Common Questions about AAC Services in Early Intervention

Parental expectations and perceptions of augmentative and alternative communication: A Sri Lankan perspective

From a critical disability rights lens, everyone has a right to communicate using any means available, which includes augmentative and alternative communication. The uptake of augmentative and alternative communication beyond the therapy room may be influenced by awareness, perceptions and acceptance of augmentative and alternative communication by caregivers, family members and the wider society. This study aimed to uncover parental perceptions of augmentative and alternative communication in a Global South context. Ten mothers and six fathers (16 participants) of children with complex communication needs were invited to be part of the study. A focus-group discussion and semi-structured interviews were undertaken using an interview guide. The participant data were analysed using Framework Analysis and through the lens of gender and critical disability theory. The key theme expressed was fear of augmentative and alternative communication deterring speech development. In addition, there was also concern that siblings might adopt the alternative communication method and stop talking. The participants questioned whether the visibility of a communication device could highlight their child's disability, thereby fearing societal stigma and negativity. Overall, parents' attitudes towards perspectives of and openness to use augmentative and alternative communication impact its uptake. The results suggest the need to consider the preparedness of parents prior to introducing augmentative and alternative communication and the need to offer on-going parental training.Lay abstractEverybody has a right to communicate in any way they can, which includes augmentative and alternative communication. The uptake of augmentative and alternative communication in everyday life may be influenced by awareness, perceptions and acceptance of augmentative and alternative communication by caregivers, family members and the wider society. This study aimed to uncover what parents thought about augmentative and alternative communication in a Global South context. Eleven mothers and five fathers (16 participants) of children with complex communication needs were included. Data were collected using an interview guide from a focus-group discussion and semi-structured interviews. The data were analysed using Framework Analysis and from a gender and critical disability theory viewpoint. The key theme found was fear of augmentative and alternative communication stopping the child from learning to speak. The parents wondered if siblings might also use the alternative communication method and stop talking. They worried whether the communication device will negatively highlight their child in society. As parents' views on augmentative and alternative communication influence whether they use it with their child, informing and preparing parents before introducing augmentative and alternative communication to a child and on-going parent training should be considered.

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.

Teletraining to Teach Communication Partners to Support Students With Multiple Disabilities Including Cortical Visual Impairment and Emerging Symbolic Communication in Communicating Choices

PURPOSE

The purpose of the current study was to investigate the impact of a teletraining to teach adult communication partners the "Communicating Choices-Cortical Visual Impairment (CVI)" strategy to support participation for students with multiple disabilities.

METHOD

A nonconcurrent, multiple-probe, across-participants design was implemented with four adult communication partner (i.e., speech-language pathologist, paraeducators, and parent) and student dyads to determine the effects of a teletraining administered over a video-calling platform on the partner's implementation of the substeps from the Communicating Choice-CVI strategy. Dyads completed a randomly predetermined number of baseline sessions, two teletraining sessions to instruct the partners in the strategy, and five intervention probes.

RESULTS

Results of the study indicated that communication partners successfully implemented an increased number of the strategy substeps following two short teletraining sessions and that all students communicated choices in every opportunity when they were provided with a structured opportunity. Communication partners reported that the strategy was successful for the students and that the strategy could be applied to other contexts or students.

CONCLUSIONS

This study provides evidence for the importance of communication partner training for students with complex needs in domains such as vision and communication. Furthermore, the Communicating Choices-CVI strategy may lead to increased opportunities for academic participation, social engagement, and self-determination for students whose opportunities to take on active roles in educational settings are often severely restricted.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28108139.

Tact Training with Augmentative Gestural Support for Language Disorder and Challenging Behaviors: A Case Study in an Italian Community-Based Setting

BACKGROUND

Gestures or manual signing are valid options for augmentative and alternative communication. However, the data in the literature are limited to a few neurodevelopmental disorders, and less is known about its application in the community setting.

OBJECTIVES

This case report explores the feasibility and preliminary efficacy of tact training with augmentative gestural support intervention for a child affected by a language disorder with challenging behaviors in a community setting.

METHODS

Baseline assessments were conducted using the Verbal Behavior Milestone Assessment and Placement Program (VB-MAPP) and Griffiths Mental Developmental Scale-III (GMDS-III). The patient received six months of standard treatment, consisting of neuropsychomotor and speech therapy each twice a week, with improved cooperation in proposed activities, but no improvement in language. Afterward, a total of 24 sessions of tact training with augmentative gestural support interventions were performed. Data were collected by two independent observers and analyzed to measure language and behavioral outcomes.

RESULTS

VB-MAPP scores increased form minimal communication and social interaction at T0 (baseline) to improved compliance but unchanged language skills at T1 (after standard therapy). After tack training with augmentative gestural support (T2), VB-MAPP scores showed significant improvements, with notable increases in verbal operants, independence in communication, and intersubjectivity skills. GMDS-III scores at T2 also demonstrated growth in social, communicative, and cognitive skills. Additionally, challenging behaviors were reduced by more than 70% and nearly resolved by the end of the intervention.

CONCLUSIONS

Personalized approaches appear to be essential for interventions tailored to developmental age. Further research is needed to determine the effectiveness of these approaches for other neurodevelopmental disorders, identify patient characteristics that may be predictors of outcomes to tailor the intervention, and explore the generalization of the results obtained with these strategies.

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.

Augmentative and alternative communication with children with severe/profound intellectual and multiple disabilities: speech language pathologists' clinical practices and reasoning

PURPOSE

Augmentative and alternative communication (AAC) is recommended to be included in communication interventions directed at children/youth with severe/profound intellectual and multiple disabilities (S/PIMD). Even so, the evidence base for AAC practices with children with S/PIMD is limited. Also, little is known about how frequently AAC is implemented with this target group, which AAC tools and methods are applied, and the related clinical reasoning of speech-language pathologists (SLPs). This study aimed to explore SLPs' beliefs, clinical reasoning and practices in relation to AAC implementation with children/youth with S/PIMD.

MATERIALS AND METHODS

In this sequential, mixed-methods study, 90 SLPs working with children with disabilities within habilitation services in Sweden participated in an online survey. The survey answers were statistically analysed. Subsequently, focus group data were collected from seven SLPs and analysed using thematic analysis.

RESULTS AND CONCLUSIONS

Despite AAC being highly prioritized, SLPs found it challenging and complex to implement with this target group. A wide variety of AAC methods and tools were considered and implemented. Clinical decision-making was a balancing act between competing considerations and was mainly guided by the SLPs' individual, clinical experiences. The resources, engagement and wishes of the social network surrounding the child were considered crucial for clinical decision-making on AAC. Implications for research and practice are discussed.Implications for rehabilitationSpeech-language pathologists (SLPs) seemingly find a wide variety of Augmentative and Alternative Communication (AAC), ranging from unaided methods to assistive technology of various complexity, to be potentially suitable for children/youth with severe/profound intellectual and multiple disabilities (S/PIMD).The motivation and preferences of the social network surrounding the child with S/PIMD seem to influence SLPs' clinical decision-making on AAC to a high degree. Sometimes this may be considered an even more important factor than the abilities of the child.SLPs' clinical decision-making on AAC for children/youth is guided by their individual, clinical experience to a high degree.An increase in family oriented AAC intervention research targeting individuals with S/PIMD could potentially strengthen the association between research and the current, experience-based clinical practice.

Teachers' use of augmented input and responsive strategies in schools for students with intellectual disability: A multiple case study of a communication partner intervention

Background and aims

Teachers serve as critical communication partners for students with intellectual disability (ID) who face communication difficulties. However, teachers may lack sufficient training in using communication partner strategies and augmentative and alternative communication (AAC) in the classroom. This study aimed to explore teacher application of a communication partner intervention (AKKtiv ComPal) in schools for students with ID.

Methods

Video observations were conducted at four schools during a teacher-led group activity at pre- and postintervention, with follow-up 7 months later, focusing on communication partner strategies and AAC use applied as a universal approach in the classroom. Differences and similarities in intervention application and contextual factors that may influence teacher application were investigated using a multiple case study approach, in which the four teachers and their contexts served as the four examined cases.

Results

All cases increased the access to communication boards in the classroom and used more augmented input and responsive strategies following intervention. Follow-up measures revealed variability in augmented input and sustained or more use of responsive strategies. Despite increased strategy use, access to communication boards remained inconsistent, and augmented input was used with variability across observation minutes. Influencing factors to teacher application seemed to be classroom setups (such as having a table), previous AAC skills, student characteristics, and postintervention efforts such as repeating the intervention or participating in follow-up sessions.

Conclusions

This study demonstrates that classroom teachers for students with ID can use augmented input and responsive strategies as a universal design approach in the classroom following the AKKtiv ComPal intervention. However, teachers may utilize the strategies somewhat differently, partly influenced by their contextual factors.

Implications

The findings suggest that while teachers for students with ID can successfully use communication partner strategies in the classroom, their use of augmented input should be nurtured over time to ensure sustained use and possibly improve consistency. Additionally, adapting to the physical environment of the classroom is crucial to optimize the application of these strategies.

Augmentative and alternative communication (AAC) in pediatric cochlear implant recipients with complex needs: A scoping review

INTRODUCTION

Augmentative and alternative communication (AAC) encompasses all forms of unaided and aided modes of communication, but typically excludes codified language such as spoken words or American Sign Language (ASL). In pediatric patients with a documented additional disability (population of interest), deficits in communication may pose a barrier to language development. While forms of AAC are frequently mentioned in the literature, recent innovations have permitted the use of high-tech AAC in the rehabilitation process. Our objective was to review the implementation of AAC in pediatric cochlear implant recipients with a documented additional disability.

METHODS

A scoping review of existing literature examining the use of AAC in pediatric CI recipients was conducted in the PubMed/MEDLINE and Embase databases. Studies with pediatric cochlear implant recipients with a concomitant diagnosis requiring additional therapeutic intervention outside the scope of standard post-CI follow-up care and rehabilitation from 1985 to 2021 met inclusion criteria (population of interest). Studies limited to spoken or formal sign language (e.g., American Sign Language, ASL) as communication modalities were excluded.

RESULTS

Four hundred twenty studies were screened of which 29 were included. 13 were prospective, 10 were retrospective, 1 was cross-sectional, and 5 were case reports. Of these 29 studies, 378 patients met the inclusion criteria (age <18, CI user, additional disability, utilized AAC). Fewer studies (n = 7) utilized AAC as the primary intervention for investigation. Autism spectrum disorder, learning disorder, and cognitive delay were frequently mentioned as additional disabilities in conjunction with AAC. Unaided forms of AAC included gesture/behavior, informal sign, and signed exact English, while aided AAC included a Picture Exchange Communication System (PECS), Voice Output Communication Aids (VOCA), and touchscreen programs such as TouchChat® HD. Various audiometric and language development outcome measures were mentioned, most commonly the Peabody Picture Vocabulary Test (PPVT) (n = 4) and the Preschool Language Scale, Fourth Edition (PLS-4) (n = 4).

CONCLUSION

There is a gap in the literature regarding the use of aided and high-tech AAC in pediatric CI users with a documented additional disability. Given the use of multiple different outcome measures, additional exploration of the intervention of AAC is warranted.

Speech-Language Pathologists' Endorsement of Speech, Language, and Literacy Myths Reveals Persistent Research-Practice Gap

PURPOSE

We explore the extent to which speech-language pathologists (SLPs) are operating under assumptions about speech, language, and literacy that are not supported by evidence or are contradicted by evidence.

METHOD

SLPs (N = 106) marked the degree to which they endorsed or rejected four true and 11 myth (i.e., false) statements on a visual analog scale via an online survey. We analyzed the degree to which participants agreed or disagreed with these statements related to speech, language, and literacy development and impairment.

RESULTS

Based on results of one-sample t tests, participants as a group correctly rejected seven myth statements and correctly endorsed three true statements. Participants as a group provided equivocal responses to the remaining four myth statements and one true statement. Scores for each statement spanned all or nearly all of the possible range. Even when participants overall showed relatively strong disagreement with a particular myth statement, at least a few participants endorsed the myth statement.

CONCLUSIONS

The findings indicate areas of relative strength for SLPs' knowledge of current evidence for augmentative and alternative communication, bilingualism, and language input that supports language development. Identified areas of relative weakness include knowledge of the expected grammatical and speech production skills of children with typical development and the influence of ear infections in childhood on language impairment. Additional research is needed to evaluate efforts to enhance SLPs' knowledge and use of evidence-based practices.

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.

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.

Effectiveness and Determinant Variables of Augmentative and Alternative Communication Interventions in Cerebral Palsy Patients with Communication Deficit: a Systematic Review

PURPOSE

Assess the effectiveness of augmentative and alternative communication (AAC) interventions in patients with CP and to reveal determinant variables of main intervention outcomes: receptive and expressive language.

RESEARCH STRATEGIES

The search was performed in following databases: MEDLINE (Ovid); PubMed (NLM); Embase (Ovid); Cochrane Database of Systematic Reviews; Cumulative Index to Nursing and Allied Health Literature; Database of Abstracts of Reviews of Effects; Cochrane Central Register of Controlled Trials; Health Technology Assessment database and PEDro.

SELECTION CRITERIA

Full-text and peer-reviewed studies in English studying the effectiveness of AAC in patients with cerebral palsy were included. Studies with patients (<18 years) diagnosed with CP were included.

DATA ANALYSIS

A narrative analysis was conducted to evaluate the efficacy of AAC methods. A random-effects model meta-analysis was used to assess determinants of AAC intervention outcomes.

RESULTS

The online database and manual reference search revealed 445 records. Nine studies investigating a total of 294 subjects with CP met predefined eligibility criteria: 4 studies with single subject, multiple baseline research designs, 3 longitudinal cohort studies, 1 case control study and 1 case series. Results revealed moderate-quality evidence that AAC interventions improve the receptive and expressive communication skills in patients with CP. The random-effects model meta-analysis revealed the power of identified determinant variables affecting the AAC intervention outcomes.

CONCLUSION

Diversity of CP patients requires proper analysis of determinant variables to ensure the efficacy of AAC assessment and intervention. More studies of high methodological and practical quality assessing the efficacy of AAC interventions are needed to clarify the evidence.

Effect of partner reauditorization on young adults' attitudes toward a child who communicated using nonelectronic augmentative and alternative communication

This study examined whether partner reauditorization affected the attitudes reported by young adults toward a child who communicated using nonelectronic AAC. The study also examined preferences for the way the AAC system was used (i.e., in the presence or absence of reauditorization), whether reauditorization was associated with differences in perceptions about the social interactions with the child, and ease of understanding the child's aided messages. For the study, 84 young adults viewed (a) one video of a child who communicated using nonelectronic AAC in which the child's communication partner reauditorized the child's aided message, and (b) a second video in which the message was not reauditorized. Participants answered survey questions designed to measure dependent variables including attitudes, ease of understanding, perceptions about the child's social interactions, and preferences regarding reauditorization. Attitudes toward the child were more positive when reauditorization was implemented. Partner reauditorization may play a role in improving attitudes that individuals hold about a child who uses nonelectronic AAC and may also contribute to the ease of understanding an aided message.

A Technology-Assisted Language Intervention for Children Who Are Deaf or Hard of Hearing: A Randomized Clinical Trial

BACKGROUND AND OBJECTIVES

Children who are deaf or hard of hearing (DHH) often have persistent language delays despite early identification and interventions. The technology-assisted language intervention (TALI), which incorporates augmentative and alternative communication technology into a speech-language therapy model, was designed to support language learning. The study objective was to evaluate the impact of the TALI on spoken language outcomes in DHH children.

METHODS

Children aged 3 to 12 years with mild to profound bilateral hearing loss were enrolled in a single-site randomized controlled trial. Children were randomly assigned to receive the TALI or treatment as usual (TAU) (with no change in current care) and were followed for 24 weeks. Primary outcomes included spoken language measures elicited from language samples. Secondary outcomes included standardized assessments. Intention-to-treat analyses were used.

RESULTS

Analyses focused on 41 children randomly assigned to TALI (n = 21) or TAU (n = 20). Among all participants, mean age was 6.3 years (SD 2.5). Over 24 weeks, children in the TALI group, compared with those in the TAU group, had significantly greater increases in the length of phrases they used to express themselves (β = .91 vs .15, respectively; P< .0001). Similar findings were seen with conversational turn-taking and number of different words spoken.

CONCLUSIONS

Providing visual supports for language concepts that are typically challenging for DHH children to acquire allowed children to process and comprehend spoken language more fully. Such strategies can mitigate persistent language delays with the goal of improving lifelong outcomes and independence across settings.

A map of assistive technology educative instruments in neurodevelopmental disorders

PURPOSE

The use of assistive technology in mental health has gained an increased interest over the last decades. A growing number of studies have investigated diverse applications of technological interventions for rehabilitation of children with neurodevelopmental disorders. This article presents a map of the technological devises applied as therapeutic instruments.

METHODS

The research question of this review was which technological applications could be referred as an educational instrument for the management of children with autism spectrum disorders (ASDs), intellectual disability and attention deficit disorder. The articles included in this review were collected after a structured literature search in electronic databases using keywords such as "Assistive Technology", "technology devices", "robots", "Autism Disorder", "Intellectual Disabilities" and "Mental Retardation".

RESULTS

Assistive technology with the most up-to-date devices and applications helps children with intellectual disability and ASDs enhance cognitive skills and improve challenging behaviour, social communication and academic performance. Different technological tools are used to foster attention span and improve time management skills in children with attention deficit syndrome.

CONCLUSION

It is important that therapists choose the instrument that will offer the best approach towards the goal that is set. Future research could provide evidence based data, evaluating each specific methodology and tailoring each therapeutic approach specifically to a case.IMPLICATIONS FOR REHABILITATIONTechnology creates environments in which children could practice and learn in a safer, more predictable and pleasant manner.Assistive Technologies provide the opportunity for better acquisition of selfhelp skills and the power of social interaction for individuals with disabilities.By mapping out the wide array of Assistive Technology that is available today, future applications for rehabilitation of children with neurodevelopmental disorders could help extend therapeutic strategies out of the clinical and school settings and into the home, thereby incorporating the family and emphasizing personalization.Future studies could develop a model for the choice and use of each tool, tailoring each therapeutic approach specifically to each case.

Using AAC to unlock communicative potential in late-talking toddlers

PURPOSE

The purpose of this study was to report on modifications we made to a standardized input-based word learning treatment for two late-talking toddlers. The modifications were the addition of an augmentative alternative communication (AAC) device and the requirement that the children use this device, or speech, to communicate.

METHOD

We used a single-subject design to track late-talking toddlers' progress through an input-based word learning treatment, which was part of a larger study. Because the input-based treatment protocol was not effective for each toddler based on absent or clinically insignificant treatment effect sizes, we modified the protocol. The modifications were meant to address each child's potential over-reliance on nonverbal communication and the potential impact of speech sound delay. We then measured their linguistic output.

RESULTS

Both toddlers showed no evidence of learning during the input-based treatment. Each child's linguistic output increased by over 600 % once we made the protocol modification and introduced the AAC device. They used both AAC and vocal speech to communicate. Both toddlers produced novel words, and one began to produce multiple word combinations.

DISCUSSION

While input-based therapy has an evidence base and has been successful for some toddlers, it may require modifications for children who have not learned the pragmatic convention of using spoken language, and for children with difficulty with speech sound production.

Malaysian teachers' experience using augmentative and alternative communication with students

Teachers play an important role in the successful implementation of augmentative and alternative communication (AAC) for students with complex communication needs. The goal of this two-phase, mixed-methods study was to explore Malaysian teachers' use of, experience with, and perceptions about AAC. Phase 1 involved 252 teachers who completed a questionnaire that was aimed at collecting nationwide data about their use and overall perceptions of AAC. Phase 2 involved semi-structured interviews with 13 teachers who had experience supporting students who used AAC. Approximately half of the participants who completed the questionnaire knew about AAC and had used AAC with their students. Almost all of the participants had positive views of AAC though some misconceptions were reported. Most participants had limited knowledge about AAC that led them to experience difficulties supporting their students. Teachers were motivated to receive AAC-related training to enable them to use AAC more successfully with their students given the small number of SLPs in the country.

Examining perceptions of a communication course for parents of children with profound intellectual and multiple disabilities

The overall aim was to examine participants' perceptions of a communication course as held for parents of children with profound intellectual and multiple disabilities. The course curriculum included responsive strategies and augmentative and alternative communication. The research questions addressed the favourability, changes in parents' or children's communication and appreciated or unappreciated course features. Twenty-two written course evaluations were analysed. The mean scores for ratings were compared with ratings in a previous study, including those of parents of children with generally milder disabilities. Comments and answers to open-ended questions were analysed using thematic analysis. Participants were slightly more satisfied with the course as compared with parents who had children with milder disabilities. The thematic analysis suggested increased parental responsiveness after the course. Perceptions of augmentative and alternative communication varied. It was unclear whether the course altered the children's communication or not. The supportive social milieu offered by the course was highly appreciated. Although generalisation beyond this course and setting is to be determined, the results suggest that parents of children with profound intellectual and multiple disabilities can appreciate a communication course and find it useful. An individual approach within the group setting and practical learning opportunities seem important.

Special Education Supports and Services for Rett Syndrome: Parent Perceptions and Satisfaction

There are no published studies describing educational experiences for girls with Rett syndrome. Given the extensive educational needs associated with Rett syndrome, it is important to understand how families perceive their daughters' educational experiences to inform education service provision. The purpose of this study was to survey parents of school-aged children with Rett syndrome to describe the educational services that they receive and understand parents' perceptions of and satisfaction with the special educational and related services. The majority of parents were satisfied with their daughters' educational services. Communication was the most frequently endorsed priority skill area, and many parents expressed frustration with limited access to augmentative and alternative communication (AAC) devices and staff training in their use. These results suggest there is a need for high-quality speech therapy and an emphasis on AAC support.

Longitudinal Effects of Adaptive Interventions With a Speech-Generating Device in Minimally Verbal Children With ASD

There are limited data on the effects of adaptive social communication interventions with a speech-generating device in autism. This study is the first to compare growth in communications outcomes among three adaptive interventions in school-age children with autism spectrum disorder (ASD) who are minimally verbal. Sixty-one children, ages 5-8 years, participated in a sequential, multiple-assignment randomized trial (SMART). All children received a developmental behavioral communication intervention: joint attention, symbolic play, engagement and regulation (JASP) with enhanced milieu teaching (EMT). The SMART included three 2-stage, 24-week adaptive interventions with different provisions of a speech-generating device (SGD) in the context of JASP+EMT. The first adaptive intervention, with no SGD, initially assigned JASP+EMT alone, then intensified JASP+EMT for slow responders. In the second adaptive intervention, slow responders to JASP+EMT were assigned JASP+EMT+SGD. The third adaptive intervention initially assigned JASP+EMT+SGD; then intensified JASP+EMT+SGD for slow responders. Analyses examined between-group differences in change in outcomes from baseline to Week 36. Verbal outcomes included spontaneous communicative utterances and novel words. Nonlinguistic communication outcomes included initiating joint attention and behavior regulation, and play. The adaptive intervention beginning with JASP+EMT+SGD was estimated as superior. There were significant (p < .05) between-group differences in change in spontaneous communicative utterances and initiating joint attention. School-age children with ASD who are minimally verbal make significant gains in communication outcomes with an adaptive intervention beginning with JASP+EMT+SGD. Future research should explore mediators and moderators of the adaptive intervention effects and second-stage intervention options that further capitalize on early gains in treatment.

AAC and Early Intervention for Children with Cerebral Palsy: Parent Perceptions and Child Risk Factors

The current study examined parent perceptions of communication, the focus of early intervention goals and strategies, and factors predicting the implementation of augmentative and alternative communication (AAC) for 26 two-year-old children with cerebral palsy. Parents completed a communication questionnaire and provided early intervention plans detailing child speech and language goals. Results indicated that receptive language had the strongest association with parent perceptions of communication. Children who were not talking received a greater number of intervention goals, had a greater variety of goals, and had more AAC goals than children who were emerging and established talkers. Finally, expressive language had the strongest influence on AAC decisions. Results are discussed in terms of the relationship between parent perceptions and language skills, communication as an emphasis in early intervention, AAC intervention decisions, and the importance of receptive language.

Support for AAC use in preschool, and growth in language skills, for young children with developmental disabilities

Little is known about how AAC use in preschool may impact language development for children with complex communication needs (e.g., children with autism, cerebral palsy, Down syndrome, and other developmental disabilities). We developed two surveys (a) to describe children's use of AAC in preschool classrooms, as well as the use of prompts and question asking, and augmented input by their communication partners; and (b) to describe teachers' experience, training, and perceived support in providing AAC. We then examined the relationship between children's experience of AAC, including the use of prompts, question asking, and augmented input by their partners, and the growth of receptive and expressive language for 71 children with developmental disabilities over a two-year period. The use of AAC by peers to provide augmented input was associated with stronger language growth; the use of prompting and question asking by teachers was associated with weaker language growth. Teachers reported that they received little training regarding ways to support a child's use of AAC. Results suggest the need for further research on promoting AAC use at the preschool level, including research to promote peer interactions for AAC users.

Acquisition and generalization of key word signing by three children with autism

OBJECTIVE

The aim of this study was to examine the effect of Key Word Sign (KWS) intervention on the acquisition and generalization of manual signing among three children with Autism Spectrum Disorder (ASD), and to measure any changes in their production of spoken words and gestures following intervention.

METHODS

A multiple baseline single-case experimental design was used to measure changes for each of the three children.

RESULTS

All three children began using signs following the introduction of the KWS intervention, and generalized their use of some signs across activities. The introduction of the intervention was associated with either neutral, or statistically significantly positive, changes in the children's production of spoken words and natural gestures.

CONCLUSION

The results provide preliminary evidence for the effectiveness of KWS for preschool children with ASD, which parents, therapists, and educators can use to inform clinical practice.

A scoping review of interventions to supplement spoken communication for children with limited speech or language skills

BACKGROUND

Augmentative and Alternative Communication (AAC) is used for treating children with severe disorders of speech-language production and/or comprehension. Various strategies are used, but research and debate on their efficacy have remained limited to a specific area and have rarely reached the general medical community.

OBJECTIVE

To systematically evaluate outcomes of AAC interventions in children with limited speech or language skills.

METHODS

Searches were conducted (up to December 2012) in the MEDLINE, EMBASE, PsycINFO, CINAHL, DARE, and Cochrane Library databases. Furthermore, relevant journals were searched by hand. References from identified studies were examined. Only RCTs were considered. Trial quality was assessed according to a standardized and validated set of criteria.

RESULTS

Fourteen of 1661 retrieved papers met inclusion criteria. A total of 666 children were included in the review and 7 papers involved only children <5 years old. Papers were of average quality and all but one had been published during the previous 10 years by one of 8 research groups, 5 of which from the United States. Seven studies directly addressed AAC use by children with different disabilities. Seven studies enrolled typically developing children: 5 evaluated the use of AAC technologies by children without disabilities in order to obtain results that could be used to improve interventions in peers with disabilities, and 2 evaluated peers' attitudes towards children who used AAC. Both interventions and outcome measures varied widely between studies. Overall findings demonstrate the effectiveness of the AAC interventions considered, but the focus on RCTs alone appears too restrictive.

CONCLUSIONS

Solid evidence of the positive effects of AAC interventions in children with severe communication disorders must be generated, and different methods are needed besides RCTs. Moreover, it is important that knowledge, research, and debate extend to the medical community in order to ensure clinically effective AAC provision for these children (and their parents).

A case study template to support experimental design in Augmentative and Alternative Communication and Assistive Technology

PURPOSE

The field of Augmentative and Alternative Communication/Assistive Technology (AAC/AT) has an extensive literature of non-experimental case descriptions. This limits the generalisation of findings. The current study aimed to develop a template to contribute to single case experimental design specifically for the field of enquiry.

METHOD

A qualitative case study methodology was adopted to construct and evaluate the content and structure of the case study template. Participants represented relevant stakeholder groups. Data were collected through template evaluations and focus groups. Data were analysed using Framework Analysis.

RESULTS

Across stakeholder groups, results produced a consensus on AAC/AT terminology, content and detail that may usefully inform single case experimental design.

CONCLUSIONS

This is a complex area of rehabilitation that can best support its service users and service commissioners by using tools that facilitate collaborative working. The findings suggest that it is possible to produce a data collection tool that is acceptable to all stakeholder perspectives.

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.

Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents

PURPOSE

This study compared the language performance of young children with developmental delays who were randomly assigned to 1 of 3 parent-coached language interventions. Differences in performance on augmented and spoken word size and use, vocabulary size, and communication interaction skills were examined.

METHOD

Sixty-eight toddlers with fewer than 10 spoken words were randomly assigned to augmented communication input (AC-I), augmented communication output (AC-O), or spoken communication (SC) interventions; 62 children completed the intervention. This trial assessed the children's symbolic language performance using communication measures from the language transcripts of the 18th and 24th intervention sessions and coding of target vocabulary use.

RESULTS

All children in the AC-O and AC-I intervention groups used augmented and spoken words for the target vocabulary items, whereas children in the SC intervention produced a very small number of spoken words. Vocabulary size was substantially larger for AC-O and AC-I than for SC groups.

CONCLUSIONS

This study found that augmented language interventions that include parent coaching have a positive communication effect on young children with developmental delays who begin with fewer than 10 spoken words. Clinical implications suggest that augmented communication does not hinder, and actually aids, speech production abilities in young children with developmental delays.

Validation of an inventory of best practices in the provision of augmentative and alternative communication services to students with severe disabilities in general education classrooms

PURPOSE

To compile and then validate a set of evidence-based best practices related to augmentative and alternative communication (AAC) and its role in fostering the inclusion of students with severe disabilities in general education classrooms and other inclusive settings.

METHOD

A comprehensive review of the literature pertaining to AAC and inclusive education for students with severe disabilities in inclusive classrooms resulted in an inventory of possible best practices. Reliability testing was conducted to verify levels of evidence assigned to each source and corresponding practice. Practices were reviewed and validated by a panel of 8 experts. Statistical analysis revealed a high level of internal consistency across items composing the inventory.

RESULTS

An inventory of 91 practices, each assigned to 1 of 8 predetermined categories, was uncovered. Themes arising in experts' comments related to items in the inventory are discussed.

CONCLUSIONS

Possible uses of the inventory are discussed along with suggestions for future research.

Research directions in augmentative and alternative communication for preschool children

PURPOSE

To review issues related to the use of augmentative systems with young children and present a case study of one child and family's experience with the System for Augmenting Language (SAL).

METHOD

The case involved a preschool child with severe developmental delays who had little functional speech. Acquisition and use of graphic symbols on a speech-output communication device was studied in home and clinical settings. Language and communication behaviours of the child and his communication partners were observed and language assessment measures were collected.

RESULTS

Child engagement state varied across the two settings with a stable profile seen in the therapy setting and a clear increase at home. Child communicative attempts increased following the introduction of the augmented system. Parents reported successful use of the SAL.

CONCLUSION

SAL is a viable communication intervention approach for young children.

Prescribing assistive-technology systems: focus on children with impaired communication

This clinical report defines common terms of use and provides information on current practice, research, and limitations of assistive technology that can be used in systems for communication. The assessment process to determine the best devices for use with a particular child (ie, the best fit of a device) is also reviewed. The primary care pediatrician, as part of the medical home, plays an important role in the interdisciplinary effort to provide appropriate assistive technology and may be asked to make a referral for assessment or prescribe a particular device. This report provides resources to assist pediatricians in this role and reviews the interdisciplinary team functional evaluation using standardized assessments; the multiple funding opportunities available for obtaining devices and ways in which pediatricians can assist families with obtaining them; the training necessary to use these systems once the devices are procured; the follow-up evaluation to ensure that the systems are meeting their goals; and the leadership skills needed to advocate for this technology. The American Academy of Pediatrics acknowledges the need for key resources to be identified in the community and recognizes that these resources are a shared medical, educational, therapeutic, and family responsibility. Although this report primarily deals with assistive technology specific for communication impairments, many of the details in this report also can aid in the acquisition and use of other types of assistive technology.

The state of research and practice in augmentative and alternative communication for children with developmental/intellectual disabilities

Augmentative and alternative communication is a compilation of methods and technology designed to supplement spoken communication for people with limited speech or language skills, including children with developmental and intellectual disabilities. The field of AAC has evolved rapidly within the last 10 years, due to a combination of empirical advances from research as well as rapid changes in technology. This article reviews some of the most significant aspects of this growth as it relates to children with developmental disabilities. Major issues within the field, the evidence base available to practitioners and researchers, and promising areas of future growth are identified.

Demographics of Preschoolers Who Require AAC

Purpose

The purpose of the investigation was to gather demographic information pertaining to preschoolers who require augmentative and alternative communication (AAC).

Method

To obtain this information, a survey was developed and then distributed to preschool speech-language pathologists (SLPs) in Pennsylvania.

Results

Results indicated that approximately 12% of preschoolers receiving special education services required AAC. These children came from diverse ethnic and racial backgrounds, had a wide variety of disabilities, used a range of AAC systems, and required services from a wide range of educational professionals.

Implications

The findings indicate the pressing need for all preschool SLPs to be prepared to provide services for children who require AAC.