Effects of Interventions That Include Aided Augmentative and Alternative Communication Input on the Communication of Individuals With Complex Communication Needs: A Meta-Analysis

A Systematic review of AAC interventions using speech generating devices for autistic preschoolers

Many autistic1 children experience communication challenges. Augmentative and alternative communication (AAC) can function as a primary or supportive mode of communication, and interventions incorporating AAC have a positive impact on the communication skills of autistic children. This systematic review investigated intervention studies using speech generating devices to enhance the expressive language of autistic preschoolers. Specifically, research questions addressed the (a) expressive communication skills and functions; (b) instructional strategies; (c) impact of interventions; and (d) ecological validity of the included studies. After an extensive search process, twenty studies from 1998 to 2023 met the inclusion criteria. Study characteristics were extracted, social and ecological validity were evaluated, and results were described using effect sizes and visual analysis. The majority targeted requesting (n=14) and the remaining addressed communication acts across diverse functions (n=6). Eleven of the studies demonstrated moderate to strong effects. Most interventions were multicomponent, including a variety of strategies, with prompting being the most common. Fewer than half of the studies met the full criteria for ecological validity, and only seven measured social validity. Implications for the field are provided including a call to action for researchers to evaluate interventions to support communication across diverse functions.

Aided Communication With Individuals Who Have Multiple Disabilities That Include Visual Impairments: A Meta-Analysis

PURPOSE

Despite several decades of research focused on improving early symbolic communication for individuals with multiple disabilities, relatively limited focus has been placed on individuals who also have visual impairments. To establish what is currently known about aided language adaptations for this population, a meta-analysis was conducted to examine augmentative and alternative communication (AAC) intervention approaches for individuals with multiple disabilities that include visual impairments.

METHOD

Six relevant databases were systematically searched. Seven hundred eighty-nine articles were narrowed to eight intervention studies that met the design standards set for this review.

RESULTS

Of the eight intervention studies that met design standards, five used modified versions of the Picture Exchange Communication System and three used a combination of approaches such as communication partner instruction plus environmental arrangement. Most studies used low-tech AAC such as tangible symbols, photo cues, and communication books, and most focused on improving independent requesting. Overall, the studies indicated positive findings for increasing pragmatic language skills such as requesting, turn-taking, and student-to-peer interactions. However, the total number of participants across studies was extremely limited (i.e., 19 participants total). Clearly, much additional research is required to devise adequate accommodations for individuals with multiple disabilities, including visual impairments, and to expand communicative functions beyond simple requests.

CONCLUSIONS

The use of visual impairment accommodations appeared largely effective for the included aided AAC interventions, although consultation with visual impairment specialists was not consistently reported across the included studies. More rigorous research must occur within this population to better inform clinical practice and future studies.

Utilising collaborative learning strategies with children who use AAC: A pilot online training program for speech-language pathologists

PURPOSE

Children who utilise augmentative and alternative communication (AAC) have difficulty participating in interactions with peers and speech-language pathologists (SLPs) lack training in the development of activities to specifically target participation. The purpose of the current study was to explore a pilot online training program designed to provide information about the development of collaborative learning (CL) activities to support participation.

METHOD

A single-subject, multiple baseline across six participants in an initial group and a replication group was completed to assess the number of CL elements included in probe responses during baseline, intervention, and maintenance phases.

RESULT

SLPs were highly accurate in their ability to answer multiple choice questions about CL elements (80%-90%); however, the overall effect of the intervention was weak with a Tau-U of 0.48 for the initial group and 0.53 for the replication group.

CONCLUSION

SLPs can begin to develop skills in designing CL activities for children who utilise AAC as a means to support participation and foster social interaction. Future research is necessary to design efficient and effective online training for SLPs.

Delivering Enhanced Milieu Teaching to Toddlers With Down Syndrome via Hybrid Telepractice: A Single-Case Experimental Design

PURPOSE

This pilot study investigated delivering enhanced milieu teaching tailored for children with Down Syndrome (EMT-DS) through hybrid telepractice.

METHOD

In this multiple-baseline design across behaviors study, a speech-language pathologist (SLP) taught EMT-DS to three caregivers and their children with DS (22-40 months) using a hybrid service delivery model. Sessions were conducted in person and via telepractice. The SLP taught caregivers EMT-DS, emphasizing the use of (a) four target EMT strategies: matched turns, expansions, time delays, and milieu teaching episodes; (b) augmentative and alternative communication (AAC; manual signs, speech-generating device); and (c) aided AAC modeling. The SLP provided caregiver instruction following the teach-model-coach-review approach. Caregiver outcomes were the accuracy (primary) and frequency (secondary) of EMT strategy use. Child outcomes were exploratory and included the rate of symbolic communication acts, weighted number of communication acts, and number of different words (NDW).

RESULTS

There was a functional relation between the intervention and the accuracy and frequency of EMT strategy use for all three caregivers. All caregivers showed an increase in the accuracy for all four target strategies. Caregivers also increased the frequency of the three EMT strategies: expansions, time delays, and milieu teaching episodes. There were no changes in the frequency of matched turns. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the rate of symbolic communication acts and NDW occurred for all three children.

CONCLUSION

Results demonstrate the preliminary efficacy of using a hybrid service delivery model to teach caregivers EMT-DS.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27115252.

Executive functioning and nonverbal cognitive factors associated with response to technology-assisted language intervention

OBJECTIVE

To explore potential differences in the relationship between executive function (EF) skills and language development when integrating augmentative and alternative communication technology into speech-language therapy for deaf/hard of hearing (DHH) children.

METHOD

Randomized trial data were analysed to investigate this relationship among children who participated in a Technology-Assisted Language Intervention (TALI) compared to treatment as usual (TAU). Language samples were assessed for pre-post-intervention changes, including mean length of utterance in morphemes (MLU), mean turn length (MTL), and number of different words spoken (NDW). EF skills were measured with standardized parent-report assessment.

RESULTS

Thirty-seven DHH children were included (TALI n = 19 and TAU n = 18). Results of regression models indicated that higher EF skills were significantly (p < 0.05) associated with improvements in MLU, MTL, and NDW among children who received TAU. No significant associations between EF skills and any of the measures (MLU, MTL, NDW) were seen in children who received TALI.

CONCLUSION

These results suggest that TALI may offer language learning support, particularly for DHH children with EF difficulties. Future research should investigate the direct relationship between EF measurements and language outcomes in TALI recipients. Establishing baseline EF measurements in DHH children could inform personalized strategies within language interventions and therapy.

Preliminary Investigation of Context-Aware Augmentative and Alternative Communication with Automated Just-in-Time Cloze Phrase Response Options for Social Participation from Children on the Autism Spectrum

INTRODUCTION

Social participation for emerging symbolic communicators on the autism spectrum is often restricted. This is due in part to the time and effort required for both children and partners to use traditional augmentative and alternative communication (AAC) technologies during fast-paced social routines. Innovations in artificial intelligence provide the potential for context-aware AAC technology that can provide just-in-time communication options based on linguistic input from partners to minimize the time and effort needed to use AAC technologies for social participation.

METHODS

This preliminary study used an alternating treatment design to compare the effects of a context-aware AAC prototype with automated cloze phrase response options to traditional AAC for supporting three young children who were emerging symbolic communicators on the autism spectrum in participating within a social routine.

RESULTS

Visual analysis and effect size estimates suggest the context-aware AAC condition resulted in increases in linguistic participation, vocal approximations, and visual attention for all three children.

CONCLUSION

While this study was only an initial exploration and results are preliminary, context-aware AAC technologies have the potential to enhance participation and communication outcomes for young emerging symbolic communicators on the autism spectrum and more research is needed.

A scoping review of AAC interventions for children and young adults with simultaneous visual and motor impairments: Clinical and research Implications

Individuals with multiple disabilities are among the most challenging to serve and AAC teams often lack direction in determining effective interventions. The purpose of this scoping review was to summarize the research evidence on AAC interventions for individuals with complex communication needs and simultaneous motor, and visual impairments as part of their multiple disabilities; to consider implications for practice; and to determine gaps and directions for future research. A total of 27 studies were identified and reviewed, involving 55 unique participants with multiple disabilities. Most studies focused on direct intervention to increase requesting or choice-making, with little focus on social communication. Only two studies focused on training communication partners. Results indicated that AAC interventions can be highly effective to increase communication for individuals with multiple disabilities. However, there is an urgent need for increased rigor and more detailed participant information in future AAC intervention research with this population. Future research should investigate AAC intervention to improve social communication and increase language development, not just expression of needs and wants. Future research should focus on the needs of individuals with multiple disabilities from culturally and linguistically diverse backgrounds and on implementation of AAC within natural environments.

Picture book videos incorporating key word signing for children who require AAC and their families: design and evaluation of a multimedia-enhanced setting

Key word signing (KWS) is an unaided form of augmentative and alternative communication (AAC) and is frequently used by children with cognitive impairments and their families. Successful implementation of KWS requires a family environment that provides aided language input by modeling the signs. However, families face challenges implementing the signs in their everyday lives. KWS requires effort and sustained parental commitment. Users may also struggle with finding good learning resources and stimulating and enjoyable shared contexts for communication. Signed videos of popular children's books may help to implement KWS and create a signing environment which exposes children and their families to KWS in meaningful ways. The aim of this study was to create videos of this type and investigate whether and how they might serve as an attractive medium of support for families' KWS experience. Three families tested the videos. A triangulated qualitative study incorporating interviews and participant observation explored the families' experience of using these videos as a context for shared communication. The findings suggest that picture book videos supplemented by KWS may be appropriate resources for the use of KWS in everyday family life. They serve as a child-centered activity involving KWS exposure, in which children and their families can participate joyfully and naturally.

Leveraging Communication Partner Speech to Automate Augmented Input for Children on the Autism Spectrum Who Are Minimally Verbal: Prototype Development and Preliminary Efficacy Investigation

PURPOSE

Augmentative and alternative communication (AAC) technology innovation is urgently needed to improve outcomes for children on the autism spectrum who are minimally verbal. One potential technology innovation is applying artificial intelligence (AI) to automate strategies such as augmented input to increase language learning opportunities while mitigating communication partner time and learning barriers. Innovation in AAC research and design methodology is also needed to empirically explore this and other applications of AI to AAC. The purpose of this report was to describe (a) the development of an AAC prototype using a design methodology new to AAC research and (b) a preliminary investigation of the efficacy of this potential new AAC capability.

METHOD

The prototype was developed using a Wizard-of-Oz prototyping approach that allows for initial exploration of a new technology capability without the time and effort required for full-scale development. The preliminary investigation with three children on the autism spectrum who were minimally verbal used an adapted alternating treatment design to compare the effects of a Wizard-of-Oz prototype that provided automated augmented input (i.e., pairing color photos with speech) to a standard topic display (i.e., a grid display with line drawings) on visual attention, linguistic participation, and (for one participant) word learning during a circle activity.

RESULTS

Preliminary investigation results were variable, but overall participants increased visual attention and linguistic participation when using the prototype.

CONCLUSIONS

Wizard-of-Oz prototyping could be a valuable approach to spur much needed innovation in AAC. Further research into efficacy, reliability, validity, and attitudes is required to more comprehensively evaluate the use of AI to automate augmented input in AAC.

Determining an Effective Language Sample Elicitation Strategy for Early Language Learners Who Speak Using Augmentative and Alternative Communication

PURPOSE

This study evaluates three different language sample elicitation strategies to determine a valid elicitation strategy for early language learners who speak using augmentative and alternative communication (AAC).

METHOD

Ten children who speak using AAC participated in this study. Language samples were elicited from each participant using three strategies: the Communication and Symbolic Behavior Scales (CSBS), a generic play-based elicitation strategy, and automatic data logging. Samples were transcribed and coded. Additionally, each participant's school speech-language pathologist completed a Communication Matrix. Data from coded language samples were correlated with Communication Matrix results to determine the elicitation strategy that yielded the most valid language sample in comparison to Communication Matrix results.

RESULTS

Both the CSBS and the play-based strategy yielded clinically relevant information. Because the log lacked communicative context, resulting data from the log was limited. An analysis of variance revealed significant differences in the amount of information elicited from each elicitation strategy. The CSBS repeatedly elicited the most data, followed by the play-based strategy and then the log. Generic play-based strategy results yielded the most correlations with Communication Matrix data.

CONCLUSIONS

This preliminary data suggest that the play-based elicitation strategy elicited the most valid language sample when compared to the Communication Matrix from early language learners who speak using AAC. Additionally, results suggest that the CSBS may be an effective tool to measure the limits of this population's expressive language abilities.

Oral language interventions can improve language outcomes in children with neurodevelopmental disorders: A systematic review and meta-analysis

Background

Young people who fail to develop language as expected face significant challenges in all aspects of life. Unfortunately, language disorders are common, either as a distinct condition (e.g., Developmental Language Disorder) or as a part of another neurodevelopmental condition (e.g., autism). Finding ways to attenuate language problems through intervention has the potential to yield great benefits not only for the individual but also for society as a whole.

Objectives

This meta-analytic review examined the effect of oral language interventions for children with neurodevelopmental disorders.

Search Methods

The last electronic search was conducted in April 2022.

Selection Criteria

Intervention studies had to target language skills for children from 2 to 18 years of age with Developmental Language Disorder, autism, intellectual disability, Down syndrome, Fragile X syndrome, and Williams syndrome in randomised controlled trials or quasi-experimental designs. Control groups had to include business-as-usual, waiting list, passive or active conditions. However, we excluded studies in which the active control group received a different type, delivery, or dosage of another language intervention. Eligible interventions implemented explicit and structured activities (i.e., explicit instruction of vocabulary, narrative structure or grammatical rules) and/or implicit and broad activities (i.e., shared book reading, general language stimulation). The intervention studies had to assess language skills in receptive and/or expressive modalities.

Data Collection and Analysis

The search provided 8195 records after deduplication. Records were screened by title and abstract, leading to full-text examinations of 448 records. We performed Correlated and Hierarchical Effects models and ran a retrospective power analysis via simulation. Publication bias was assessed via p-curve and precision-effect estimate.

Main Results

We examined 38 studies, with 46 group comparisons and 108 effects comparing pre-/post-tests and eight studies, with 12 group comparisons and 21 effects at follow-up. The results showed a mean effect size of d = 0.27 at the post-test and d = 0.18 at follow-up. However, there was evidence of publication bias and overestimation of the mean effects. Effects from the meta-analysis were significantly related to these elements: (1) receptive vocabulary and omnibus receptive measures showed smaller effect sizes relative to expressive vocabulary, grammar, expressive and receptive discourse, and omnibus expressive tests; and (2) the length of the intervention, where longer sessions conducted over a longer period of time were more beneficial than brief sessions and short-term interventions. Neither moderators concerning participants' characteristics (children's diagnosis, diagnostic status, age, sex, and non-verbal cognitive ability and severity of language impairment), nor those regarding of the treatment components and implementation of the language interventions (intervention content, setting, delivery agent, session structure of the intervention or total number of sessions) reached significance. The same occurred to indicators of study quality. The risk of bias assessment showed that reporting quality for the studies examined in the review was poor.

Authors’ Conclusions

In sum, the current evidence base is promising but inconclusive. Pre-registration and replication of more robust and adequately powered trials, which include a wider range of diagnostic conditions, together with more long-term follow-up comparisons, are needed to drive evidence-based practice and policy.

The use of augmentative and alternative communication by children with developmental disability in the classroom: a case study

PURPOSE

Augmentative and alternative communication (AAC) systems are often introduced to children with disabilities who demonstrate complex communication needs. As attending school is an essential part of these children's lives, it is important that they use their AAC system to communicate in the classroom. This study aimed to describe the nature of the use of AAC by students with developmental disabilities in the classroom.

MATERIALS AND METHOD

This study was conducted in Malaysia. Six students were observed twice each in their classroom and their classroom interactions were video recorded. The video recordings were transcribed and coded for the presence of a communication event, the student's mode of communication and communication function, the communication partner involved, and access to the AAC system.

RESULTS

Contrary to past studies, most students in this study spontaneously initiated interaction almost as many times as they responded. They primarily communicated with gestures and verbalizations/vocalizations despite having been introduced to an AAC system. When students communicated using their AAC system, they mainly interacted with the teachers, and for the function of either behavioral regulation or joint attention. It was found that for 39% of communicative events, the student's aided AAC system was not within arm's reach.

CONCLUSION

The findings highlight the need for efforts to encourage students with complex communication needs to use AAC more frequently in their classroom to be able to communicate more effectively and for a wider range of communicative functions. Speech-language pathologists can work closely with teachers to provide the necessary support to these students.

Identifying Implementation Strategies to Increase Augmentative and Alternative Communication Adoption in Early Childhood Classrooms: A Qualitative Study

PURPOSE

The goal of this study was to identify promising implementation strategies that may increase teachers' and speech-language pathologists' (SLPs) adoption of augmentative and alternative communication (AAC) during routine classroom activities.

METHOD

A grounded theory approach was used to collect and code online, semistructured interviews with six special education teachers and 14 SLPs who taught children aged 3-8 years who used AAC in inclusive and self-contained special education classrooms. Interviews were transcribed and coded verbatim using the constant comparative method. During a member checking process, six participants (n = 30%) confirmed their transcripts and commented on emerging themes.

RESULTS

Participants shared a range of implementation strategies to increase AAC use during typical classroom activities, which were organized into seven themes: distribute modern AAC equipment, provide foundational training, share video examples, develop a systematic plan for adoption, deliver practice-based coaching, alter personnel obligations to provide protected time, and connect with professionals. A preliminary thematic map was created to link implementation barriers, strategies, and potential outcomes.

CONCLUSIONS

AAC interventions effective in clinical research can be difficult to translate into routine practice unless investigators directly explore the needs of and demands on educational professionals. Future research should define implementation strategies clearly, solicit feedback from school-personnel, and match implementation strategies to the needs of local schools to support the uptake of AAC interventions in routine classroom settings.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23699757.

Promising Strategies for Teaching Augmentative and Alternative Communication in Inclusive Educational Settings: A Systematic Review

PURPOSE

The purpose of this article was to conduct a systematic review of the literature on teaching or increasing the use of augmentative and alternative communication (AAC) by students with significant intellectual disabilities and complex communication needs (CCNs) within inclusive school settings.

METHOD

A systematic review of research literature from 1998 to 2022 was completed using multiple electronic databases, as well as citation chaining and cited author reference searches. Three hundred two articles were located with 17 meeting criteria for inclusion in this systematic review. Articles were initially screened by one author for potential inclusion; the remaining 83 were coded by one author and reviewed for consensus by three authors for inclusion in this review. Articles were analyzed and rated regarding both level of research design and quality of methodology.

RESULTS

All studies reported positive outcomes, with students with significant intellectual disabilities and CCN, of AAC intervention implemented in an inclusive setting. Fourteen over 17 studies were single-case designs with an average rating of 76% on the Single-Case Experimental Design measure of methodological quality. Less than half of the studies assessed generalization of subject learning. Review of interventions used in the studies, however, revealed the majority of studies utilized packages of interventions, making it difficult to determine the effectiveness of individual approaches.

CONCLUSIONS

This systematic review indicates there are promising interventions within inclusive settings for improved use of AAC by students with significant intellectual disabilities and CCN. Further research is needed, however, to obtain more data on generalization of student gains as well as to determine which specific interventions might be the most successful for this population of students in inclusive settings.

Building Family Capacity: supporting multiple family members to implement aided Language modeling

Family-centered capacity-building practices have been shown to benefit children and families. However, limited research explores these practices for children who use augmentative and alternative communication. This study explored an intervention to teach family members to implement an Aided Language Modeling (ALM) strategy across natural activities at home. A single case multiple probe design was used to evaluate the intervention with five family members and a girl with autism. Results showed the intervention increased family members' percentage of high-fidelity ALM strategy use and rate of ALM. Descriptively, a modest increase was also observed in the proportion of the child's communication using the speech-generating device. Social validity interviews suggested the goals, procedures, and outcomes were socially valid and supported family capacity building.

Systematic Review of Variables Related to Instruction in Augmentative and Alternative Communication Implementation: Group and Single-Case Design

PURPOSE

This article provides a systematic review and analysis of group and single-case studies addressing augmentative and alternative communication (AAC) intervention with school-aged persons having autism spectrum disorder (ASD) and/or intellectual/developmental disabilities resulting in complex communication needs (CCNs). Specifically, we examined participant characteristics in group-design studies reporting AAC intervention outcomes and how these compared to those reported in single-case experimental designs (SCEDs). In addition, we compared the status of intervention features reported in group and SCED studies with respect to instructional strategies utilized.

PARTICIPANTS

Participants included school-aged individuals with CCNs who also experienced ASD or ASD with an intellectual delay who utilized aided or unaided AAC.

METHOD

A systematic review using descriptive statistics and effect sizes was implemented.

RESULTS

Findings revealed that participant features such as race, ethnicity, and home language continue to be underreported in both SCED and group-design studies. Participants in SCED investigations more frequently used multiple communication modes when compared to participants in group studies. The status of pivotal skills such as imitation was sparsely reported in both types of studies. With respect to instructional features, group-design studies were more apt to utilize clinical rather than educational or home settings when compared with SCED studies. In addition, SCED studies were more apt to utilize instructional methods that closely adhered to instructional features more typically characterized as being associated with behavioral approaches.

CONCLUSION

The authors discuss future research needs, practice implications, and a more detailed specification of treatment intensity parameters for future research.

The effect of aided language stimulation on the acquisition of receptive vocabulary in children with complex communication needs and severe intellectual disability: a comparison of two dosages

Aided language stimulation is an augmented input strategy that facilitates the expressive and receptive language skills of persons who require augmentative and alternative communication (AAC). The aim of this study was to determine and compare the acquisition of receptive vocabulary items during implementation of aided language stimulation with dosages of 40% and 70%, respectively. An adapted alternating treatment design was replicated across six participants with complex communication needs and severe intellectual disability. All participants demonstrated receptive vocabulary acquisition when aided language stimulation was provided with a dosage of 70%, and two participants demonstrated acquisition when a dosage of 40% was provided. Receptive vocabulary acquisition was maintained following a 6-day withdrawal period. The dosage of augmented input may impact receptive vocabulary acquisition for children with complex communication needs and severe intellectual disability, with higher dosages being more effective for some participants. The findings indicate that clinicians should be aware that dosage is an important consideration when providing aided language stimulation to facilitate receptive vocabulary acquisition in children with complex communication needs and severe intellectual disability.

Siblings Supporting the Social Interactions of Children Who Use Augmentative and Alternative Communication

PURPOSE

The purpose of this study was to examine the effectiveness of a training and coaching program aimed to increase the use of the aided language modeling (ALM) strategy by siblings to support the social interactions of children with disabilities who use augmentative and alternative communication (AAC) in the natural environment.

METHOD

A single-case, multiple-probe design that included a training and coaching intervention was implemented to teach four typically developing siblings to use the ALM strategy with high fidelity with their sibling who used AAC. In addition, a second research question investigated the rate at which siblings used the ALM strategy with the child.

RESULTS

Results revealed that the sibling training and coaching was (a) effective in increasing high fidelity of the siblings' implementation of the ALM strategy and (b) participants and family members found the intervention to be impactful and meaningful.

CONCLUSIONS

The changes observed throughout this study demonstrate the need for more sibling- and family-centered training to increase the use of AAC in the natural environment. Families were satisfied with the goals, procedures, and outcomes; however, they also expressed their need for additional support.

Demands Associated With an Augmentative and Alternative Communication System in Relation to Alternative Forms of Access for Individuals With Motor Impairments

PURPOSE

Successful adoption and use of aided augmentative and alternative communication (AAC) must address how to promote fluid, efficient, and organized execution of the motor behavior needed to access the AAC system. A substantial number of people who use AAC have significant motor impairments and require "alternative" access options, such as eye gaze or switch use. Such individuals may be particularly vulnerable to interference from a poorly designed system. However, the inherent demands of alternative access methods have received little direct study. The goal of this tutorial is to offer a clinically and theoretically guided framework for considerations concerning AAC access, with the hope of spurring further discussion and empirical research.

METHOD

A framework that draws upon dynamic systems theory was used to illustrate the interactions between the various elements of importance to AAC access. Information and research from the fields of motor learning, developmental dynamic systems theory, AAC, and assistive technology was integrated into this tutorial to examine their applications for alternative AAC access methods.

RESULTS

The framework illustrated that AAC access involves a complex coordination between individual skills, the demands of the communication environment, the activity being undertaken, and the supports and demands inherent in the AAC system itself.

CONCLUSIONS

Awareness of the many demands that alternative forms of access place on the person who uses them can guide clinicians during assessment and intervention decision making regarding access options for individuals with significant motor impairments. Specific directions for future research are considered.

The Effects of Symbol Format and Psycholinguistic Features on Receptive Syntax Outcomes of Children Without Disability

PURPOSE

The graphic symbol is the foundation of augmentative and alternative communication (AAC) for many preliterate individuals; however, research has focused primarily on static graphic symbol sequences despite mainstream commercial technologies such as animation. The goal of this study was to compare static and animated symbol sequences across receptive communication outcome measures and psycholinguistic features (e.g., word frequency).

METHOD

A counterbalanced, 2 × 2 × 2 mixed design was used to investigate the effects of symbol format (animated and static), first condition (animated or static), and first experimental task (identification or labeling) on identification accuracy and labeling accuracy of graphic symbol sequences (five symbols) in 24 children with typical development ages 7 and 8 years old. Additionally, three 2 × 2 repeated-measures analyses of variance were conducted using symbol format (animated and static) and (a) word frequency (low, high), (b) imageability (low, high), and (c) concreteness (low, high).

RESULTS

In addition to superior identification and labeling accuracy of animated sequences, a significant interaction between symbol format and the first condition was observed for both experimental tasks. When the animation format was the first condition, then the children's performance improved in the subsequent static condition. Finally, word frequency, imageability, and concreteness ratings for all verbs and prepositions had significant effects on labeling accuracy of verbs and prepositions. Significant interactions between symbol format and psycholinguistic features were also found. For example, highly imageable, animated verbs were labeled with greater accuracy when compared with all other variables.

CONCLUSIONS

Animation technology appears to alleviate some of the burden associated with word- and sentence-level outcomes in children with typical development. Moreover, animation appears to reduce the effects of psycholinguistic features such as word frequency and imageability by increasing the transparency of the symbol. Given the increase in research in this area, speech-language pathologists may consider adopting animated graphic symbols on a case-by-case basis as a tool to augment the learning of word classes in which movement is integral to comprehension.

Examining the influencing factors and the functioning mechanism of online learning supporting learners’ empowerment

The construction of an effective technology-based environment to promote learning and enable online learning to truly empower learners has become an increasingly important issue of concern. To some extent, an in-depth analysis of the key influencing factors and their functioning mechanism of online learning supporting learners’ empowerment may pave a new way for the understanding of this issue. In view of this, this study, grounded on the reciprocal determinism theory, explored the influencing paths among environment elements, online behaviors, person factors, and learners’ empowerment by using structural equation modeling (SEM) approach, and examined the structure effect relationships among these dimensions. A total of 396 Chinese university students reported on their perceptions of environment elements, online behaviors, person factors, and learners’ empowerment through the questionnaire survey. The results showed that there was a strong correlation between the three dimensions of the reciprocal determinism theory, and the three dimensions all exerted a positive effect on learners’ empowerment. Among them, the item parameter estimates revealed that online environment, online interaction, and online cooperation were significant in explaining the influence of environment elements and online behaviors on learners’ empowerment. Based on the empirical results, this study provided some implications and suggestions for the rationality of the structure devising of online learning environment, the effectiveness of online teacher-student interaction, and the development of students’ learning autonomy in technology-based learning. Thus, this study helped understand the specific contribution of external and internal factors to learners’ empowerment of using technology for online learning and would inform the construction of the optimized online learning environments and teacher-student relationships to enhance students’ sense of online presence and learning initiative.

Technology assisted language intervention (TALI) for children who are deaf/hard of hearing: promising impact on pragmatic skills

Children who are deaf and hard of hearing (DHH) often demonstrate pragmatic language difficulties which can impact academic and social outcomes. This randomized control trial for DHH children, ages 3-12 years, explored the Technology-Assisted Language Intervention (TALI), incorporating augmentative and alternative communication technology (AAC) into traditional speech/language therapy, compared to treatment-as-usual (TAU) to determine impact on pragmatics. Pragmatic outcome measures included parent reported Pragmatics Profile of the CELF-5 (for children age ≥5 years) and CELF-P Descriptive Pragmatics Profile (for children <5 years) in addition to parent reported Social and Communication domains of the Vineland Adaptive Behavior Scales,Third Edition (VABS). Over 24 weeks, children ≥5 years in the TALI made significantly more progress (increase in raw scores) on the Pragmatics Profile compared to children in TAU (12.7 points vs. -6.0 points; p = 0.04) and also showed significant gains on two of the three subscales. For children ≥5 years, no significant VABS changes were seen in either intervention group. For children <5 years, there were no statistically significant differences in growth on the CELF-P total pragmatics raw score or on any subdomain. However, children in TALI had significant increases in the mean VABS Communication (86.7-99.1) and Social domain standard scores (91.8-97.4;p = 0.01), while gains for children in TAU on the Communication and Social domain standard scores were not statistically significant. These promising results support the need for additional research exploring the effectiveness of AAC supported speech/language therapy to enhance DHH children's pragmatic language skills.

Trial registration

ClinicalTrials.gov identifier: NCT02998164.

Participant characteristics predicting communication outcomes in AAC implementation for individuals with ASD and IDD: a systematic review and meta-analysis

This meta-analysis examined communication outcomes in single-case design studies of augmentative and alternative communication (AAC) interventions and their relationship to participant characteristics. Variables addressed included chronological age, pre-intervention communication mode, productive repertoire, and pre-intervention imitation skills. Investigators identified 114 single-case design studies that implemented AAC interventions with school-aged individuals with autism spectrum disorder and/or intellectual disability. Two complementary effect size indices, Tau(AB) and the log response ratio, were applied to synthesize findings. Both indices showed positive effects on average, but also exhibited a high degree of heterogeneity. Moderator analyses detected few differences in effectiveness when comparing across diagnoses, age, the number and type of communication modes, participant's productive repertoires, and imitation skills to intervention. A PRISMA-compliant abstract is available: https://bit.ly/30BzbLv.

A trained communication partner’s use of responsive strategies in aided communication with three adults with Rett syndrome: A case report

Purpose

To explore and describe a trained communication partner’s use of responsive strategies in dyadic interaction with adults with Rett syndrome.

Introduction

Responsive partner strategies facilitate social, communicative, and linguistic development. The common feature is that the communication partner responds contingently to the other’s focus of attention and interprets their acts as communicative. Research on responsive partner strategies that involves individuals with significant communication and motor disabilities remains sparse. The same applies to if, and how, the use of communication aids impacts on the partner’s use of responsive strategies.

Materials and methods

A therapist, trained in responsive partner strategies and aided communication interacted during 14 sessions with each of three participants. The participants were adults with Rett syndrome. A gaze-controlled device and responsive strategies were used during all sessions. The Responsive Augmentative and Alternative Communication Style scale (RAACS) was used to assess the partner’s responsiveness. RAACS consists of 11 items including ratings of to what extent the partner is being attentive to, confirms, and expands the individual’s communication. During eight of the 14 sessions, aided AAC Modelling was also used, i.e., the communication partner pointed at symbols on the gaze-controlled device while interacting. In addition to RAACS, each time the communication partner confirmed or expanded on communication when (a) the participants used the gaze-controlled device and (b) the participants did not use the gaze-controlled device was counted. Descriptive statistics were used to present the results. Non-parametric tests were used to compare means between the two conditions and between participants.

Results

Inter-rater agreement for the different RAACS items ranged from 0.73 to 0.96 and was thus found to be fair to excellent. The communication partner’s use of responsive strategies varied when communicating with different participants and the scores were higher when aided AAC modeling was used. The communication partner’s number of responses and use of responsive strategies were higher when the participants communicated through a gaze-controlled device.

Conclusion

The communication partner’s use of responsive and scaffolding strategies is not a fixed construct but varies in interactions with different non-speaking persons. The same is true whether the non-speaking person uses a gaze-controlled device with digitized speech or not.

Design of an Intervention and Education System for Children with Emotional Disorders Based on Semantic Analysis

In this paper, a semantic analysis approach to children's emotional disorder intervention and education is thoroughly analyzed and discussed, and a corresponding educational system is designed for application in real life. This paper acquires video data by deploying a common camera acquisition and transforms, annotates, frames, and processes the data with the help of feature engineering methods. In addition, this paper proposes a fine-grained action decomposition strategy to solve the problem of extreme imbalance in the dataset to improve the performance of the model and proposes an iterative sampling data fusion strategy, which aims to integrate and fuse data from multiple sources to make them more effective and further improve the robustness and generalization ability of the model. Since it is difficult for families to improve the emotional management skills of migrant children, and it is also difficult to obtain professional help and support from the community or schools, it is important to take advantage of the professional strengths of social work to provide professional support for migrant children and their families. From the perspective of theoretical research, most of the existing studies focus on individual migrant children and cannot give global guidance from the perspective of the family system. The comparison results show that T-SVR trained using data from all subjects outperforms the inductive method based on individual training of trainees, validating the effectiveness of the proposed adaptive emotion recognition model. Therefore, from the perspective of system integration, it is important to explore social work interventions to improve the emotional management skills of migrant children. The system network structure design is determined according to the actual situation; then from the system requirements, the system is abstracted with the help of UML entity-relationship diagram, and the database table design is completed; so far, the overall system can be divided into independent functional modules, and the boundaries of each module and the participating roles are gradually clarified, and the detailed design within each functional module is illustrated by UML timing diagram and class diagram to clarify the classes used. Finally, the system is tested end-to-end to verify whether the results of the view layer meet the design guidelines, whether the system modules work together properly, and whether the functional development meets the requirements.

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.

Augmentative and Alternative Communication in the Classroom: Teacher Practices and Experiences

PURPOSE

This study explored the practices and experiences of teachers who teach students using augmentative and alternative communication (AAC), more specifically, speech-generating devices (SGDs).

METHOD

Nine teachers (one general education, eight special education) from four countries participated in semistructured interviews. A generic qualitative approach was taken to inductively code interview transcripts and establish descriptive themes.

RESULTS

Three themes emerged from the data. The teaching experience theme captured teachers' feelings, role, collaboration with others, knowledge and learning around AAC, and challenges teaching students who use SGDs. The teaching practices theme included curricula that teachers use, instructional planning, materials and adaptations, instructional strategies, and methods for student evaluation and progress monitoring. Finally, the overarching views and practices theme captured teachers' beliefs and interpretation of the educational system for students using SGDs, as well as teachers' overarching views on communication and approach to AAC implementation.

CONCLUSIONS

In sharing their perspectives and practices, teachers highlighted a number of constructs that speech-language pathologists could consider when responding to and supporting teacher and student needs. The findings of this study have implications for facilitating collaborative relationships and supporting the use of AAC in schools. Discussion on how educational placement can influence teacher experiences and student outcomes is also integrated into the context of this study.

Teaching Parents Read, Ask, Answer, Prompt Strategies via Telepractice: Effects on Parent Strategy Use and Child Communication

PURPOSE

This study aimed to explore the feasibility of a telepractice communication partner intervention for children who use augmentative and alternative communication (AAC) and their parents.

METHOD

Five children (aged 3;4-12;9 [years;months]) with severe expressive communication impairments who use AAC and their parents enrolled in a randomized, multiple-probe design across participants. A speech-language pathologist taught parents to use a least-to-most prompting procedure, Read, Ask, Answer, Prompt (RAAP), during book reading with their children. Parent instruction was provided through telepractice during an initial 60-min workshop and five advanced practice sessions (M = 28.41 min). The primary outcome was parents' correct use of RAAP, measured by the percentage of turns parents applied the strategies correctly. Child communication turns were a secondary, exploratory outcome.

RESULTS

There was a functional relation (intervention effect) between the RAAP instruction and parents' correct use of RAAP. All parents showed a large, immediate increase in the level of RAAP use with a stable, accelerating (therapeutic) trend to criterion after the intervention was applied. Increases in child communication turns were inconsistent. One child increased his communication turns. Four children demonstrated noneffects; their intervention responses overlapped with their baseline performance.

CONCLUSIONS

Telepractice RAAP strategy instruction is a promising service delivery for communication partner training and AAC interventions. Future research should examine alternate observation and data collection and ways to limit communication partner instruction barriers.

Speech, Language, and Communication Deficits and Intervention in a Single Case of Pediatric Autoimmune Encephalitis

Purpose The current literature on pediatric autoimmune encephalitis (AE) focuses on medical identification/diagnosis and medical treatments. Data about the identification and treatment of communication disorders in these children are limited. This clinical focus article provides an example of the speech, language, and communication characteristics, intervention, and recovery of a single child with medical diagnoses of pediatric AE and pediatric acute-onset neuropsychiatric syndrome (PANS) and special education eligibility under the autism spectrum disorder category. Method This is an in-depth illustrative/descriptive case study. Medical, educational, and speech-language documentation of one child diagnosed with AE at age 7 years was reviewed. Methods included interviews with family members, teachers, and the school speech-language pathologist and reviews of documentation including evaluations, reports, and Individualized Education Programs. Results This child received special education and therapy services through his public school and a university speech-language clinic. He concurrently received medical treatment for AE and PANS. Comprehensive augmentative and alternative communication (AAC) intervention included the use of core words, modeling, parallel talk, self-talk, expansive recasts, shared book reading, family counseling, and collaboration with the parents and the school speech-language pathologist. The child made progress on all goals despite irregular attendance to therapy due to medical complications. Discussion Because experimental research including this population is currently limited, this descriptive case study provides valuable information to clinicians, educators, pediatricians, medical diagnosticians, and anyone providing services to a child with a complex neuropsychological disorder like AE. Future research is needed with more children who have AE, especially experimental investigations of the intervention methods utilized here. Additional research of more children with AE can provide information about the scope and severity of speech, language, and communication needs and the trajectory of recovery given AAC intervention.

An Initial Investigation Into the Feasibility of the Communication Matrix Professional Development Program for Educational Professionals Working With Students With Complex Communication Needs

Purpose The goal of this study was to investigate the initial feasibility of the Communication Matrix Professional Development Program (CMPDP), an online program created to help educational professionals teaching students with complex communication needs. Method A one-group pretest-posttest design was employed with 102 educational professionals and their students with complex communication needs. Students (M age = 12.5 years, SD = 4.8 years) had severe expressive communication impairments characterized by an expressive vocabulary of < 10 words. The online CMPDP included webinars, coursework, and engagement with an online community of practice. We examined the students' expressive communication skills measured by the Communication Matrix Assessment and Individualized Education Program (IEP) goal quality measured by the Design to Learn IEP Goal Development Guide before and after their teachers and speech-language pathologists participated in the intervention. Results Students showed small but significant increases on the Communication Matrix Assessment. The average increase in scores was 10.6, z = 5.37, 95% confidence interval (CI; [6.65, 14.54]), Glass's delta = 0.37. The mean gain in scores for IEP quality was not significant (0.82, z = 2.43, 95% CI [0.14, 1.49], Glass's delta = 0.28). Conclusions Results demonstrate the initial feasibility of the CMPDP for educational professionals and their students with complex communication needs. Findings must be interpreted cautiously as the study design has methodological limitations including lack of a control condition and a potential for correlated measurement error and demand characteristics. Supplemental Material https://doi.org/10.23641/asha.16734553.

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.

Encouraging Emotional Conversations in Children With Complex Communication Needs: An Observational Case Study

Children with complex communication needs (CCN) regularly have barriers to express and discuss emotions, and have fewer opportunities to participate in emotional conversations. The study explores and analyzes the changes after a training program focused on offering an interactive home learning environment that encouraged and modeled emotion-related conversations between a parent and a child with CCN within storybook-reading contexts. An observational design (nomothetic/follow-up/multidimensional) was used to explore and analyze the changes in the communicative interaction around emotions between mother-child. Augmentative and alternative communication (AAC) technologies were used to provide the child access to emotion-related vocabulary. The training program resulted in the mother providing more opportunities to engage her child in emotional conversations, suggesting that when opportunities and resources to talk about emotions were promoted, the child showed more engagement in emotion-related conversations using his AAC system. The mother-child communicative patterns and behavioral relationships observed during the phases are also presented. This case study illustrates the importance of a primary communication partners' role in facilitating emotional conversations, and the promising efficacy of a training program implemented in a storybook interactive learning environment to promote conversations about emotion-related events while encouraging children with CCN to learn, explore, express, and discuss emotions.

Alignment of Supplementary Aids and Services With Student Needs and Placement

Trends in the supplementary aids and services (SAS) written in individualized education programs (IEPs) for students with significant disabilities (a) in different educational placements, (b) with and without behavior support plans (BSP), and (c) with and without complex communication needs (CCN) are examined using multivariate analysis of variance. Results show no significant differences in SAS for students across separate, resource, and inclusive placements. Students with BSPs had significantly more collaborative and behavior SAS than those without BSPs. Students with CCN had significantly more social-communication SAS than those whose IEPs indicated little to no communication support needs; however, 51.1% of students with CCN had no social-communication SAS. Findings raise concern around the extent to which SAS are considered before placement decisions, the high frequency of paraprofessional support for students with BSPs, and the low frequency of social-communication SAS written for students with CCN. Implications for policy, practice, and future research are provided.

Effectiveness and Utility of Visual Scene Displays as Communication Supports for Adults and Children With Complex Communication Needs: Perspectives of Clinicians and Researchers

Purpose The aims of this research study were to describe the perspectives of clinicians and researchers regarding the effectiveness of visual scene displays (VSDs) as communication supports in order to inform the translation of research to clinical practice. Method An online survey was completed by 298 clinicians and nine VSD researchers. Participants rated the effectiveness of VSDs in supporting a variety of communication functions and their strength of agreement regarding statements of VSD utility. Results Regardless of population served, clinicians and researchers rated VSDs as effective at supporting a range of communication functions. Participants also tended to agree with statements of VSD utility. Conclusions The current study highlights the perceptions of clinicians and researchers regarding the uses and benefits of VSDs for adults and children with complex communication needs and provides an initial measure of the current translation of research to clinical practice. Results indicate that VSDs can be used to support a variety of communication functions and utilities; however, further work is necessary to explore additional communication functions and delineate similarities and differences of VSD uses for differing populations. Supplemental Material https://doi.org/10.23641/asha.14551344.

The Effects of Telepractice to Support Family Members in Modeling a Speech-Generating Device in the Home

Purpose Family members are an integral support for children with complex communication needs (CCN). However, there is limited research exploring "whole family" intervention to support children with CCN, including evidence-based approaches such as aided language modeling and innovative delivery options such as telepractice. The purpose of this study was to explore whether the use of telepractice-based training and coaching is a valid means of delivering intervention to the whole family unit to implement aided language modeling. Method A 4-year-old child with CCN who uses a speech-generating device and her four family members participated in the study. A single-case multiple-probe design across the four dyads was used to determine the effect of the memory aid, namely, Prepare, Show, Wait, and Respond, via telepractice intervention to teach family members to provide aided language modeling with fidelity during natural routines. Results We found that telepractice-based training and coaching increased family members' high-fidelity models and rate of modeling. The target child also showed an increase in independent communication and rate of augmentative and alternative communication use. Social validity interviews indicated that the participants found the intervention to be socially valid. Conclusions Given the findings of this study, speech-language pathologists should encourage the involvement of the whole family in augmentative and alternative communication interventions. Future research should examine the impact of training and coaching all family members together in their natural environment, explore specific adaptations for participants, and investigate the effects of intervention delivered by speech-language pathologists who work directly with families and utilize family-centered practices.

A Survey of American Speech-Language Pathologists' Perspectives on Augmentative and Alternative Communication Assessment and Intervention Across Language Domains

Purpose The aim of the study was to collect information about American speech-language pathologists' preprofessional training, practice, self-perceived competence, adequacy of resources, and interest in continuing education related to augmentative and alternative communication (AAC) assessment and intervention strategies addressing each of the five language domains: semantics, pragmatics, phonology, morphology, and syntax. Method An anonymous online survey of American speech-language pathologists was conducted. Results A majority of participants rated their preprofessional training for assessing semantic and pragmatic skills positively. Otherwise, a majority of participants rated preprofessional training for assessment and intervention negatively across language domains. High interest in continuing education opportunities addressing assessment and intervention was found across language domains. A discrepancy between responses to questions addressing semantic and pragmatic skills and responses to questions addressing phonological, morphological, and syntactic skills was consistently found for ratings of preprofessional training, practice, perceived competence, and adequacy of resources. In all cases, higher frequencies of positive ratings were found for questions addressing semantic and pragmatic skills. Conclusions Improved preprofessional training and continuing education opportunities are needed to support AAC assessment and intervention across language domains. Perspectives and practice patterns reflect a historical emphasis on semantic and pragmatic skills in the external evidence base, even though there are several recent journal articles addressing morphology and syntax in clients who use AAC.

Improving Facilitation of Student Communication Through Observational Feedback Within a Partner Instruction Model

Purpose The purpose of this study was to further evaluate an eight-step partner instructional model developed by Kent-Walsh and McNaughton that has been demonstrated to improve implementation quality and fidelity among adults in clinical and educational settings who support the use of augmentative and alternative communication (AAC) for individuals with complex communication needs. Method This study examined the effectiveness of the eight-step model in a K-12 special education setting. Participants included 26 staff and 19 students. Effects on both communication partner modeling and student AAC system use were assessed. The study expanded upon prior research by employing a group design, including largely adolescent participants, and utilizing multiple AAC hardware and software types. Results Staff receiving training and coaching via the full eight-step model demonstrated gains in the percentage of utterances modeled, and their student partners increased mean length of utterance. The study failed to find statistically significant differences between the experimental group and a comparison group receiving only Stages 1-5 of the model. Conclusion Findings provide additional evidence for the viability of the eight-step instructional model as a methodology to promote the communication skills of students who utilize AAC, and also point to the advanced practice and feedback element of the model as a potential mediator of intervention outcomes.

Augmentative and Alternative Communication for Children with Intellectual and Developmental Disability: A Mega-Review of the Literature

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.

The Early Development of Emotional Competence Profile: A Means to Share Information About Emotional Status and Expression by Children With Complex Communication Needs

Purpose This clinical focus article introduces a summary profile template, called the Early Development of Emotional Competence Profile (EDEC-P). This profile distills information from a longer interview tool that solicits a detailed case history (the EDEC), but in a format that is readily accessible for communication partners of children with complex communication needs, including parents, educators, and other professionals. Method In this clinical focus article, we will (a) introduce the EDEC-P structure, (b) illustrate via case examples the types of information that can be shared, and (c) offer preliminary feedback from parents and other professionals on its usefulness. We will review literature that supports the importance of scaffolding communication about emotions by specialists who work with children with complex communication needs and by parents and other communication partners. Results An EDEC-P was generated for two participants as an illustration of the process. Feedback was solicited from these children's parents and other communication partners. The feedback demonstrated that the EDEC-P was viewed as a positive tool and identified some of the ways that it might be used. Conclusions The EDEC-P may be useful for professionals who are interested in approaching communication about emotions in children with complex communication needs. Guidelines are proposed to present and discuss the results from the interview to support the decision-making process in the clinical practice and next steps in research. Supplemental Material https://doi.org/10.23641/asha.14219777.

Caregivers', teachers', and assistants' use and learning of partner strategies in communication using high-tech speech-generating devices with children with severe cerebral palsy

Communication with speech generating devices (SGDs) with children with severe physical, communicative and cognitive impairments, such as children with cerebral palsy (CP), can be difficult. Use of partner strategies facilitates the communication and instructional approaches such as feedback and role play facilitate communication partners' learning in how to use partner strategies. To describe communication partners' use and learning about partner strategies in SGD-mediated communication with children with severe CP. Questionnaires (n = 65) were sent to caregivers (n = 30), teachers (n = 17), and teaching or personal assistants (n = 18) of children with severe CP. Response rate was 80%. To ask open-ended questions was the most frequently used partner strategy and aided augmented input the least frequently used partner strategy. Most commonly, participants learned partner strategies from speech and language pathologists (SLPs) who used verbal instructions when teaching partner strategies but seldom or never feedback, role play or video examples. Communication partners' learning about partner strategies in SGD-mediated communication is inadequate and needs to be improved. SLPs, who are the main prescribers of SGDs and responsible for training and support in using them, should consider using instructional approaches when teaching communication partners about partner strategies in communication with an SGD.

Personalized Early AAC Intervention to Build Language and Literacy Skills: A Case Study of a 3-Year-Old with Complex Communication Needs

Personalized AAC intervention refers to an approach in which intervention is tailored to the individual's needs and skills, the needs and priorities of the individual's family and other social environments, the evidence base, and the individual's response to intervention. This approach is especially relevant to AAC intervention for young children with complex communication needs given their unique constellations of strengths and challenges, and the qualitative and quantitative changes that they experience over time as they develop, as well as the diversity of their families, schools, and communities. This paper provides detailed documentation of personalized AAC intervention over a six-month period for a 3-year-old girl with developmental delay and complex communication needs. The paper describes (1) personalization of multimodal AAC supports to provide this child with the tools to communicate; (2) personalized intervention to build semantic and morphosyntactic skills; and, (3) personalized instruction in literacy skills (i.e., letter-sound correspondences, sound blending, decoding, sight word recognition, reading simple stories, reading comprehension, and encoding skills). Specific goals, instructional materials, and procedures are described; data on speech, language, and literacy outcomes are presented.

Language Development From Early Childhood to Adolescence in Youths With Fragile X Syndrome

Purpose The aim of this study was to investigate language growth in individuals with fragile X syndrome (FXS) from early childhood to adolescence and the influence of maternal responsivity on language growth. Method We conducted a longitudinal analysis of language development in 55 youths (44 males, 11 females) with FXS. Data collection spanned the ages of 11-216 months. We measured expressive and receptive vocabulary with standardized tests. The number of different words and mean length of utterance were obtained from language sample analyses of mother-child interactions. We also measured maternal comments (responsivity indicator) produced during the language samples and child nonverbal IQ. Results Growth models indicated that rates of number of different words and receptive vocabulary were related to maternal commenting. Mean length of utterance did not change significantly over time. Expressive vocabulary measured with a standardized test grew, but the growth was not related to maternal commenting. Nonverbal IQ was related to all language outcomes at age of 10 years and to changes over time in vocabulary. Visual analysis indicated that the highest scores on standardized tests were produced by girls; however, measures derived from language sample analyses appeared similar for boys and girls. Language models for boys only were similar to the total sample models with lower scores at age of 10 years for some outcomes. Conclusion Results of persistent language impairments for most youths with FXS suggest the need for continued, focused interventions aimed at improved language productions in addition to a responsive environment. Supplemental Material https://doi.org/10.23641/asha.13022825.

Longitudinal Development of Receptive Vocabulary in Children with Cerebral Palsy and Anarthria: Use of the MacArthur-Bates CDI

OBJECTIVE

To examine receptive language growth in children with cerebral palsy (CP) and anarthria using a parent-reported measure of vocabulary.

METHOD

Scores from 47 children (29 males) with CP and anarthria were obtained from the vocabulary checklists on the MacArthur-Bates Communication Development Inventories (MCDI) and analyzed to examine the distribution of receptive language growth. Linear trajectories of word composite scores were created using a linear-mixed model, incorporating between two and ten data points per child.

RESULTS

Three different growth trajectories emerged: approximately 23% grew by 100 or more words per year, 13% grew by 50-100 words per year, and 64% grew by 50 words per year or less. Age-four vocabulary was strongly correlated with rate of increase in vocabulary.

CONCLUSION

Receptive vocabulary scores from the MCDI are increasing at a reduced pace for most children with CP and anarthria. More sensitive measures of language assessment are necessary to gain a complete picture of their language ability levels.

Instruction Using Augmentative and Alternative Communication Supports: Description of Current Practices by Speech-Language Pathologists Who Work With Children With Autism Spectrum Disorder

Purpose The aim of this research study was to examine common practices of speech-language pathologists (SLPs) who work with children with autism spectrum disorder (ASD) with respect to whether or not SLPs consider processing differences in ASD or the effects of input during their instruction. Method Following a qualitative research method, how SLPs instruct and present augmentative and alternative communication systems to individuals with ASD, their rationale for method selection, and their perception of the efficacy of selected interventions were probed. Semistructured interviews were conducted as part of an in-depth case report with content analysis. Results Based on completed interviews, 4 primary themes were identified: (a) instructional method, (b) input provided, (c) decision-making process, and (d) perceived efficacy of treatment. Additionally, one secondary theme, training and education received, was identified. Conclusions Clinicians reported making decisions based on the needs of the child; however, they also reported making decisions based on the diagnostic category that characterized the child (i.e., ASD). The use of modeling when teaching augmentative and alternative communication to individuals with ASD emerged as a theme, but variations in the method of modeling were noted. SLPs did not report regularly considering processing differences in ASD, nor did they consider the effects of input during instruction.

A Hearing Screening Pilot Study With Students With Significant Cognitive Disabilities

Purpose

Many children with severe intellectual and developmental disabilities are at a higher risk for hearing loss than their peers who are typically developing. Unfortunately, they do not consistently participate in routine school-based hearing screenings. The current study investigated the feasibility of increasing their participation using an otoacoustic emissions protocol and documented results relative to student educational profiles.

Method

A total of 43 students with significant cognitive disabilities enrolled at a public school exclusively serving this population participated in the study. All but 9, who were excluded because of known hearing loss, were screened by a licensed audiologist assisted by audiology doctoral students. The protocol included otoscopy, tympanometry, distortion product otoacoustic emissions (DPOAEs), and teacher surveys.

Results

DPOAE screening was attempted on 33 students without previously diagnosed hearing loss and successfully completed for 26 (78.8%). Two students (4.6%) with absent otoacoustic emissions and normal tympanograms were referred for further assessment due to concerns about possible sensorineural hearing loss in one or both ears, and 10 (23.3%) had abnormal tympanograms in one or both ears.

Conclusions

Considering the high risk of sensorineural hearing loss for children with significant disabilities, it is important for them to be included in school hearing screenings. The results of this study demonstrate the feasibility of using DPOAEs for school-based hearing screenings with this population with an interprofessional team of licensed audiologists, educators, and speech-language pathologists. The results further suggest that students with significant disabilities and hearing loss may be unidentified and underserved. Given the complex needs of this population, an interprofessional practice model for hearing screenings and intervention services is recommended.

Core vocabulary lists for young children and considerations for early language development: a narrative review

For early symbolic communicators, acquisition of an initial vocabulary is a critically important achievement that sets the stage for future language development. Children who require augmentative and alternative communication (AAC) rely on others to select and provide these important first words for them. One resource to help guide this process includes published lists of words that may contribute to a core vocabulary for individuals who require AAC. Although some clinicians report that they consider or prioritize core words during the vocabulary selection process, it is not known whether an emphasis on core words will best meet the expressive vocabulary needs of early symbolic communicators. The purposes of this narrative review were to (a) review studies that have developed word lists to inform selection of a core vocabulary for young children who require AAC, (b) compare the words on these lists to the early words used by children with typical development, and (c) consider the implications for vocabulary selection and language development for early symbolic communicators who require AAC. Results suggest that core word lists may under-emphasize many of the types of words that predominate in early expressive vocabulary; these lists may not be the most appropriate resources to guide AAC system design and instruction for early symbolic communicators.

Teaching Preschoolers With Down Syndrome Using Augmentative and Alternative Communication Modeling During Small Group Dialogic Reading

Purpose This study evaluated the effect of aided augmentative and alternative communication modeling (AAC-MOD) on the communication skills of children with Down syndrome (DS) during small group dialogic reading. Method Four children with DS between 3;1 and 5;3 (years;months; M = 4;5) and 5 typically developing peers between 3;5 and 5;9 (M = 4;3) participated. Effects were examined using a multiple probe across behaviors design with 4 children with DS. To simulate typical dialogic reading routines in inclusive classrooms, a strategy called Read, Ask, Answer, Prompt (Binger, Kent-Walsh, Ewing, & Taylor, 2010) was applied during the baseline and intervention sessions. Results A functional relation was demonstrated between (a) AAC-MOD and percentage of correctly identified symbols for 3 participants, (b) AAC-MOD and rate of symbolic communication for 2 participants, and (c) AAC-MOD and number of different words for 2 participants. Increases in number of multiple word combinations occurred for 2 participants. All 4 children maintained their percentage of correctly identified symbols. Increases in rate of symbolic communication did not generalize to thematic play contexts, a distal measure of response generalization. Conclusion AAC-MOD is an effective strategy for teaching target vocabulary and increasing rate of symbolic communication in young children with DS. Supplemental Material https://doi.org/10.23641/asha.10093538.

The Effect of Symbol Background Color on the Speed of Locating Targets by Adults Without Disabilities: Implications for Augmentative and Alternative Communication Display Design

Purpose

Previous research with children with and without disabilities has demonstrated that visual–perceptual factors can influence the speech of locating a target on an array. Adults without disabilities often facilitate the learning and use of a child's augmentative and alternative communication system. The current research examined how the presence of symbol background color influenced the speed with which adults without disabilities located target line drawings in 2 studies.

Method

Both studies used a between-subjects design. In the 1st study, 30 adults (ages 18–29 years) located targets in a 16-symbol array. In the 2nd study, 30 adults (ages 18–34 years) located targets in a 60-symbol array. There were 3 conditions in each study: symbol background color, symbol background white with a black border, and symbol background white with a color border.

Results

In the 1st study, reaction times across groups were not significantly different. In the 2nd study, participants in the symbol background color condition were significantly faster than participants in the other conditions, and participants in the symbol background white with black border were significantly slower than participants in the other conditions.

Conclusion

Communication partners may benefit from the presence of background color, especially when supporting children using displays with many symbols.