Comparison of Sign alone and in combination with an electronic communication device in early language intervention: Case study

Parent-implemented augmented communication intervention and young children with Down syndrome: an exploratory report

Introduction

Young children with Down syndrome (DS) present with speech and language impairments very early in childhood. Historically, early language intervention for children with DS included manual signs, though recently there has been an interest in the use of speech-generating devices (SGDs). This paper examines the language and communication performance of young children with DS who participated in parent-implemented communication interventions that included SGDs. Specifically, we compared the functional vocabulary usage and communication interaction skills of children with DS who received augmented communication interventions (AC) that included an SGD with those children with DS who received spoken communication intervention (SC).

Methods

Twenty-nine children with DS participated in this secondary data analysis. These children were part of one of two longitudinal RCT studies investigating the effectiveness of parent-implemented augmented communication interventions in a larger sample of 109 children with severe communication and language impairments.

Results

There were significant differences between children with DS in the AC and SC groups in terms of the number and proportion of functional vocabulary targets used and the total vocabulary targets provided during the intervention at sessions 18 (lab)and 24 (home).

Discussion

Overall, the AC interventions provided the children with a way to communicate via an SGD with visual-graphic symbols and speech output, while the children in the SC intervention were focused on producing spoken words. The AC interventions did not hinder the children's spoken vocabulary development. Augmented communication intervention can facilitate the communication abilities of young children with DS as they are emerging spoken communicators.

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.

A Systematic Review of Augmented Input Interventions and Exploratory Analysis of Moderators

Purpose Augmented input is the act of concurrently modeling language verbally and on a communication device, and is one strategy for teaching individuals to effectively use aided modes of communication. The purpose of this literature review is to assess the efficacy of augmented input for increasing communication and to identify intervention components, participant characteristics, and instructional contexts related to therapeutic outcomes. Method We double screened all potential sources and double coded all included sources. Database, forward, and backward searches yielded 99 single case designs in 26 sources. We coded characteristics of participants, instructional contexts, independent variables, and dependent variables. We also coded quality/rigor and primary outcomes for each design or comparison. Results Across high-quality studies, two thirds of designs indicated that augmented input was effective compared to baseline conditions and alternative interventions, and exploratory analyses indicated that receptive language skills, age, and diagnoses may moderate intervention efficacy. Most augmented input interventions included additional components that may serve as "active ingredients" (e.g., systematic prompting, contextual reinforcement). Most studies also did not report participant characteristics hypothesized to moderate intervention efficacy (e.g., joint attention skills, imitation repertoire). Results also indicated high risk of publication bias, with peer-reviewed sources twice as likely to include positive effects than dissertations and theses. Conclusions Across high-quality studies, augmented input was inconsistently effective as a stand-alone intervention. Packaged interventions that included augmented input were typically more effective than augmented input in isolation, particularly for individuals who were young, had strong receptive language skills, or had no comorbid diagnoses.

A Meta-Analysis of Single-Case Research on Applied Behavior Analytic Interventions for People With Down Syndrome

This systematic review evaluates single-case research design studies investigating applied behavior analytic (ABA) interventions for people with Down syndrome (DS). One hundred twenty-five studies examining the efficacy of ABA interventions on increasing skills and/or decreasing challenging behaviors met inclusion criteria. The What Works Clearinghouse standards and Risk of Bias in N-of-1 Trials scale were used to analyze methodological characteristics, and Tau-U effect sizes were calculated. Results suggest the use of ABA-based interventions are promising for behavior change in people with DS. Thirty-six high-quality studies were identified and demonstrated a medium overall effect. A range of outcomes was targeted, primarily involving communication and challenging behavior. These outcomes will guide future research on ABA interventions and DS.

Systematic Review of Interventions Involving Aided AAC Modeling for Children With Complex Communication Needs

Building the communicative competence of individuals who use augmentative and alternative communication (AAC) requires intervention and support. This systematic review examined experimental studies involving aided AAC modeling to promote the expressive communication of children and youth (i.e., birth to age 21) with complex communication needs. A search yielded 48 studies involving 267 participants. Interventions were categorized according to three different approaches to aided AAC modeling-augmented input, models as prompts, and models within instructional demonstrations. Although the procedures varied, interventions were generally effective at improving diverse measures of expressive communication. This review provides insight for both researchers and practitioners by describing interventions involving three distinct approaches to aided AAC modeling, highlighting areas needing future research, and offering implications for practice.

Naturalistic Speech-Generating Device Interventions for Children With Complex Communication Needs: A Systematic Review of Single-Subject Studies

PURPOSE

This article presents a systematic review that aimed to synthesize single-subject-design studies that have examined naturalistic interventions for teaching the expressive use of speech-generating devices (SGDs) to children with complex communication needs. Specifically, this review describes what intervention strategies are most commonly applied in studies with positive effects and minimal methodological flaws and examines the populations and outcomes for which these strategies have been effective.

METHOD

A systematic approach was used to qualitatively code variables of interest to this review. Results were summarized via both visual analysis and effect size methods, and a certainty of evidence methodology was adopted to describe the quality of the evidence.

RESULTS

Thirty-two unique studies met inclusion criteria, with 19 having consistent positive results and meeting minimum requirements for certainty of evidence. Although studies used a variety of titles to describe intervention packages (e.g., milieu teaching, interaction strategies), certain strategies were common across studies. These included (a) creating and capturing communication opportunities via methods such as time delay and questioning; (b) providing feedback via methods such as reinforcement of requests, praise, or expansions; (c) prompting (verbal, physical, gestural); (d) modeling; and (e) training communication partners.

CONCLUSIONS

Findings regarding these intervention components help to provide practical guidelines for naturalistic SGD intervention. Limitations of the current body of research (e.g., need to include more home-based studies and more intermediate to advanced SGDs, need to critically analyze the most critical intervention components) provide suggestions for future research.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.6615332.

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

PURPOSE

The purpose of this meta-analysis was to investigate the effects of augmentative and alternative communication (AAC) interventions that included aided AAC input (e.g., aided AAC modeling, aided language modeling, aided language stimulation, augmented input) on communicative outcomes (both comprehension and expression) for individuals with developmental disabilities who use AAC.

METHOD

A systematic search resulted in the identification of 26 single-case experimental designs (88 participants) and 2 group experimental designs (103 participants). Studies were coded in terms of participants, intervention characteristics, dependent variables, outcomes, and quality of evidence.

RESULTS

AAC interventions that included aided AAC input in isolation, or as part of a multicomponent intervention, were found to be highly effective across participants of various ages, disabilities, and language skills. The interventions typically included aided AAC input in conjunction with expectant delay, direct prompting (e.g., spoken, gestural), contingent responding, and open-ended questions. The interventions were found to be highly effective in supporting both comprehension and expression across the domains of pragmatics, semantics, and morphosyntax. Outcomes related to expression were reported more often than outcomes related to comprehension.

CONCLUSION

Aided AAC input may reduce input-output asymmetry and enhance expression and comprehension for individuals who use AAC; the evidence suggests that partners should utilize this strategy. Future research is needed to investigate the effects of AAC input (aided and unaided) on long-term language development for individuals who require AAC.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.6394364.

Communication intervention for individuals with Down syndrome: Systematic review and meta-analysis

OBJECTIVE

A systematic review was conducted to identify effective intervention strategies for communication in individuals with Down syndrome.

METHODS

We updated and extended previous reviews by examining: (1) participant characteristics; (2) study characteristics; (3) characteristics of effective interventions (e.g., strategies and intensity); (4) whether interventions are tailored to the Down syndrome behavior phenotype; and (5) the effectiveness (i.e., percentage nonoverlapping data and Cohen's d) of interventions.

RESULTS

Thirty-seven studies met inclusion criteria. The majority of studies used behavior analytic strategies and produced moderate gains in communication targets. Few interventions were tailored to the needs of the Down syndrome behavior phenotype.

CONCLUSION

The results suggest that behavior analytic strategies are a promising approach, and future research should focus on replicating the effects of these interventions with greater methodological rigor.

Teaching ‘Yes’ and ‘No’ Responses to Children with Multiple Disabilities through a Program Including Microswitches Linked to a Vocal Output Device

The present study introduced two children (a boy and a girl of 9.2 and 12.3 yr. of age, respectively, with multiple disabilities) to an intervention program for establishing Yes and No responses in relation to preferred and nonpreferred stimuli and assessed the acquisition and generalization of those responses. The program involved the use of microswitches, which monitored the nonverbal Yes and No responses performed by the children and ensured that these responses produced the matching verbal utterances via a vocal output device. Analysis showed children acquired Yes and No responses in relation to the stimuli used for the intervention and, to a comparable degree, to the stimuli used for generalization checks as well. An interview of 30 educational staff of a center for persons with multiple disabilities indicated that they considered the presence of Yes and No verbal utterances preferable to the absence of such utterances, and thought that the utterances could be helpful for the children's response acquisition and would be useful and pleasing for staff and parents. General implications of the findings were discussed.

iPods and iPads as AAC Devices for Children with Developmental Disorders

The Apple iPod Touch™ and iPad™ are increasingly used as augmentative and alternative communication (AAC) devices. This chapter discusses the use of iPods™/iPads™ loaded with software applications that enable speech output and thereby transform them into speech-generating devices (SGD). While a popular mode of communication for children with developmental disorders (DD) who have little or no spoken language, assessment of the effectiveness of such new technology to enhance communicative functioning is necessary. Research on the use of iPods™/iPads™ was evaluated to assess whether they are (a) effective as AAC devices, (b) at least as effective as other AAC interventions, and (c) effective at the individual level of implementation. Findings suggested that the use of iPods™/iPads™ as AAC devices is promising, also in comparison to other AAC systems. Children typically preferred using iPods™/iPads™. Selection of an AAC system based on the child's preference coupled with appropriate instructional strategies may lead to the enhancement of communicative functioning for children with DD.

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.

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

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

Speech-generating devices versus manual signing for children with developmental disabilities

We compared speed of acquisition and preference for using a speech-generating device (SGD) versus manual signing (MS) as augmentative and alternative communication (AAC) options. Four children with developmental disabilities (DD), aged 5-10 years, were taught to request preferred objects using an iPod(®)-based SGD and MS. Intervention was introduced in a multiple-probe across participants design and SGD and MS conditions were compared in an alternating treatments design. A systematic choice-making paradigm was implemented to determine if the children showed a preference for using SGD or MS. All participants showed increased use of SGD when intervention was introduced, but only three learned under the MS condition. Three participants exhibited a preference for the SGD while the remaining participant demonstrated a preference for using MS. Results support previous studies showing that individuals with DD often show a preference for different AAC options and extend previous data by suggesting that acquisition and maintenance was better for the preferred option.

Assessing preferences for AAC options in communication interventions for individuals with developmental disabilities: a review of the literature

We synthesized studies that assessed preference for using different augmentative and alternative communication (AAC) options. Studies were identified via systematic searches of electronic databases, journals, and reference lists. Studies were evaluated in terms of: (a) participants, (b) setting, (c) communication options assessed, (d) design, (e) communication skill(s) taught to the participant, (f) intervention procedures, (g) outcomes of the intervention and outcome of the preference assessment, (h) follow-up and generalization, and (i) reliability of data collection and treatment integrity. Seven studies, involving 12 participants, met the inclusion criteria. In these studies, individuals were taught to use either speech-generating devices (SGD), (b) picture exchange (PE) systems, and/or (c) manual signs. Assessments to identify preferences for using each AAC option were conducted in each study. Sixty-seven percent (n=8) of participants demonstrated some degree (≥55%) of preference for using SGD compared to 33% (n=4) of participants who demonstrated some degree (≥55%) of preference for PE. The results indicate that individuals with developmental disabilities often show a preference for different AAC options. Incorporating an assessment of such preferences might therefore enable individuals to exert some degree of self-determination with respect to AAC intervention.

The use of speech generating devices in communication interventions for individuals with developmental disabilities: a review of the literature

OBJECTIVE

This review synthesizes communication interventions that involved the use of speech generating devices (SGD) for individuals with developmental disabilities.

METHODS

Systematic searches of electronic databases, journals and reference lists identified 35 studies meeting the inclusion criteria. These studies were evaluated in terms of (a) participants, (b) SGD function, (c) SGD characteristics, (d) intervention procedures, (e) intervention results and (f) certainty of evidence.

RESULTS

Across these studies, intervention was provided to a total of 86 participants aged 1-42 years. Communication skills targeted included requesting, social or conversational skills, labelling items and receptive language. Intervention approaches were categorized as using Discrete Trial Training, Milieu teaching or a combined instructional approach. Positive outcomes were reported in 86% of the studies with 54% of studies categorized as providing conclusive evidence.

CONCLUSION

This literature base is considered promising due to the large number of conclusive studies and the replication of intervention approaches.

Concomitant use of the matrix strategy and the mand-model procedure in teaching graphic symbol combinations

Matrix strategies employing parts of speech arranged in systematic language matrices and milieu language teaching strategies have been successfully used to teach word combining skills to children who have cognitive disabilities and some functional speech. The present study investigated the acquisition and generalized production of two-term semantic relationships in a new population using new types of symbols. Three children with cognitive disabilities and little or no functional speech were taught to combine graphic symbols. The matrix strategy and the mand-model procedure were used concomitantly as intervention procedures. A multiple probe design across sets of action-object combinations with generalization probes of untrained combinations was used to teach the production of graphic symbol combinations. Results indicated that two of the three children learned the early syntactic-semantic rule of combining action-object symbols and demonstrated generalization to untrained action-object combinations and generalization across trainers. The results and future directions for research are discussed.

Comprehension: An overlooked component in augmented language development

PURPOSE

Despite the importance of children's receptive skills as a foundation for later productive word use, the role of receptive language traditionally has received very limited attention since the focus in linguistic development has centered on language production. For children with significant developmental disabilities and communication impairments, augmented language systems have been devised as a tool both for language input and output. The role of both speech and symbol comprehension skills is emphasized in this paper.

METHOD

Data collected from two longitudinal studies of children and youth with severe disabilities and limited speech serve as illustrations in this paper. The acquisition and use of the System for Augmenting Language (SAL) was studied in home and school settings. Communication behaviors of the children and youth and their communication partners were observed and language assessment measures were collected.

RESULTS

Two patterns of symbol learning and achievement--beginning and advanced--were observed. Extant speech comprehension skills brought to the augmented language learning task impacted the participants' patterns of symbol learning and use.

CONCLUSIONS

Though often overlooked, the importance of speech and symbol comprehension skills were underscored in the studies described. Future areas for research are identified.

Multimodality: a basis for augmentative and alternative communication–psycholinguistic, cognitive, and clinical/educational aspects

PURPOSE

Message generating is a complex process involving a number of processes, including the selection of modes to use. When expressing a message, human communicators typically use a combination of modes. This phenomenon is often termed multimodality. This article explores the use of models that explain multimodality as an explanatory framework for augmentative and alternative communication (AAC).

METHOD

Multimodality is analysed from a communication, psycholinguistic, and cognitive perspective.

RESULTS

Theoretical and applied topics within AAC can be explained or described within the multimodality framework considering iconicity, simultaneous communication, lexical organization, and compatibility of communication modes.

CONCLUSION

Consideration of multimodality is critical to understanding underlying processes in individuals who use AAC and individuals who interact with them.

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

PURPOSE

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

METHOD

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

CONCLUSIONS

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

PECS and VOCAs to enable students with developmental disabilities to make requests: an overview of the literature

This paper provides an overview of the literature dealing with the use of the Picture Exchange Communication System (PECS) and voice output communication aids (VOCAs) for promoting the performance of requests by students with developmental disabilities. Computerized and manual searches were carried out to identify the studies published during the last 15 years (i.e., the period between 1992 and 2006 during which PECS and VOCA approaches became popular). Thirty-seven studies were identified and then divided into three groups concerning the use of the PECS or equivalents, the use of VOCAs or equivalents, and the comparison of both these approaches, respectively. Of the 173 students involved in studies using the PECS or equivalents only three could be considered failures, while a fourth one did not progress in the program due to illness. Similarly, of the 39 students who used VOCAs or equivalents only three could be considered failures, while one was partly successful. Finally, of the 11 students involved in the comparisons between PECS and VOCAs none could be classified as a failure. The results are very encouraging but methodological concerns and the relatively limited use of the systems in terms of request items and request opportunities suggest caution. Caution may also be needed in interpreting the reported similarities between the two systems in usability and effectiveness.

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.

Augmentative and alternative communication interventions for persons with developmental disabilities: narrative review of comparative single-subject experimental studies

Augmentative and alternative communication (AAC) as an area of clinical and educational practice involves a myriad of decisions related to the symbols, devices, and strategies from which each client must choose. These decision-making points can be productively informed through evidence from comparative intervention studies. The purpose of this review was to synthesize comparative AAC intervention studies using single-subject experimental designs involving participants with developmental disabilities. Following a systematic search, each qualifying study was reviewed in terms of a priori determined appraisal criteria, and summarized in tabular format. Studies were divided into three groups according to their study of aided approaches, unaided approaches, or a combination of both. Results are discussed in terms of methodological adequacy of the studies and their implications for future research and practice.