Effect of mobile technology featuring visual scene displays and just-in-time programming on communication turns by preadolescent and adolescent beginning communicators

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.

Increasing linguistic and prelinguistic communication for social closeness during naturalistic AAC instruction with young children on the autism spectrum

This study examined the effects of an intervention package using high-tech augmentative and alternative communication (AAC) with Naturalistic Instruction (NI), time delay, and prompting during social routines for preschoolers on the autism spectrum. The AAC was a communication application on a tablet programmed with color photo representations of participants and communication partners engaged in social routines. The primary dependent measure was a linguistic communication turn on the AAC device completing the instructor's cloze phrase related to the routine. A secondary dependent measure was prelinguistic communication -nonspecific vocalizations and smiling - within each turn of the routine. Results indicated that all communication types increased and maintained for all three participants with two participants meeting mastery criteria within the minimal number of sessions. These results are significant in providing additional evidence for the effectiveness of AAC intervention beyond teaching simple object requests and in teaching more socially meaningful communication to children on the autism spectrum. Additionally, this study supports the use of color photo representations to promote social interaction. Future research should continue to evaluate such interventions on a larger scale and include naturally occurring communication partners, such as siblings and peers.

Effects of Interaction Approaches and Added High-Tech Augmentative and Alternative Communication on Prelinguistic and Linguistic Communication from School-Age Beginning Communicators

INTRODUCTION

Augmentative and alternative communication (AAC) intervention research is rarely focused on school-age beginning communicators, despite the urgent need to ensure individuals in this population have access to the fundamental human right of communication.

METHODS

Four school-age children with multiple disabilities who were primarily prelinguistic communicators participated in the current study. The study used a single-subject research design to explore the effects of two interaction approaches - a social routine approach and a directive approach - on prelinguistic communication, compared to independent play and to one another. This study then evaluated the added effects of high-tech AAC within the most effective interaction approach for each participant.

RESULTS

All participants demonstrated prelinguistic communication indicating positive affect most frequently when interacting within a social routine. Furthermore, all participants increased linguistic communication while either maintaining or increasing prelinguistic communication when high-tech AAC was added to the social routine interaction.

CONCLUSIONS

Clinicians should consider building accessible, predictable, engaging, and age-respectful social routines into leisure contexts to promote prelinguistic communication from school-age beginning communicators. Clinicians should also provide access to linguistic communication through high-tech AAC while continuing to honor and promote prelinguistic communication.

Effect of Low-Tech Augmentative and Alternative Communication Intervention on Intentional Triadic Gaze as Alternative Access by School-Age Children With Multiple Disabilities

PURPOSE

Students with multiple disabilities who are beginning communicators require augmentative and alternative communication (AAC) to communicate during school and participate in its academic and social aspects. Triadic gaze is a method for accessing low-tech AAC that minimizes physical demands on access for students with limited mobility, such as students with multiple disabilities. Thus, this study evaluated an instructional protocol for teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities.

METHOD

Three students with multiple disabilities who were beginning communicators participated in a multiple baseline across participants design with three phases: baseline, treatment, and generalization and maintenance. Participants engaged in instruction around using triadic gaze to communicate by making selections on an eye gaze board.

RESULTS

Visual analysis showed that all three participants acquired the use of triadic gaze as a method of accessing low-tech AAC in response to instruction. Effect size estimations suggested instruction was effective. The participants also demonstrated that the newly acquired skill generalized to interactions with familiar communication partners after instruction ended.

CONCLUSIONS

These findings show that instruction can be effective in teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities. Future research should explore the effects of using this access method on communicating across school contexts.

The effects of AAC video visual scene display technology on the communicative turns of preschoolers with autism spectrum disorder

Over 40% of children with autism spectrum disorder (ASD) experience difficulty in using speech to meet their daily communication needs. Although augmentative and alternative communication (AAC) can be of benefit, the AAC intervention must support beginning communicators in the early social interactions that provide the foundation for more sophisticated communication skills. An AAC video visual scene display approach uses an AAC app (provided on a tablet computer), including videos based on the interests of the child and infused with AAC supports, to provide opportunities for social interaction and communication between the child and the communication partner. The purpose of this study was to investigate the impact of video visual scene display technology on the communicative turns taken by three preschoolers with ASD and complex communication needs during a high-interest, shared activity (i.e., watching videos). All three participants demonstrated a large increase in the number of communicative turns taken with their partner (Tau-U of 1.00) following the introduction of the video VSD app. The results provide evidence that a video VSD approach may be a promising intervention to increase participation in communication opportunities for young children with ASD.

Clinical and Research Perspectives on Visual Scene Displays

Purpose The purposes of this study were to measure the perceptions of speech-language pathologists (SLPs) and researchers regarding the design of visual scene displays (VSDs) and to investigate the perceived difficulties of SLPs in regard to the acquisition and programming of VSDs. Method We recruited 270 SLPs and nine researchers who focus on VSDs to complete an online survey. The SLP survey addressed both perception of VSD design and difficulties associated with implementing these images as communication supports in the clinical realm. The researcher group was surveyed solely regarding their opinions associated with VSD design. Results SLPs and researchers both ranked high-context VSDs as more effective at supporting communication than low-context VSDs. In addition, both groups ranked VSDs with task-engaged people as more effective at supporting communication than VSDs with camera-engaged people or no people. SLPs reported difficulties with acquiring high-quality VSDs from online sources as well as difficulties with maintenance and upkeep of VSDs. In addition, a large portion of SLPs reported challenges with representing complex concepts through VSDs. Conclusions Results from this study provide evidence of general agreement between SLPs and researchers regarding perception of VSD design. SLPs continue to report challenges with the acquisition and programming of VSDs. Further research is needed to develop evidence-based guidelines to support clinical endeavors in these areas.

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.

Personalization of Patient-Provider Communication Across the Lifespan

People with disabilities are more likely to be hospitalized and use healthcare services relative to people without disabilities. They also report experiencing negative experiences interacting with health care providers during these encounters placing them at risk for preventable adverse medical events, poor quality of life, and dependence on others. Fortunately, providers and people with communication disabilities can take steps to improve these interactions by personalizing and implementing communication supports to empower people with communication disabilities to actively participate in these interactions and improve outcomes. The purpose of this article is to describe strategies that health care providers can use to develop and implement personalized communication supports for children and adults with communication disorders during health care interactions. Additional strategies are provided to guide people with disabilities as well as their community/school providers and families to prepare for health care interactions. Case examples are provided to illustrate use of these strategies in acute care, inpatient rehabilitation, and outpatient settings. The use of emerging training tools (e.g., video visual scene displays) and AAC partner training formats (e.g., just-in-time training) are also presented as future directions to expedite learning and implementation of communication supports in fast-paced and time-limited health care interactions.

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

Purpose

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

Method

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

Results

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

Conclusions

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

Speech-Language pathologists' decisions when designing an aided AAC display for a compilation case study of a beginning communicator

PURPOSE

The current study sought to identify decisions speech-language pathologists (SLPs) make and their rationale for those decisions when designing an AAC display for a hypothetical school-aged child who was a beginning communicator. Augmentative and alternative communication (AAC) displays support communicative interactions for children who are unable to use spoken language to meet their communication needs. Children who are at the early stages of learning language, often termed beginning or emerging communicators, may rely heavily on the AAC display to support comprehension and expression. Thus, it is important for speech-language pathologists (SLPs) to design a display that facilitates beginning communicators' communication development.

METHODS

This paper reports on the answers related to a specific case study presented in an online survey completed by 77 SLPs with experience in AAC.

RESULTS

Data illustrated design decisions driven by child-specific characteristics and informed by research regarding type of layout, representation, and the importance of various design features.

CONCLUSIONS

Suggestions for future research are provided, including identifying goals and communicative functions best supported by different types of displays, clinicians' challenges/successes growing a system with the child, and determining the importance of symbol arrangement and organisation in communicative tasks by AAC users.Implications for RehabilitationIdentification of current practices reported by speech-language pathologists given a case study to develop and implement future research.A gap between research and practice suggests the need for better dissemination and application of research supporting the inclusion of people engaged in the event depicted in a visual scene display.Foundations for future research to provide guidance regarding best design of and communication goals supported by visual scene displays and grid-based displays.

Effect of AAC technology with dynamic text on the single-word recognition of adults with intellectual and developmental disabilities

Purpose: Single-word recognition can support participation in life, including engagement in leisure activities, navigation through the community, and vocational opportunities. Given the limited reading skills of many adults with intellectual and developmental disabilities (IDD) and limited speech, the current study evaluated the effects of using an augmentative and alternative communication (AAC) app, featuring dynamic text and speech output embedded in visual scene displays, on the single-word recognition performance of six adults with IDD who demonstrated limited speech.Method: A multiple baseline across participants single-subject design was used. Ten target sight words for each participant were selected on an individual basis, based on participant interest. Intervention consisted solely of interactions between investigators and individual participants using the app.Result: In the absence of any formal instruction and solely through the use of the AAC app interaction, three of the six participants demonstrated increased accuracy in single-word recognition.Conclusion: Results from the study were mixed, but suggest that AAC apps which provide the dynamic display of text in conjunction with voice output can assist some adults with IDD in achieving gains in single-word reading.

Preliminary investigation of the effects of a prelinguistic AAC intervention on social gaze behaviors from school-age children with multiple disabilities

Some school-age children with multiple disabilities communicate predominately through the display of prelinguistic behaviors such as gestures, vocalizations, facial expressions, and eye gaze. Increasing the frequency and complexity of these behaviors may be one approach to building communication and transitioning toward linguistic communication (i.e., symbolic language). The current preliminary study used a single-subject ABB'B" design nested within a multiple baseline across participants design with randomization to evaluate a multi-phase intervention aimed at increasing social gaze behaviors. The participants were 5 school-age children with multiple disabilities. Participants appeared to demonstrate increases in both the frequency and complexity of their social gaze behavior during the intervention according to Improvement Rate Difference calculations that largely maintained four months after intervention ended. More research is needed, but the intervention shows promise as one aspect of AAC intervention for children who are prelinguistic communicators. Future research is critical to evaluating this or related interventions with a larger number of individuals and across a larger range of profiles and ages.

Comparative Effects of High-Tech Visual Scene Displays and Low-Tech Isolated Picture Symbols on Engagement From Students With Multiple Disabilities

Purpose

Augmentative and alternative communication (AAC) is an intervention approach that can promote communication and language in children with multiple disabilities who are beginning communicators. While a wide range of AAC technologies are available, little is known about the comparative effects of specific technology options. Given that engagement can be low for beginning communicators with multiple disabilities, the current study provides initial information about the comparative effects of 2 AAC technology options—high-tech visual scene displays (VSDs) and low-tech isolated picture symbols—on engagement.

Method

Three elementary-age beginning communicators with multiple disabilities participated. The study used a single-subject, alternating treatment design with each technology serving as a condition. Participants interacted with their school speech-language pathologists using each of the 2 technologies across 5 sessions in a block randomized order.

Results

According to visual analysis and nonoverlap of all pairs calculations, all 3 participants demonstrated more engagement with the high-tech VSDs than the low-tech isolated picture symbols as measured by their seconds of gaze toward each technology option. Despite the difference in engagement observed, there was no clear difference across the 2 conditions in engagement toward the communication partner or use of the AAC.

Conclusions

Clinicians can consider measuring engagement when evaluating AAC technology options for children with multiple disabilities and should consider evaluating high-tech VSDs as 1 technology option for them. Future research must explore the extent to which differences in engagement to particular AAC technologies result in differences in communication and language learning over time as might be expected.

Telling tales: unlocking the potential of AAC technologies

Augmentative and alternative communication (AAC) has been transformed by the social media revolution made possible by the emergence of mobile technology. The cumbersome dedicated devices of the 1970s have evolved into a burgeoning AAC app industry. However, the limited use and abandonment of AAC technologies remains high. Unlocking the untapped potential of technology requires a paradigm shift in the design of AAC technologies by building systems that minimize the cognitive load placed on users, adapting to their individual physical and language needs. Telling Tales shares insights and stories of how the combination of user-centred design, interdisciplinary research and the application of intelligent computing is providing a vision of future generations of AAC technologies.

Designing effective AAC displays for individuals with developmental or acquired disabilities: State of the science and future research directions

This paper reviews research on the impact of AAC display variables on visual attention and performance of children with developmental disabilities and adults with acquired conditions, and considers implications for designing effective visual scene displays (VSDs) or grids. When using VSDs with children with developmental disabilities or adults with acquired conditions, research supports the use of personalized photo VSDs that include familiar people engaged in meaningful activities, with navigation bars with thumbnail VSDs, located adjacent to the main VSD. Adults with acquired conditions seem to benefit from the inclusion of text boxes adjacent to the scene. Emerging evidence supports the use of motion to capture visual attention to VSDs (video VSDs) or to specific elements in VSDs. When using grid displays with children with developmental disabilities, research supports the use of spatial cues and clustering based on internal symbol colour to facilitate visual searching and selection. Background colour does not seem to facilitate searching for symbols on smaller displays, and may actually distract children from processing the meaningful components of symbols. Preliminary research suggests that the organization of onscreen keyboards and the number, types, and pairings of symbols in grids may impact performance of adults with acquired conditions. Directions for future research are discussed.

Effect of Video Embedded with Hotspots with Dynamic Text on Single-Word Reading by Children with Multiple Disabilities

Background

The purpose of the study was to evaluate the effects of an intervention using an AAC app programmed with video visual scene displays (VSDs) embedded with hotspots with the Transition to Literacy (T2L) feature on single-word reading.

Method

Three school-aged children with multiple disabilities participated in a multiple baseline across participants design. Four names of characters in favorite movies and shows served as target words for each participant.

Results

All three children demonstrated an increase in accurate identification of target words from baseline to intervention with Tau-U effect sizes for the participants of 0.69, 0.76, and 0.84, all of which were statistically significant (p<0.05).

Conclusions

Clinicians can consider including the intervention evaluated in the current study as one component of literacy intervention for school-aged children with multiple disabilities. Future research should further evaluate video VSDs and the T2L feature for use with individuals with multiple disabilities.