Alternative Communication Intervention Research Articles

Socio-Communicative Behaviors Involving Minimally Speaking Autistic Preschoolers and Their Typically Developing Peers: Effects of an Augmentative and Alternative Communication Intervention Package.

The purpose of this study was to examine the effectiveness of an augmentative and alternative communication (AAC) intervention package consisting of systematic instruction and aided AAC modeling with speech-output technology on the acquisition, maintenance, and generalization of socio-communicative behaviors in four minimally speaking, preschool-aged, autistic children. A multiple-probe design across behaviors (i.e., initiating a request for a turn, answering questions, and commenting) replicated across participants was implemented to evaluate the effects of the intervention package on socio-communicative behaviors. Furthermore, a pretreatment and posttreatment multiple-generalization-probe design was used to assess generalization across typically developing peers who were not a part of the intervention. Maintenance data were collected 3 weeks post intervention. Visual analysis, corroborated by nonoverlapping of all pairs statistics, established a strong functional relationship between the AAC intervention package and all targeted socio-communicative outcomes for two participants. For the other two participants, inconsistent intervention effects were observed. In terms of generalization from interacting with the researcher to typically developing peers, a functional relationship between the intervention and generalization outcomes for all targeted behaviors was established for only one participant (i.e., Aiden). The outcomes of this study suggest that aided AAC modeling and systematic instruction using a speech-output technology may lead to gains in socio-communicative behaviors in some minimally speaking, preschool-aged, autistic children. https://doi.org/10.23641/asha.27091879.

Frequency of Hebrew word usage by children with intellectual and developmental disabilities: implications for AAC core vocabulary

Appropriate vocabulary selection for augmentative and alternative communication (AAC) intervention is crucial to support communication and language development in children with intellectual and developmental disabilities (IDD). Core vocabulary lists are commonly used to guide this process, and there is a need for language-specific consideration. This paper aimed to develop a wordlist for selecting the core vocabulary for AAC intervention for young Hebrew-speaking children with IDD. Five children (age 3;5–8;4) were audio-recorded in naturalistic interactions with an interviewer and family members. Using Levy’s clinical corpus in the Child Language Data Exchange System (CHILDES) and Child Phonology Analyzer (CPA) tools and preestablished codes, wordlists with usage frequencies were extracted and coded for lexeme, lexical categories and functions or content. The percentages of the 20, 50, 100, and 200 most frequent lexemes were calculated for each child and for the five children combined. The top 200 most frequently used lexemes constituted 85% of the composite lexicon. A comparison was made between this study list and a previous list derived from language samples of typically developing (TD). Lexemes representing function words dominated, albeit with a slight preference for content words in children with IDD. Among the content words, children with IDD used more adverbs, while children with TD used more verbs. Implications for AAC core vocabulary are discussed.

Combining low-technology augmentative and alternative communication with regular aphasia treatment: interim findings of a hospital-based RCT in post-stroke patients

ABSTRACT Background Previous research indicates that low-technology (low-tech) augmentative and alternative communication interventions (AACT) can enhance communication skills in individuals with post-stroke aphasia in China. However, there is limited evidence for low-tech AACT in inpatient settings. Aim This study aims to evaluate the impact of low-tech AACT combined with speech-language therapy (SLT) on communication skills related to basic needs, quality of life, and spoken language function among individuals with post-stroke aphasia in an inpatient setting. Methods & Procedures Twelve participants with aphasia having difficulty in daily communication were randomly assigned to an experimental group, receiving 30 minutes of SLT and 30 minutes of low-tech AACT per session (AACT + SLT), or a control group, receiving 60 minutes of SLT per session (SLT), over ten sessions in two weeks. Primary outcomes were measured using the basic needs (CBN) domain of the functional assessment of communication skills for adults (FACS). Secondary outcomes included scores from the Chinese version of the stroke-specific quality of life scale (SS-QOL) and subtests of spoken language production and comprehension from the aphasia battery of Chinese (ABC). The study was registered in the Chinese clinical trial registry (ChiCTR2000028870). Results The results indicated a significant improvement in the CBN domain of FACS in the AACT + SLT group, with larger clinically significant changes compared to the SLT group. The AACT+ SLT group also showed significantly higher overall scores on the SS-QOL and more significant improvements in the content of spontaneous speech than the SLT group after intervention. Comparable improvements were observed in other subtests of the ABC between the two groups. Conclusions Incorporating low-tech AACT into regular SLT in inpatient settings can improve communication for basic needs in an in-patient setting, facilitate language recovery, and potentially support the overall quality of life, compared to SLT alone, for people with post-stroke aphasia. This combined approach demonstrates preliminary feasibility in hospital settings, suggesting the value of low-tech AACT in aphasia rehabilitation.

Augmentative and Alternative Communication Interventions in Critical and Acute Care With Mechanically Ventilated and Tracheostomy Patients: A Scoping Review.

Communication with nonspeaking patients is a critical challenge of person-centered care. This scoping review aimed to map the literature on augmentative and alternative communication (AAC) interventions for nonspeaking mechanically ventilated and tracheostomy patients in critical and acute care settings. Electronic database, ancestry, and forward citation searches were conducted using eligibility criteria established a priori. Data were extracted, synthesized, and summarized according to scoping review methodology. Studies were categorized by type of intervention and summarized in terms of purpose, participants, design, quality appraisal (including validity and reliability of selected efficacy measures), and efficacy. Small-to-large treatment effect sizes indicated demonstrable impact on patient health and communication efficacy with high-tech and no-tech visual interface-based interventions and systematic nurse training interventions. Treatment effects primarily pertained to dependent variables of patient anxiety, communication satisfaction, comfort, symptom self-reporting, and nursing practice changes. There is a paucity of high-quality AAC intervention research for mechanically ventilated and tracheostomy patients in critical and acute care settings. Emergent evidence suggests that select visual interface and nurse training interventions can impact efficacy of patient-provider communication and patients' overall health. https://doi.org/10.23641/asha.26506102.

Special Education Teachers’ Perspectives Toward Tablet-Based Augmentative Alternative Communication (AAC) Devices

Several communication interventions have been used with nonverbal individuals with autism spectrum disorder (ASD) for a long time. One of these methods that are effective in enhancing the communication skills of these individuals is tablet-based devices (e.g., iPads). Special education teachers have a significant role in successfully implementing the augmentative alternative communication (AAC) intervention. Therefore, this study used a qualitative approach to determine special education teachers’ perspectives on the effectiveness of iPads as an AAC system and the barriers they face when using such devices. The researcher interviewed two special education teachers who had experience using iPads for communication in their classrooms. In addition to the semi-structured interviews, the researcher observed group/individualized instructions and noted the teachers’ reactions to using iPads to communicate with their students. The findings indicated that practitioners had positive attitudes toward using iPads for communication. As for the difficulties, teachers stated that one of the significant barriers was having students whose perspective of the iPad as an entertainment tool only.

Identifying Components of a Person-Centered Augmentative and Alternative Communication Intervention for People With Dementia: Opinions of an International Expert Panel.

Despite general agreement on the importance of person-centered care in speech-language pathology, guidelines for developing person-centered interventions for those with dementia are limited. This study aimed to obtain expert opinion on the components of a person-centered augmentative and alternative communication (AAC) intervention for persons with dementia. A modified electronic Delphi technique was employed in a single round. A purposively sampled panel of experts was invited to provide their opinion on three open-ended questions related to (a) the elements of person-centered care, (b) communication supports, and (c) the interaction outcomes of a person-centered intervention. Thirty-one experts from nine countries participated on the panel. The majority were speech-language pathologists primarily involved in research. Qualitative written data were coded and analyzed using content analysis. Nine components were identified across the three open-ended questions: (a) the unique characteristics of the person with dementia, (b) working with a person with dementia, (c) preserving personhood, (d) a different view on person-centered care, (e) a range of communication supports, (f) supportive conversational partners, (g) designing communication supports, (h) interaction outcome measure, and (i) meaningful interaction outcomes. This study identified nine components that are useful in guiding speech-language pathologists in crafting future person-centered AAC interventions for people with dementia.

Aided augmentative and alternative communication intervention for adults with developmental disabilities: a scoping review

Objectives The purpose of the current study was to review the available literature on aided augmentative and alternative communication (AAC) intervention for adults with developmental disabilities (DD) excluding autism. AAC refers to strategies used to compensate for temporary or permanent impairments, activity limitations, and participation restrictions of individuals with severe disorders of speech and language production. Methods The scoping review searched seven databases and utilized keywords including adults, developmental disabilities, and augmentative and alternative communication. Extracted variables included study design, study intervention domain according to the Communicative Competence framework (linguistic, operational, social, strategic), and study results (positive, negative, mixed). Results Nineteen studies were included in the review with 43 participants in a 30-year period. Most studies were single-subject design studies (n = 12). Interventions varied widely but most focused on social (n = 11) or linguistic (n = 9) skills. Communication partner training was targeted in eight of the 19 studies. Conclusions Relatively limited research has addressed aided AAC interventions for adults with DD. While outcomes of current research studies are largely positive, it is necessary to further investigate AAC intervention techniques for adults with DD.

Effects of an Augmentative and Alternative Communication Intervention Package on Socio-Communicative Behaviors Between Minimally Speaking Autistic Children and Their Peers.

The purpose of this study is to investigate the effectiveness of an augmentative and alternative communication (AAC) intervention package consisting of systematic instruction and aided modeling with speech-output technologies on the acquisition, maintenance, and generalization of socio-communicative behaviors-initiating a request for a turn, answering questions, and commenting-in four, minimally speaking (MS) autistic children between the ages of 6 and 9 years. A multiple-probe design across behaviors replicated across participants was implemented to evaluate the effects of systematic instruction and aided modeling on initiating requests for a turn, answering questions, and commenting behaviors. Additionally, a pre- and posttreatment multiple-generalization-probes design was used to assess generalization across peers. Visual analyses demonstrated experimental control for two participants (i.e., Derek, Ajay) showing a functional relationship between the intervention and outcomes across all social communicative behavior. For one participant (i.e., Matthew), experimental control could not be established because he did not reach the learning criterion for commenting. The fourth participant (i.e., John) transferred to a different school after making some progress on requesting. Effect size indicator analyses corroborated these findings, indicating medium-to-strong effects for initiating requests for a turn strong effects for answering questions, and medium-to-strong effects for commenting. Generalization of socio-communicative behaviors from researcher to a typically developing peer was variable across participants. Participants maintained socio-communicative behaviors 3 weeks after the last intervention session with varying degrees of success. The outcomes of this study suggest that aided modeling and systematic instruction using speech-output technologies may lead to gains in socio-communicative behaviors in some MS autistic children. https://doi.org/10.23641/asha.25799935.

The prevalence of relational basic concepts on core vocabulary lists for AAC: is frequency enough?

The selection of appropriate vocabulary is a crucial and challenging aspect of augmentative and alternative communication (AAC) intervention. Core vocabulary lists are frequently used to support vocabulary selection for children who require AAC. A vocabulary domain that has garnered limited attention within the AAC literature is relational basic concepts (RBCs). RBCs describe relationships between objects, persons, or situations, and play a pivotal role in language development, communication, and academic success. For the present study, we created a list of 156 RBCs, drawing primarily from assessments that measure basic concept knowledge in preschool and early elementary school students. We examined the overlap of these words on nine core vocabulary lists. We found that most concepts were not represented on any core lists. Additionally, there was relatively little overlap of RBCs between the core lists. These findings suggest that vocabulary selection resources created using exclusively a core vocabulary approach may have limited utility for identifying many concepts that preschool and early elementary students are expected to know and use. Implications for AAC research and practice are discussed with emphasis on the need for further consideration of RBCs within vocabulary selection practice and the field of AAC at large.

Speech and language in DDX3X-neurodevelopmental disorder: A call for early augmentative and alternative communication intervention.

Pathogenic variants in DDX3X are associated with neurodevelopmental disorders. Communication impairments are commonly reported, yet specific speech and language diagnoses have not been delineated, preventing prognostic counseling and targeted therapies. Here, we characterized speech and language in 38 female individuals, aged 1.69-24.34 years, with pathogenic and likely pathogenic DDX3X variants (missense, n = 13; nonsense, n = 12; frameshift, n = 7; splice site, n = 3; synonymous, n = 2; deletion, n = 1). Standardized speech, language, motor, social, and adaptive behavior assessments were administered. All participants had gross motor deficits in infancy (34/34), and fine motor deficits were common throughout childhood (94%; 32/34). Intellectual disability was reported in 86% (24/28) of participants over 4 years of age. Expressive, receptive, and social communication skills were, on average, severely impaired. However, receptive language was significantly stronger than expressive language ability. Over half of the assessed participants were minimally verbal (66%; 22/33; range = 2 years 2 months-24 years 4 months; mean = 8 years; SD = 6 years) and augmented speech with sign language, gestures, or digital devices. A quarter of the cohort had childhood apraxia of speech (25%; 9/36). Despite speech and language impairments, social motivation was a relevant strength. Many participants used augmentative and alternative communication (AAC), underscoring the need for early, tailored, and comprehensive AAC intervention.

A systematic review of acquisition and mastery of skills taught using the Picture Exchange Communication System

The Picture Exchange Communication System (PECS) is a popular augmentative and alternative communication intervention for individuals with developmental disabilities that includes six, sequential phases of instruction. We systematically reviewed published and unpublished single-case PECS studies for details about the percentage of participants mastering PECS phases, how long it took participants to master PECS phases (in trials to mastery), and what constituted mastery of PECS phases. We found most participants mastered only the first two phases of PECS, and Phases I, II, and IV showed the slowest and widest variability in trials to mastery. Moreover, participants who were taught the third PECS phase learned to select from an average array of three symbols, which may limit the range of messages they can communicate. We discuss our findings in light of a few important limitations and provide directions for future researchers along with recommendations for professionals who might consider PECS.

Current Trends in Augmentative and Alternative Communication Intervention for Minimally Verbal Autistic Children

Current Trends in Augmentative and Alternative Communication Intervention for Minimally Verbal Autistic Children

Parents' Perspectives of Augmentative and Alternative Communication: From Assessment to Implementation

Purpose: Parents are known to be effective communication partners in their children's augmentative and alternative communication (AAC) intervention. This study aimed to better understand the parent perspective in the AAC acquisition, implementation, and handing processes across various primary disability labels and ages. Method: Twenty-two parents of children who use AAC engaged in phone interviews to discuss their family's experiences with AAC obtainment and intervention. A thematic analysis of the interview data was conducted. Results: The following five themes emerged: assessment procedures, early recommendations for AAC, external variables that influence device access, supports and barriers parents face when navigating AAC use with their child, and what participants would do differently. Further subthemes were also established to categorize parent responses. Conclusions: Findings support the inclusion of family-centered care for children with complex communication needs who use AAC. Parent responses indicate a greater need for interprofessional communication between children's team members and their family to provide comprehensive support. Parents also emphasized a desire to introduce AAC earlier into their family.

The application of the family of participation-related constructs (fPRC) framework to AAC intervention outcomes in children with complex communication needs: a scoping review

Participation is a fundamental human right, and being able to communicate is an essential component of participation in various life situations, such as at school, with peers, and in the community. Augmentative and alternative communication (AAC) interventions aim to facilitate communication and social interaction, independence, and participation in all aspects of life. The purpose of this study was to summarize and map the AAC intervention outcomes for children with complex communication needs onto the Family of Participation-Related Constructs (fPRC) framework. The scoping review identified 270 studies for inclusion, and the data gathered was extracted and mapped onto the fPRC framework. The results indicate that although many studies have reported on participation-related constructs such as activity competence and context, there is still insufficient focus on attendance and involvement, sense of self, and environment constructs. Hence, future research in the field of AAC is needed on the various constructs of participation proposed by the fPRC framework.

Applying a Developmental Model to Preliterate Aided Language Learning.

Childhood spoken language interventions and augmentative and alternative communication (AAC) interventions share a common purpose: maximizing communication and language outcomes. To ensure that interventions for children who require AAC also address expressive language acquisition, this clinical focus article focuses on how to apply a developmental model of language acquisition to guide AAC decision making for preliterate aided communicators, with a particular focus on vocabulary selection. A brief review of early expressive language development is presented, along with arguments for why relying on a developmental model to guide AAC decision making is so critical. A series of detailed examples of how to apply a developmental model to various AAC vocabulary selection approaches are provided, including analyses of how well each approach aligns with pragmatic, semantic, grammatical, and narrative development. No single AAC approach for preliterate AAC language learners adequately addresses both immediate and longer-term expressive language needs; every approach has both strengths and weaknesses. Clinical decision making requires an analysis of each approach to ensure that AAC service delivery teams clearly understand the inevitable linguistic gaps, with plans put into place to fill in those gaps with different approaches. Future efforts to improve preliterate AAC service provision should use a developmental model of language as a starting point, in combination with input from families, educators, and clinicians to ensure the feasibility of the chosen approaches.

Is Research on Augmentative and Alternative Communication Intervention With Children With Autism Spectrum Disorder Reflected in the Clinical Practice of Speech-Language Pathologists?

Purpose: Individuals with autism spectrum disorder (ASD) who have little to no functional speech require augmentative and alternative communication (AAC). Research on AAC intervention with individuals with ASD consistently indicates that teaching requesting skills has been the primary focus, with limited guidance on teaching social communication skills, despite the critical impact of these skills on language development. Furthermore, receptive language is typically not considered when measuring responsiveness to intervention. Thus, it is unclear how individuals with severely affected receptive language respond to current intervention techniques and whether these techniques support generalization of skills. The purpose of this qualitative study was to determine if clinical practice follows the patterns observed in the research literature and to learn more about how intervention techniques are impacting individuals in this population. Method: Thirteen practicing speech-language pathologists (SLPs) were interviewed to describe AAC intervention with this population. An interpretive phenomenological approach was used to analyze qualitative data and identify unique themes. Results: Seven primary themes emerged related to intervention targets, requesting, social communication, motivation, receptive language, perceived efficacy and challenges, and communication partners. Subthemes for each primary theme are described. Conclusions: Clinical practice resembles the research literature, as SLPs emphasize requesting and report the use of evidence-based strategies. However, SLPs reported a lack of guidance for teaching social communication, limited generalization of skills, and lack of AAC uptake by communication partners. Finally, SLPs may not consider individual receptive language abilities when making clinical decisions related to AAC. This article indicates a robust need to identify more effective AAC intervention methods that promote social communication, meet the needs of children with severely affected receptive language, and include families to improve outcomes.

Augmentative and Alternative Communication Services During the COVID-19 Pandemic: Contextual Determinants of the Parent-Speech-Language Pathologist Partnership.

The COVID-19 pandemic caused significant changes for family-professional interactions. Many services shifted to telepractice, with new opportunities for parents and speech-language pathologists (SLPs) to partner for service delivery. Parent-coached models of augmentative and alternative communication (AAC) intervention provide positive outcomes for children; however, SLPs have reported difficulty building strong partnerships with families. The shift to telepractice during the COVID-19 pandemic provided a unique context to examine factors influencing parent-SLP partnerships, particularly for parents with children who use aided AAC. Twenty-five parents and 25 SLPs who engaged in services with children and youth from 3 to 21 years of age who used aided AAC during the initial stages of the COVID-19 pandemic in June 2020 participated. Semistructured interviews were conducted individually with parents and SLPs to understand perspectives on whether the change in service delivery facilitated or hindered family-oriented practice. Inductive qualitative analysis was used to analyze information about the factors impacting parent-SLP partnerships. The parent-SLP partnership was influenced by setting and systemic determinants, and intrinsic determinants to the parent and the SLP that included their history and rapport, beliefs about partnering, and knowledge and skills. These determinants served as barriers or facilitators to their partnership. It is essential to consider the relationship, expectations, and knowledge and skills that SLPs and parents bring to the partnership, along with extrinsic structural factors that can impact this partnership. Positive rapport, valued partnership, and an openness to sharing knowledge through teaming and collaboration provided for positive parent-SLP partnerships.

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.

A Systematic and Quality Review of Augmentative and Alternative Communication Interventions that use Core Vocabulary

AbstractCore vocabulary is defined as “lexical items that are accepted as being central and indispensable to language use” (Bell, 2012, p. 1). Use of core vocabulary is common amongst professionals who teach augmentative and alternative communication (AAC) to individuals with disabilities. Although the use of AAC is often classified as an evidence-based practice (EBP) (Steinbrenner et al., 2020; Wong et al., Journal of Autism and Developmental Disorders, 45(7), 1951–1966, 2015) an analysis of the relevant intervention procedures as well as the vocabulary used is often missing from syntheses of the literature. Therefore, a systematic review was conducted to determine the quality and strength of the evidence for AAC interventions that use core vocabulary. A systematic database search and a subsequent screening process resulted in a total of 10 peer-reviewed studies that involved an AAC intervention that used core vocabulary. Each study’s outcomes were then categorized as positive, mixed, or negative and a quality review was performed using the Council for Exceptional Children’s (CEC) standards for evidence-based practices (Cook et al., Teaching Exceptional Children, 46(6), 206-212, 2015a; Remedial and Special Education, 36, 220-234, 2015b). Overall, the results suggest a lack of strong evidence in favor of AAC interventions that use core vocabulary. The results are discussed in the context of general suggestions for vocabulary selection and teaching practices for AAC systems.

Effects of Aided Communication on Communicative Participation for People With Amyotrophic Lateral Sclerosis.

Many people with amyotrophic lateral sclerosis (PALS) experience speech changes, which may interfere with participation in communication situations. This study was designed to investigate the effects of aided communication on self-rated communicative participation among PALS and the relationship between speech function and communicative participation for PALS at various stages of speech impairment and communication aid use. Participants with amyotrophic lateral sclerosis completed an online questionnaire in which they identified their current communication methods, rated their speech function, and rated their communicative participation in various situations on a modified version of the Communicative Participation Item Bank short form. PALS who reported using aided communication rated their communicative participation under two conditions: with unaided communication only and with access to all of their communication methods. Communication aids appeared to support communicative participation for many participants with dysarthria. Across all levels of speech function, PALS who use aided communication reported better participation under the all-methods condition than the unaided-only condition, with the largest benefits for participants with anarthria (Revised ALS Functional Rating Scale [ALSFRS-R] speech rating = 0). Communicative participation ratings worsened with more severe speech impairment under both conditions for most levels of speech function, but PALS with anarthria (ALSFRS-R speech rating = 0) reported better participation under the all-methods condition than those who used residual speech in combination with non speech methods (ALSFRS-R speech rating = 1). Aided communication can help PALS continue to participate in various communication situations as their speech function deteriorates. Variability in self-rated communicative participation, even for PALS at the same level of speech function, highlights the need for an individualized approach and consideration of personal and environmental factors in augmentative and alternative communication intervention. https://doi.org/10.23641/asha.22782986.