The Urgency of Using Speech Generating Devices (SGD) for Social Communication Improvement Therapy for Autistic Children in Schools

Purpose: In this paper the perceptions of three mentors and three mentees who took part in a speech generating device (SGD) mentoring programme are presented. The aims of the study were to investigate the participants’ views on taking part in the mentoring programme and their satisfaction with the outcomes.Method: Information was gathered through semi-structured interviews with the six mentoring programme participants. Interview data were analysed for content themes.Results: Thematic analysis revealed six themes. Of these themes, five were identified in both the mentor and mentee’s data. These themes were: satisfaction with the SGD mentoring programme, mentee improvement in SGD use, the importance of a role model of SGD use, the SGD mentoring relationship as a helping relationship, and SGD mentoring contributes to mentor self-esteem. The remaining theme, mentors who use an SGD learn from the mentoring experience, was generated from the mentor’s data only.Conclusions: The results of this study provide initial evidence in support of mentoring among people who use an SGD. A total of five of the six participants perceived that people learning an SGD can benefit from SGD mentoring by experienced users of SGDs and agreed on a need for such mentoring programmes to improve SGD use.Implications for RehabilitationA mentoring programme involving experienced and new users of speech generating devices (SGDs) has the potential to improve learners’ SGD use.The results of this study provide preliminary evidence in support of mentoring from the perspective of people who took part in an SGD mentoring programme.Five of the six participants perceived that learners can benefit and agreed on a need for such programmes to improve SGD use.Participation in mentoring can contribute to the personal growth of adult mentors and enable them to make a positive contribution to the AAC community.

Purpose. This study explored the perspectives of adults who use a speech generating device (SGD) on the development of a mentoring programme to improve device use. Adults who are competent SGD communicators would mentor new learners. The aims were to investigate the participants' views on peer mentoring to improve SGD use, the critical components of an SGD mentoring programme and the issues that might facilitate the likelihood of a programme's success.Method. Semi-structured interviews were conducted with 14 adults who use an SGD. These interviews were analysed for content themes.Results. Thematic analysis revealed that participants perceived that new SGD learners would benefit from mentoring by experienced SGD communicators. Participants considered benefits for new learners would include the opportunity to see successful use of an SGD and the opportunity to receive support and guidance from someone who has a shared experience of learning to use an SGD. Participants considered benefits for mentors to include the satisfaction gained from helping new learners. Participants suggested guidelines for establishing a programme and areas in which SGD mentors would require training.Conclusions. Participants indicated a need for a mentoring programme to improve SGD use. Such a programme might help address challenges that those new to learning an SGD encounter.

Learning to use a speech generating device (SGD), also known as a voice output communication aid (VOCA), is a challenging experience for new device learners. These learners typically rely on training from speech-language pathologists (SLPs) and may not meet other users who are competent SGD communicators. The aim of this study was to explore SLPs' perceptions of the important components of a program where adults who use an SGD mentor new learners. A total of 17 SLPs experienced in augmentative and alternative communication (AAC) participated in one of three focus groups. The focus group discussions were analysed for content themes and these were verified with participants. Thematic analysis revealed that experienced SLPs perceived that a mentoring program to improve SGD use might help people new to using SGDs. Participants were positive about SLPs collaborating with SGD mentors to support new learners. They suggested ways in which SLPs could provide assistance and guidelines for establishing a mentoring program. Potential benefits identified for new learners included opportunities to view successful use of an SGD in everyday settings and to receive support and guidance. Benefits for mentors included the satisfaction of helping new learners.

Purpose: Language learning, including on a speech-generating device (SGD), relies on having communication opportunities to use language. Yet, children who use SGDs do not consistently use their devices throughout the day. As a first step towards increasing device use, it is important to determine how the numerous contexts (e.g. recess, lunch, academic) that exist throughout the school day impact the frequency and type of communication opportunities that children have. Within this study, we used complex adaptive systems theory to investigate whether there were differences in how frequently nonspeaking autistic children classified as emerging communicators (i.e. children who do not consistently produce two-word utterances independently and do not communicate for a variety of communicative functions) used their SGDs to communicate and the type of communication they produced (i.e. spontaneous, prompted, or imitation) across different classroom contexts. Method: Fourteen autistic children who use an SGD as their primary mode of communication were videotaped up to nine times throughout different school days. The videos were coded for the type of device use (i.e. whether the child’s use of the device was spontaneous, prompted, or imitation) and classroom context, which were categorised by the inherent level of support and directiveness. Result: There was a significant difference in SGD use across classroom contexts. Overall, the children communicated more and engaged in more spontaneous, prompted, and imitated communication in classroom contexts with high levels of structure (e.g. tabletop work) compared to contexts with low levels of structure and directiveness (e.g. free play). Conclusion: This study highlights the need to increase communication opportunities across all school contexts. Creating appropriate communication opportunities in all contexts, especially those with less structure, will help ensure that communication does not become context-bound.

Children with Autism Spectrum Disorders: Three Case Studies

The aim of this study was to explore practicing speech-language pathologists' (SLPs') perceptions of factors that could facilitate or prevent the use of speech-generating devices (SGDs) in bilingual individuals with aphasia. Specifically, this exploratory study sought to identify the facilitators and barriers to SGD use in individuals with culturally and linguistically diverse backgrounds. An online survey was distributed to SLPs through an e-mail listserv and social media of an augmentative and alternative communication company. This article focused on the results of the survey items related to (a) the presence of bilingual individuals with aphasia on an SLP's caseload, (b) training related to SGD or bilingual aphasia, and (c) barriers and facilitators to SGD use. A thematic analysis was conducted to analyze the barriers and facilitators to SGD use reported by the respondents. A total of 274 SLPs who met the inclusion criteria had experience in implementing SGD for people with aphasia. Regarding relevant training, our results indicated that very few SLPs received bilingual aphasia intervention training (17.22%) or bilingual SGD training (0.56%) in graduate school. The results from our thematic analysis revealed four major themes of barriers and facilitators to SGD use, including (a) hardware and software, (b) cultural and language content, (c) SLP's cultural and linguistic competency, and (d) resources. Practicing SLPs reported several barriers to SGD use in bilinguals with aphasia. Most notably, language barriers for monolingual SLPs were seen as the greatest barrier to language recovery in individuals with aphasia whose primary language is not English. Several other barriers were consistent with previous research, such as financial factors and insurance disparities. The top three most important factors that facilitate SGD use in bilinguals with aphasia, as identified by the respondents, include user-friendly symbol organization, personalized words, and ease of programming.

To describe the communication of patients who received electronic speech-generating devices (SGDs) following surgical procedures for head or neck cancer. Exploratory, complementary mixed methods. Otolaryngology surgical inpatient unit of an urban teaching hospital. 10 purposively selected patients with a mean age of 57.1 years (SD = 12.8 years) and moderately severe illness (Acute Physiology and Chronic Health Evaluation III score mean = 27.1 + 13.2) who had SGDs in their hospital rooms for 9.1 + 6.2 days. Observation, interviews, questionnaires, and clinical record review. Communication methods, communication content, SGD use, communication quality (i.e., ease and user satisfaction), barriers to SGD use, and patient clinical characteristics. SGDs were used in message construction in 8 (17%) out of 48 total observed communication events. Writing (31%) and nonverbal communication (46%) were the most frequently observed primary methods of communication used by patients with head and neck cancer postoperatively. Five patients demonstrated occasional SGD use with or without cuing, and one used the SGD as the dominant communication method. Ease of Communication Scale scores showed only slightly less difficulty with communication when compared to a historic control group. Patients initiated communications more often when SGDs were used in message construction. Poor device positioning, staff unfamiliarity with SGDs, and patient preference and ability for writing were barriers to SGD use. Although writing and making gestures were the most common communication methods, SGDs were used successfully by selected patients and may be particularly beneficial for constructing complex messages during conversation. SGDs may be an appropriate assistive communication strategy for postoperative patients with head and neck cancer. Nurses can facilitate effective patient communication with SGDs by cuing patients on device options and positioning SGDs within easy reach.

Telepractice is rapidly gaining popularity as a cost-effective and convenient alternative to in-person services for a range of speech-language pathology (SLP) applications. To date, there has been little research investigating the use of telepractice to support families with a new speech generating device (SGD). This paper reports on the outcomes of a novel online training and support program, trialed with 4 underserviced Australian families of children with a new SGD. The program consisted of 6 video-narrated lessons on SGD use, along with an online supervision and practice component conducted via videoconference. Semi-structured interviews were undertaken with parents following their completion of the program. Parents noted the telepractice support model offered a range of benefits, including convenient service access and flexible learning options. Challenges included technology limitations and increased pressure on parents to coordinate home practice. Overall, parents reported that the telepractice program was a positive experience for them and their children. Findings indicated that telepractice is a promising mode of service delivery for those learning to use a new SGD. Further research in this area is warranted.

Silence Is Not Golden

You have accessThe ASHA LeaderFeature1 Nov 2008Carriers to Cover Communication Devices: ASHA Helps to Reverse Exclusion Policies in Northwest States Angela Foehl Angela Foehl Google Scholar More articles by this author https://doi.org/10.1044/leader.PA.13152008.1 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Thousands of children with communication disorders in Northwestern states could benefit from the reversals of health insurance policies that excluded coverage for augmentative and alternative communication (AAC) devices and speech-generating devices (SGD). The reversals of two separate policies—which may also benefit adolescents and adults who qualify for the coverage—followed ASHA’s strong advocacy. The companies are Premera and The Regence Group, both Blue Cross Blue Shield carriers based in the Northwest. Neither company explicitly excluded coverage, but did so indirectly, characterizing the devices as “investigational” for relevant speech disorders. Premera excluded AAC devices and SGDs for disorders “due primarily to autism or other pervasive developmental disorders.” Regence’s language was slightly different, excluding the devices “for the treatment of autism, autism spectrum disorders, or mental retardation.” “Investigational” or “experimental” are terms used by insurers to preclude coverage for a given treatment or device because they are not accepted practice in the field and do not meet the “medical necessity” prerequisite for coverage. Premera Blue Cross Premera’s coverage change for AACs or SGDs could affect nearly 9,000 children with autism spectrum disorders (ASD). Adolescent and adult subscribers who require the devices for ASD or pervasive developmental disorders also will be eligible. Under the revised policy, SGD and AAC devices still must meet the durable medical equipment (DME) and medical-necessity criteria. Devices that are not dedicated SGDs, such as computers and personal digital assistants that perform other functions, will not meet the DME definition. AAC/SGD-enabling software is covered, but installation and technical support costs are not. The Premera companies include Premera Blue Cross of Washington and Premera Blue Cross Blue Shield of Alaska—with more than 1.6 million subscribers in Washington, Alaska, Oregon, and Arizona—and other non-Blues subsidiary plans. In correspondence with Premera earlier this year, ASHA documented how the use of SGD and AAC devices for autism-related speech-language impairments conforms to the national practice standard for speech-language pathologists and is not considered investigational. In advocating that autism-related disorders receive the same treatment as other etiologies in coverage determinations for SGDs and AAC devices, ASHA emphasized documented research, such as the 2006 meta-analysis by Diane C. Millar and Janice C. Light (Journal of Speech, Language, and Hearing Research, 49, 248–64), which demonstrate communication improvements in clients with autism through the use of AAC devices. The Regence Group Up to 18,000 children covered by Regence could have ASD; there may be adult patients who would benefit from these devices as well. Regence comprises several Blue Cross and/or Blue Shield Plans that serve Idaho, Oregon, Utah, and much of Washington. ASHA used documentation from the Premera advocacy package with Regence, emphasizing that Premera reversed its policy on the same basis. In response to ASHA, Regence removed the investigational status of AAC devices and SGDs effective Sept. 1. Author Notes Angela Foehl, director of private health plans advocacy, can be reached at [email protected] or 800-498-2071, ext. 5677. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 13Issue 15November 2008 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2008 Metrics Downloaded 81 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2008 American Speech-Language-Hearing AssociationLoading ...

Purpose: Although parent-implemented interventions for children with a speech-generating device (SGD) have been well researched, little is known about parents’ or speech-language pathologists’ (SLPs) views around parent training content. In this project, we aimed to identify areas that parents and SLPs consider should be included in training for families with a new SGD. Methods: Seven parents of children with an SGD and three SLPs who were new to the SGD field, participated in individual semi-structured interviews. Ten SLPs experienced in SGD practice took part in two focus groups. Data were analysed using grounded theory methods. Results: Participants identified the following areas suitable for inclusion in a family SGD training package: (a) content aimed at improving acceptance and uptake of the SGD, including technical guidance, customisation and reassurance around SGD misconceptions; (b) content around aided language development and (c) home practice strategies, including responsivity, aided language stimulation and managing children’s motivation. Conclusions: Participants identified diverse training targets, many of which are unexplored in parent-training research to date. Their recounted experiences illustrate the diversity of family capacity, knowledge and training priorities, and highlight the need for collaborative planning between families and SLPs at all stages of SGD training.Implications for RehabilitationTraining needs for families with a new speech generating device (SGD) are diverse, ranging from technology-specific competencies to broader areas, such as advocacy, teamwork and goal-setting skills.Each family with a new SGD will have a unique profile of training needs, determined by individual learning capacity, priorities, prior knowledge and experience, as well as their child’s current communication skills and future support needs.Parents and speech-language pathologists (SLPs) may hold different priorities concerning family SGD training, necessitating ongoing team discussion.

Purpose: This study reports a secondary analysis of the nature of communicative functions and modalities used in initiations and responses of minimally verbal preschoolers with severe autism spectrum disorder (ASD) from a previously published study (Thiemann-Bourque, Feldmiller, Hoffman, & Johner, 2018). This analysis focused on the final cohort (n = 6) from a group design study (N = 45) that examined a peer mediation and speech-generating device (SGD) intervention compared to an SGD-only condition.Method: After teaching peers to use an iPad as an SGD within a modified stay-play-talk approach, school staff implemented SGD instruction in child–peer dyads during typical preschool activities. To investigate individual differences among children who demonstrated increased communication acts in the peer + SGD condition, changes in reciprocity, modalities used, and communicative functions were examined using a multiple-baseline design across children. Fidelity of implementation and social validity data were also collected.Results: Six children with ASD and their peers demonstrated more balanced reciprocity, with individual differences in how and why children communicated during exchanges. That is, all children with ASD increased in SGD use as their primary communication mode; 3 children used different modalities including more speech, and 3 children used primarily gestures and SGD. The most frequent function expressed was requests for objects. More modest increases were observed in comments and requests for actions, with negligible changes in gaining attention. Social validity reports by naive judges reflected clear improvements in communication interactions. Conclusion: Findings are promising for a preschool SGD intervention that can expand children’s modalities and communicative functions to engage in balanced exchanges with peer partners.Figure S1. Total rates of communication acts for children with ASD directed to peer partners across phases.Figure S2. Total rates of communication acts for peer partners directed to children with ASD.ResultsBourque, K. S., & Goldstein, H. (2019). Expanding communication modalities and functions for preschoolers with autism spectrum disorder: Secondary analysis of a peer partner speech-generating device intervention. Journal of Speech, Language, and Hearing Research. Advance online publication. https://doi.org/10.1044/2019_JSLHR-19-00202

2013 Medicare Proposal Outlines New Reporting Rules

The use of technology, especially speech-generating devices (SGDs), has generated a great deal of attention. In order to assess the quality and effectiveness of such strategies, many issues related to terminology and teaching require careful attention. The first section begins with a discussion about functional communication, including long-term goals, from a behavioral perspective. Key issues will include speaker vs. listener distinctions, functional units, and factors related to expanding communication repertoires. The next section reviews SGDs, their popularity, and concerns such as distinguishing between toy use vs. communication device and the role of the audio output. Next, factors related to demonstrations that a user knows the meaning of words in different modalities will be considered. There follows a look at some research examples related to both SGD and picture use by adolescents and adults with ASD regarding functional communication. This section includes examples of studies that appear to have overestimated functional outcomes as well as noting the overall paucity of research demonstrating a robust gain in repertoire size and complexity. Lastly, suggestions are offered associated with determining how clinicians can assure that efforts to teach functional communication to individual teenagers and adults will result in effective outcomes.

Three children diagnosed within the autism spectrum between the ages of 5 and 7 years at different stages of communication development were supplied with speech-generating devices (SGDs) in their homes. The parents were taught to introduce the SGDs into home routines and the effects were evaluated naturalistically. Videotapes recorded by the parents before and during SGD use were coded with respect to communication effectiveness, mode, role in turn taking, and engagement in activity. Findings varied among the children and activities, but an increased level of communication effectiveness was seen during SGD use for all children. Variations of outcome among the three children and factors of importance for effective SGD use in the homes of children with autism spectrum disorders are discussed.