recurso em sua rotina diária. CONCLUSÃO: todos os profissionais pesquisados afirmaram ter ganhos no uso da CSA, especificamente na melhora do vínculo e da interação com o paciente com ECNE, mas também afirmaram ter dificuldades com aspectos instrumentais que limitam o uso da CSA, como tamanho da prancha de CSA, seu modo de construção individualizado para cada paciente e a dinâmica da sessão de fisioterapia. Atribuem à dificuldade de aceitação familiar a limitação social de uso da CSA. A presença do Fonoaudiólogo na equipe de atendimento ao sujeito com ECNE foi aspecto fundamental para que tais profissionais fizessem uso da CSA.

Synthesized speech output and children: a scoping review

PURPOSE

Many computer-based augmentative and alternative communication systems in use by children have speech output. This article (a) provides a scoping review of the literature addressing the intelligibility and listener comprehension of synthesized speech output with children and (b) discusses future research directions.

METHOD

Studies investigating synthesized speech intelligibility and/or comprehension with children as listeners were systematically identified and coded according to their objectives and methodology.

RESULTS

Ten studies were identified. They were organized according to the following variables: intelligibility variables related to the stimuli (context and rate), intelligibility variables related to aspects of the listener (age of the child, the language or languages spoken by the listener, experience, and practice effects), and comprehension. Each of these factors-and the research support with child participants-was discussed.

CONCLUSIONS

Overall, there is a paucity of research investigating synthesized speech for use with children. Available evidence suggests that children produce similar trends but lower levels of intelligibility performance when compared with adults. Future areas of applied research are required to adequately define this relationship and the variables that may contribute to improving the intelligibility and comprehension of synthesized speech for children.

Teaching educational assistants to facilitate the multisymbol message productions of young students who require augmentative and alternative communication

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.

Novas perspectivas em comunicação suplementar e/ou alternativa a partir da análise de periódicos internacionais

TEMA: A Comunicação Suplementar e/ou Alternativa (CSA) é uma área do conhecimento da prática clínica, educacional e de pesquisa que favorece a qualidade de vida de seus usuários e familiares. OBJETIVO: propor diretrizes de intervenção e pesquisa na área de CSA a partir da identificação e síntese descritiva de artigos publicados em periódicos indexados em bases de dados eletrônicas internacionais, quanto à temática comunicação suplementar e/ou alternativa, abrangendo pesquisas experimentais, relatos de atendimento individual e/ou em grupo, estudos de casos que incluíssem sujeitos com paralisia cerebral ou com problemas neurológicos não definidos e/ou com retardo mental. CONCLUSÃO: A individualização das práticas quanto ao design, relevância e velocidade do processamento da informação e o processo de inclusão da família e demais parceiros conversacionais são fundamentais ao sucesso na intervenção, generalização e manutenção de uso da prancha de comunicação suplementar e/ou alternativa em contextos formais e informais. A prescrição individualizada dos recursos da área de CSA conforme características físicas, mentais, psíquicas, cognitivas e lingüísticas do usuário tem impacto positivo na sua qualidade de vida e na de seus familiares. Portanto, recomenda-se a introdução o mais breve possível dos recursos terapêuticos da área da comunicação suplementar e/ou alternativa para sujeitos com oralidade restrita e/ou ausente.

AAC technologies for young children with complex communication needs: State of the science and future research directions

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.

When "Simon says" doesn't work: alternatives to imitation for facilitating early speech development

PURPOSE

To provide clinicians with evidence-based strategies to facilitate early speech development in young children who are not readily imitating sounds. Relevant populations may include, but are not limited to, children with autism spectrum disorders, childhood apraxia of speech, and late-talking toddlers.

METHOD

Through multifaceted search procedures, we found experimental support for 6 treatment strategies that have been used to facilitate speech development in young children with developmental disabilities. Each strategy is highlighted within this article through a summary of the underlying rationale(s), empirical support, and specific examples of how it could be applied within intervention.

CONCLUSIONS

Given the relatively sparse experimental data focused on facilitating speech in children who do not readily imitate, theoretical support emerges as particularly key and underscores the need for clinicians to consider why they are doing what they are doing. In addition, this review emphasizes the need for the research community to bridge the gap between pressing clinical needs and the limited evidence base that is currently available.

Augmentative and alternative communication for preschool children: intervention goals and use of technology

This study sought to describe speech-language interventions for preschool-aged children who required augmentative and alternative communication (AAC) as provided by AAC experts and by general speech-language pathologists who were not AAC experts. The study also examined the types of technology used in AAC intervention by AAC experts. A retrospective chart review was conducted in which clinic records of 38 preschool-aged children who received expert AAC services were examined. Results showed that interventions provided to the children by general speech-language pathologists (who were not AAC experts) tended to be broader in scope, focusing on reducing underlying impairments. Interventions provided by AAC experts tended to focus on improving activities and participation and were oriented toward improving functional communication. The most commonly used AAC intervention tools by AAC experts were low-tech tools and simple digitized devices.

Preparation in augmentative and alternative communication: an update for speech-language pathology training

PURPOSE

To report on data from the current survey about academic and clinical education in augmentative and alternative communication (AAC), as well as to compare these findings with earlier surveys in an attempt to identify any changes being made as programs in the United States implement the new certification standards of the American Speech-Language-Hearing Association in the area of speech-language pathology.

METHOD

A survey was sent to all speech-language pathology training programs in the United States via e-mail directed to program directors or faculty teaching in AAC.

RESULTS

A total of 168 surveys were returned, for a return rate of 57.93%. Seventy-three percent of the respondents had a separate course in AAC, and 80% indicated AAC content was infused in other courses.

CONCLUSIONS

Academic preparation in AAC, while varying across academic programs, has in general increased over the past decade. Data also suggested a continuing critical need for more academic and clinical preparation in this area.