Telepractice-Supported Augmentative and Alternative Communication Intervention: A Systematic Review

Purpose: The purpose of this article is to illustrate the potential of applying augmentative and alternative communication (AAC) intervention through a short-term (2 week), intensive protocol in order to increase the communication behaviors in Chinese-speaking children with autism. In addition, possible cultural factors that may affect the outcomes of AAC intervention were identified. Method: Our project investigated the feasibility of a 2-week AAC intervention using a 32-location touch screen AAC system designed to support Mandarin Chinese (MC) with nine children with autism spectrum disorder. Mixed model trajectory analyses (MMTA) was used to evaluate changes of the targeted communication behaviors over the course of intervention. A quality assurance survey was completed by eight parents and three speech language pathologists (SLPs) implementing the program at the collaborating hospital clinic in Shanghai, China as a social validation measure. Results: The results of this collaborative project suggest a significant increase in intentional AAC usage of the pre-stored MC vocabulary during typical child-centered activities. An increase in intentional speech was observed also along with a decrease in vocalizations and gestures over the two weeks of intervention. Both primary caregivers and SLPs of the nine children reported positive attitudes and favorable agreement of the AAC intervention with the MC AAC system. Conclusion: Use of MMTA showed that a short-term, intensive AAC intervention protocol incorporating the use of a high performance MC AAC system resulted in gains in communication competence. The protocol also showed the potential of improving natural speech using an AAC system with children with autism. The results across primary caregivers and the SLPs support the importance and resource feasibility of this Chinese AAC protocol. Family values and preferences influencing clinical decisions regarding intervention and methodological considerations are discussed.

This study focused on the learning styles and preferences of augmentative and alternative communication (AAC) intervention specialists. The specific purposes of this project were to examine AAC interventionists' (a) self-efficacy for AAC intervention, (b) goal achievement orientation, (c) computer technology interest levels, and (d) learning mode preferences regarding AAC. The results revealed that AAC intervention specialists viewed themselves as highly selfconfident (self-efficacious) with regard to their ability to learn new AAC technology and teach it to others. They demonstrated a highly consistent achievement orientation profile with emphasis on mastery of content and skill and on performance to achieve goals. Their interest in computer technology was relatively low, and they preferred individual and small-group learning opportunities compared with direct instruction in new technology.

Purpose: To ensure long-term adoption and use of augmentative and alternative communication (AAC) technologies, they must be designed to support children to participate within everyday activities and routines that are prioritized by families. The aim of this study was to gain parent perspectives on how AAC technologies were integrated into everyday life.Method: Nine parents of children with cerebral palsy who used AAC technologies participated in semistructured interviews to provide their perspectives on how AAC technologies were integrated into the functional contexts of everyday life.Results: Five major themes emerged from the discussions: (a) integrating AAC into life, (b) AAC technologies, (c) child needs and skills, (d) parent responsibilities and priorities, and (e) AAC process and decision making. Children were able to use AAC technologies within a variety of everyday contexts with various partners; however, challenges included access to technologies within care routines and outdoor activities as well as partners who lacked knowledge regarding operational competencies and effective interaction strategies. To integrate AAC technologies into life, parents prioritized technology features including ease of programming, improved physical design, features to enhance efficiency and ease of access, and availability of multiple functions and features (e.g., games and leisure activities, environmental controls).Conclusion: AAC manufacturers and mainstream technology developers should work to ensure that technologies are responsive to the supports, limitations, and ideal features identified by parents. Future research should seek input from a larger group of stakeholders and use longitudinal methods to examine perceptions of AAC technologies over time.Supplemental Material S1. Semi-structured interview guide. Supplemental Material S2. Codebook. Supplemental Material S3. Bracketing statement. O'Neill, T., & Wilkinson, K. M. (2020). Preliminary investigation of the perspectives of parents of children with cerebral palsy on the supports, challenges, and realities of integrating augmentative and alternative communication into everyday life. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2019_AJSLP-19-00103

The empirical evidence to support the efficacy of augmentative and alternative communication (AAC) interventions is still quite limited. Further efficacy research is urgently needed to establish best practices, maximize outcomes, ensure accountability, and justify cost. However, conducting efficacy research in the AAC field poses significant challenges because of the heterogeneity of the population of AAC users, the complexity of AAC systems and interventions, and the intricacies of the communication process. This paper discusses some of the challenges confronted when conducting AAC efficacy research—challenges in defining meaningful research questions, determining appropriate methods to investigate these questions, and analyzing the results or outcomes of efficacy research. Some potential solutions to these challenges are discussed and illustrated using examples from current efficacy research on AAC interventions to build communicative competence.

For children with developmental disabilities and little or no functional speech, the effect of augmentative and alternative communication (AAC) interventions on the development of receptive language has been neglected in research. Purpose To map and synthesise research evidence of the effects that aided and unaided AAC interventions have on the receptive language of children with developmental disabilities. Method This scoping review used a four-pronged search strategy (electronic databases, dissertations and theses, hand search, ancestry searches) to identify germane studies. A total of 16 studies met the inclusion criteria. These studies were described in terms of the number of participants, participant characteristics, research design, AAC interventions, intervention outcomes, intervention effects, and quality appraisal. Result The review revealed positive associations between aided and unaided AAC, vocabulary acquisition and symbol comprehension. Conclusion AAC interventions may have merit for the development of receptive language skills in children with developmental disabilities. Specific gaps in relation to unaided AAC, aided augmented input strategies, morphological and syntax development, and discourse comprehension are highlighted.

Ensuring equitable access to augmentative and alternative communication (AAC) intervention services for children with complex communication needs (CCN) is crucial. Evidence suggests that racial disparities exist in access to communication interventions, disadvantaging Black children. However, no research has investigated specifically the evidence for racial disparities in AAC services for children with developmental disabilities and CCN. The current study applied post hoc data analysis methods within a preexisting, open-access data set to explore preliminary evidence of racial disparities in AAC intervention. Amount of AAC intervention was compared for Black versus white 1 preschool students at study initiation (M age = 3;8 [years;months]) and 2 years later at study completion (M age = 5;10). Black preschool students were reported to receive significantly less AAC intervention per week as compared to their white peers, both at study initiation and 2 years later. By study end, 75% of the Black children were receiving less than 60 min of AAC intervention per week, an inadequate amount to achieve meaningful gains given their significant disabilities. It is unclear what mechanisms may contribute to the observed disparities; however, it is critical that concrete steps are taken by individual speech-language pathologists, school districts, preservice preparation programs, and researchers to identify inequities in AAC services and take actions to rectify them. Future research is essential to investigate the potential factors contributing to inequalities and determine effective interventions to address them.

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. 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. 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. 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. 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. 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.

Introduction: Young children with intellectual and developmental disabilities (IDD) who have limited speech and language require access to augmentative and alternative communication (AAC) intervention, including technology and instruction. While research shows that AAC intervention can effectively support communication from children with IDD, research on its impact on school readiness skills is limited. Methods: Two preschool aged children with IDD participated in this study. Using a single case, multiple baseline across responses design for each participant, this study evaluated the effectiveness of an AAC intervention, including a high-tech AAC with a personalized color photo visual scene display with modeling, time delay, prompting, and social praise. The targeted responses were three questions from the participants’ state kindergarten readiness standards, including: “What is your first name?”; “What is your last name?”; and “How old are you?”. Results: In baseline, both participants demonstrated little success communicating answers to questions. During intervention, both participants mastered the school readiness skill of responding accurately and independently to the targeted questions. Conclusion: The current study shows that with early access to AAC intervention, children with IDD may begin to build communication skills that align with school readiness standards, providing them increased opportunity to participate fully and meaningfully in general education curricula, upon entering kindergarten.

Evidence-Based Practice in AAC

The purpose of this article is to reflect on the needs of people with little or no functional speech and the difficulties they experience throughout their lives. The mismatch between the needs of Augmentative and Alternative Communication (AAC) users and intervention provided is explored by firstly addressing the need for AAC users to become an integral part of the intervention team and in this way to professionalise consumer input. Secondly, the need for a more collaborative approach to team work is highlighted to ensure more effective problem-solving of lifespan issues. Finally, some brief comments are made about the role of the physiotherapist as part of the AAC intervention team

This article suggests the need for rethinking the role that consumer perspectives will play (and ought to play) in the design and development of future augmentative and alternative communication (AAC) technologies. After carefully defining what they mean by “AAC consumers,” “consumer perspectives,” and “AAC technologies,” the authors consider the extent to which current research has illuminated our understanding of (1) how consumers view AAC technologies and (2) how consumers themselves would define future technology needs. It's not a pretty picture. While it is clear that there already exist specific constructs and methods that could enable researchers and developers to learn more about consumer perspectives, it is equally clear that few, if any, researchers make much use of these constructs and methods. The authors focus specifically on ways that consumer perspective can helpfully infuse participatory action research, technology transfer processes, and ergonomics. In addition, the authors consider how research that investigates the ways in which assistive technologies impact the daily lives of individuals with severe communication impairment also influences public policy issues, which can in turn affect future definitions of AAC technology needs. Throughout the article, the authors advocate for a paradigm shift in the quantity and quality of the collaborations that occur between AAC consumers and AAC researchers, manufacturers, and developers. Augmented communicators and their families have a major stake in all types of research that can affect the design and development of AAC devices and accessories, and the results of this research, in turn, can affect public policy decisions about AAC technologies. This makes it all the more important that AAC consumers be involved at each step of the research and development process.

Purpose The purpose of this study was to determine the effects of augmentative and alternative communication (AAC) intervention using a speech-generating device (SGD) on acquisition, maintenance, and generalization of multistep requesting and generic small talk in three children with severe autism spectrum disorder (ASD) between the ages of 7 and 13 years. Method A multiple-baseline design across participants combined with a posttreatment multiple-generalization-probe design was used to assess acquisition, generalization, and maintenance of target communicative behaviors with the experimenter and the participants' familiar communication partners (FCPs). Intervention was composed of systematic instruction in the use of an SGD using least-to-most prompting, constant time delay, error correction, and reinforcement. Results Visual analysis established a strong functional relationship between the independent variable and the two dependent variables (i.e., requesting preferred activities, engaging in generic small talk) for all three participants. Effect size indicator analyses corroborated these findings, indicating strong effects for performing multistep requesting and medium effects for engaging in generic small talk. All participants were able to generalize the acquired communicative behaviors to request new and untrained snacks and activities and engage in generic small talk with FCPs who were not part of the training. Maintenance of acquired communicative behaviors was demonstrated 3 weeks post completion of intervention. Conclusion This study provides preliminary evidence that AAC intervention using an SGD and incorporating least-to-most prompting, constant time delay, error correction, and reinforcement is effective in terms of multistep requesting and generic small talk behaviors in children with severe ASD. Supplemental Material https://doi.org/10.23641/asha.16663630.

Access to Justice: An SLP’s Guide to Helping Persons with Complex Communication Needs Voice Their Case

This systematic review aimed to determine the effects of augmentative and alternative communication (AAC) intervention on speech production in children with autism or pervasive developmental disorder-not otherwise specified. A systematic review methodology was utilized to limit bias in searching, selecting, coding, and synthesizing relevant treatment studies. This involved a multifaceted search for studies written between 1975 and May 2007 using various bibliographic databases, dissertation databases, hand searches of selected journals and published compilations of AAC theses and dissertations, and ancestry searches. To be included, studies had to meet stringent criteria. A coding manual and form facilitated data extraction in terms of participant characteristics, treatment characteristics, design and measurement, and outcomes. Nine single-subject experimental design (27 participants) and 2 group studies (98 participants) were included. Results indicated that AAC interventions do not impede speech production. In fact, most studies reported an increase in speech production. However, in-depth analyses revealed that the gains were rather modest. Although AAC interventions do not appear to impede speech production and may result in increased speech production, the modest gains observed require realistic expectations among clinicians and other stakeholders. Future research should be more hypothesis driven and aim to identify predictive child characteristics, such as prior speech imitation and object exploration skills.

Children with Autism Spectrum Disorders: Three Case Studies