Parents' priorities for AAC and related instruction for their children with Angelman Syndrome

Are minimally verbal autistic children's modality and form of communication associated with parent responsivity?

Prior work examined how minimally verbal (MV) children with autism used their gestural communication during social interactions. However, interactions are exchanges between social partners. Examining parent-child social interactions is critically important given the influence of parent responsivity on children's communicative development. Specifically, parent responses that are semantically contingent to the child's communication plays an important role in further shaping children's language learning. This study examines whether MV autistic children's (N = 47; 48-95 months; 10 females) modality and form of communication are associated with parent responsivity during an in-home parent-child interaction (PCI). The PCI was collected using natural language sampling methods and coded for child modality and form of communication and parent responses. Findings from Kruskal-Wallis H tests revealed that there was no significant difference in parent semantically contingent responses based on child communication modality (spoken language, gesture, gesture-speech combinations, and AAC) and form of communication (precise vs. imprecise). Findings highlight the importance of examining multiple modalities and forms of communication in MV children with autism to obtain a more comprehensive understanding of their communication abilities; and underscore the inclusion of interactionist models of communication to examine children's input on parent responses in further shaping language learning experiences.

A Systematic Review of Research on Augmentative and Alternative Communication Interventions for Children Aged 6-10 in the Last Decade

Purpose The purpose of this systematic review was to identify, appraise, and critically synthesize the latest available evidence on the effects of augmentative and alternative communication (AAC)-based interventions on communication skills in children aged between 6 and 10 years with mixed diagnoses. Method MEDLINE (OVID), PsycINFO (EBSCO), ERIC (ProQuest), SCIELO (WOS), Teacher Reference Center (EBSCO), and Education Database (ProQuest) were searched. The studies were independently selected by two reviewers for the purposes of the review. The methodological quality of the included studies was assessed, and characteristics and results of the studies were extracted. Results This review included 14 studies from a total of 1,204 found through an electronic search. The AAC interventions studied were effective at improving various outcomes in children with mixed diagnoses. Interventions that focused on narrative skills were the most common type. When considering the quality of the studies, the independence of assessors, data analysis, replication, and generalization of interventions were the weaker areas. Conclusions Interventions analyzed in this review improve communication skills, including phonological awareness, vocabulary, requesting, and developing narrative skills in children aged between 6 and 10 years with mixed diagnoses. The results of one study also indicate that the acquisition of skills using an AAC method is superior when the child prefers the method. Supplemental Material https://doi.org/10.23641/asha.14462256.

Refining the Behavioral Phenotype of Angelman Syndrome: Examining Differences in Motivation for Social Contact Between Genetic Subgroups

Angelman syndrome (AS) is caused by loss of information from the 15q11.2-13 region on the maternal chromosome with striking phenotypic difference from Prader–Willi syndrome in which information is lost from the same region on the paternal chromosome. Motivation for social contact and sensory seeking behaviors are often noted as characteristics of the phenotype of AS and it has been argued that the strong drive for social contact supports a kinship theory interpretation of genomic imprinting. In this study we developed an experimental paradigm for quantifying the motivation for social contact in AS and examined differences across the genetic subtypes that cause AS [deletion, imprinting centre defect (ICD), uniparental disomy and UBE3A mutation]. Using single case experimental designs we examined the rate of acquisition of behavioral responses using operant learning paradigms for 21 children with AS whilst systematically varying the nature of social and sensory reinforcement. Variability in rates of acquisition was influenced by the nature of rewarding stimuli. Across the total sample both sensory stimuli and social contact could increase the rate of rewarded behavior with difference between children in the most effective reward. A striking difference in the rewarding properties of social contact across genetic subtypes was evidenced by non-deletion genetic causes of AS showing significantly higher rates of responding than the deletion cause in the social reinforcement paradigm. The results indicate that reinforcer assessment can beneficially inform behavioral interventions and that within syndrome variability in the behavioral phenotype of AS is likely driven by genetic difference. The non-deletion cause of AS, and particularly the ICD group, may be the optimal group for further study of genomic imprinting.

The Effects of an Online Training on Preservice Speech-Language Pathologists' Use of Family-Centered Skills

Purpose Despite the recognition that family-centered services are best practice in augmentative and alternative communication services, many speech-language pathologists (SLPs) are lacking in their acquisition and implementation of family-centered skills. The purpose of this study was to evaluate the effects of online instruction in a family-centered, relational skills strategy on preservice SLPs use of family-centered skills. Method A switching replications design was used to evaluate the effects of an online training on the use of family-centered behaviors by 15 preservice SLPs who were randomly assigned to two groups. The online training taught the students a four-step relational skills strategy (summarized by the acronym LAFF): (a) Listen, empathize, and communicate respect; (b) Ask questions; (c) Focus on the issues; and (d) Find a first step. Participants were videotaped during interactions with simulated parents before and after the training. Results After an average of 61 min of instruction via the online module, all of the preservice SLPs significantly improved their demonstration of relational skills. Additionally, one parent of a child who used augmentative and alternative communication viewed the video recordings and chose 14 of the 15 postinstruction role plays as more family-centered. Conclusion The findings from this study provide support for the use of an online environment to teach preservice SLPs family-centered relational skills. In order to prepare future SLPs and ensure the delivery of family-centered services, future research is necessary, including investigations to determine whether other family-centered skills can be effectively taught through an online environment. Supplemental Material https://doi.org/10.23641/asha.12462344.

Unmet clinical needs and burden in Angelman syndrome: a review of the literature

Background

Angelman syndrome (AS) is a rare disorder with a relatively well-defined phenotype. Despite this, very little is known regarding the unmet clinical needs and burden of this condition, especially with regard to some of the most prevalent clinical features—movement disorders, communication impairments, behavior, and sleep.

Main text

A targeted literature review using electronic medical databases (e.g., PubMed) was conducted to identify recent studies focused on specific areas of the AS phenotype (motor, communication, behavior, sleep) as well as epidemiology, diagnostic processes, treatment, and burden. 142 articles were reviewed and summarized. Findings suggest significant impairment across the life span in all areas of function. While some issues may resolve as individuals get older (e.g., hyperactivity), others become worse (e.g., movement disorders, aggression, anxiety). There are no treatments focused on the underlying etiology, and the symptom-based therapies currently prescribed do not have much, if any, empirical support.

Conclusions

The lack of standardized treatment protocols or approved therapies, combined with the severity of the condition, results in high unmet clinical needs in the areas of motor functioning, communication, behavior, and sleep for individuals with AS and their families.

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.

AAC Considerations for Individuals With Angelman Syndrome

Purpose

To provide an overview of communication characteristics exhibited by individuals with Angelman Syndrome (AS) and special considerations associated with the design and implementation of augmentative and alternative communication (AAC) programs.

Method

Results of recent studies exploring individuals' uses of AAC are reviewed, with particular emphasis on factors related to individuals' acceptance and successful uses of AAC systems.

Results

Not applicable

Conclusion

Despite their inconsistent access to practices previously found to foster individuals' acceptance of AAC systems, individuals with AS demonstrate the ability to use AAC systems, including high-tech AAC devices, successfully.

Parents' perceptions of communication patterns and effectiveness of use of augmentative and alternative communication systems by their children with Angelman syndrome

PURPOSE

The author describes communication patterns and outcomes of augmentative and alternative communication (AAC) intervention for individuals with Angelman syndrome.

METHOD

Parents self-administered a web-based survey using Qualtrics software. A series of rating scales and closed questions were used to gather information about individuals' current methods of communication, including AAC devices they were using. Individuals' uses of their single most advanced AAC devices were further explored in terms of associated importance, usefulness, success, acceptance, and functional outcomes.

RESULTS

Nonsymbolic methods of communication proved to be very important to individuals, as did electronic AAC devices, although to a lesser extent. Individuals tended to have access to more than one electronic device concurrently. Although numerous devices were cited, mobile technologies, particularly iPads, were especially prevalent. This represented a significant change from a previous investigation. Overall, device use was perceived to be frequently important, accepted, successful, and useful in relation to 8 different factors, although ratings across a series of 19 functional outcomes varied. Differences were noted on several measures when individuals' ages and educational placements were considered.

CONCLUSION

Results suggest a changing landscape in terms of types of devices used, particularly with respect to mobile technologies, and show clear evidence that device use is often, although not uniformly, associated with positive outcomes.

Autism spectrum disorders in the era of mobile technologies: impact on caregivers

OBJECTIVE

This paper explores possible connections among existing literature on parental stress, augmentative and alternative communication (AAC), and use of mobile technology for persons with autism spectrum disorder (ASD).

METHODS

A narrative review of the literature.

RESULTS

Parental support contributes to positive outcomes for children who use AAC. Parents identify communication as a high priority, but describe the process as challenging. AAC is often used with children with ASD, a population in which parental stress is especially high. Though there is research evidence that mobile technology is a promising tool for individuals with ASD, potentially misleading media anecdotes exist, and the effects on parental expectations and stress remain unstudied questions.

CONCLUSION

Increased understanding of the connections in these research areas should help clarify the potential impact of mobile technologies on parental stress level, help to define appropriate future research directions, and contribute to development of appropriate caregiver training.