And Alternative Communication Intervention Research Articles

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.

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.

Speech-Language Pathologists' Approach to Alternative Access for Augmentative and Alternative Communication for Children With Motor Impairments.

This study examined the processes that speech-language pathologists (SLPs) use during an augmentative and alternative communication (AAC) assessment with children with motor impairments to determine alternative access solutions. These children often are the most vulnerable to a poor fit of their AAC system, which alternative access is an integral part. Although there is an abundance of information as to what types of considerations should be made during these assessments, there is no guidance as to how the assessment is completed. The goal of this study is to build evidence about the process. A collective case design was used to gain detailed insights into the decision-making process. Interviews and vignette responses were two components of the data collection. Each of the five SLPs, or cases, who participated in the study transcripts was analyzed in isolation as part of a within-case analysis. Once each SLP's process was understood, a cross-case comparison was completed to ascertain similarities or differences across the five. The cross-case assertions are presented in this article. Although the SLPs individually reported a lack of defined process, a clear systemization became evident when considered collectively. The SLPs all focused on the child, isolated motor access skills, and used a process of experimentation over time to build their final recommendations. These results have implications for SLPs working with children with motor impairments who may benefit from AAC intervention. The shared framework can serve as a roadmap to other SLPs, especially those with less experience with these types of complex cases. The varying teaming approaches to support these cases are also discussed.

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.

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.

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.

Aided Enhanced milieu teaching to develop symbolic and social communication skills in children with autism spectrum disorder

Children who lack functional spoken language are candidates for augmentative and alternative communication (AAC). Aided AAC and naturalistic interventions offer the potential to extend the communication functions demonstrated by children with autism spectrum disorder (ASD) who are nonspeaking. Related intervention research, however, has been limited, in that interventions have generally targeted a limited range of communication functions taught in highly structured, decontextualized environments. The aim of this study was to investigate the efficacy of an intervention that combined aided AAC with a naturalistic intervention – enhanced milieu teaching (AEMT) - to increase symbolic communication in children with autism spectrum disorder. Three children with autism spectrum disorder participated in a multiple probe design, in which a range of communication functions were targeted using the AEMT. Results showed increases in the use of symbolic communication from baseline to intervention phases, which were found to be statistically significant for two of the three children (phi 0.7–0.81; p < .001). Intervention outcomes were generalized to a communication partner not involved in the intervention and maintained over time for all children. The study provides preliminary evidence that communication functions beyond object requests could be taught using a systematic, multi-element approach implemented across activities.

Experiences of Parents Supporting Their Young Children Who Use Speech-Generating Devices

Despite evidence for the usefulness of augmentative and alternative communication (AAC) for young children with complex communication needs (CCN), several barriers prevent children from accessing AAC intervention. This qualitative study is focused on understanding the lived experiences of parents accessing and learning how to use speech-generating devices with their young children (3-6 years) with CCN. Findings generate insight into the similarities and differences across families’ experiences through several categories and themes: (a) foundational perspectives (determination and resilience; finding balance); (b) experiences getting access to an AAC device (initiating access; navigating barriers); (c) experiences using an AAC device (learning and navigating challenges; supporting their child’s communication at home and in the community; seeing progress); and (d) surrounding factors (family structure, informal supports, and demands; access to services and professional supports; the COVID-19 pandemic). Implications for practice and policy are discussed related to how to improve AAC access and intervention.

A scoping review of communication outcomes measures in augmentative and alternative communication

ABSTRACT Although outcomes are a critical component of evidence-based practice, measuring augmentative and alternative communication (AAC) outcomes remains problematic. This is, in part, because there is no consensus on how to operationally define AAC communication outcomes. To gain greater insight into AAC communication outcomes, we used the communicative competence framework to determine which areas of AAC intervention have received the greatest attention and how these outcomes are being measured. The following data were charted from the 77 studies that met the inclusion criteria for the scoping review: study design, study participants, study communication target (e.g., language, word learning, etc.), and communication outcome measurements. Across the included studies, researchers used a variety of standardized and non-standardized measures to assess outcomes. Seventy-seven percent of the studies assessed social skills and 62% assessed linguistic skills. A limited number of studies measured operational (14%), strategic (4%), and psychosocial (18%) skills. Using the communicative competence framework enabled us to identify gaps in the research that has been conducted to date.

Perspectives and Experiences of Eight Latina Mothers of Young Children With Augmentative and Alternative Communication Needs

Purpose: The purpose of this study was to examine the perceptions of eight Latina mothers on early augmentative and alternative communication (AAC) services for their young children, including their decision-making process, and knowledge of AAC. The ultimate goal is to help professionals develop culturally responsive and family-centered education and training programs to facilitate AAC intervention for Latinx parents with young children who benefit from AAC. Method: The method involved in-person semistructured interviews conducted in Spanish at the mothers' homes or preferred locations, which were then video-recorded, transcribed verbatim, and translated to English. Transcripts were analyzed through a process consisting of coding, identifying themes, constructing thematic networks, summarizing thematic networks, and interpreting patterns. Results: Mothers' perceptions of early intervention services revealed a lack of knowledge about AAC, unquestioned acceptance of early intervention services, and gratitude for receiving these services. They also reported having received minimal training in AAC and expressed a desire to receive additional training. The decision-making process was matriarchal with professionals serving as the primary informants of services to be received. Discussion: This investigation adds to the existing literature by providing insight into Latinx parental perceptions of AAC, their decision-making process, and the types of training they prefer. The study highlights the importance of providing Latina mothers with meaningful opportunities to participate in the early intervention process related to the communication and language needs of their children. To establish trust, professionals should communicate clearly, accurately, and straightforwardly. Additionally, a family-centered approach rooted in the language and culture is crucial. Professionals can achieve this by providing culturally and linguistically accessible training, learning about the family's specific values and beliefs regarding AAC, and facilitating their learning so that AAC is achievable and practical. Supplemental Material: https://doi.org/10.23641/asha.24059043

Promising Strategies for Teaching Augmentative and Alternative Communication in Inclusive Educational Settings: A Systematic Review.

The purpose of this article was to conduct a systematic review of the literature on teaching or increasing the use of augmentative and alternative communication (AAC) by students with significant intellectual disabilities and complex communication needs (CCNs) within inclusive school settings. A systematic review of research literature from 1998 to 2022 was completed using multiple electronic databases, as well as citation chaining and cited author reference searches. Three hundred two articles were located with 17 meeting criteria for inclusion in this systematic review. Articles were initially screened by one author for potential inclusion; the remaining 83 were coded by one author and reviewed for consensus by three authors for inclusion in this review. Articles were analyzed and rated regarding both level of research design and quality of methodology. All studies reported positive outcomes, with students with significant intellectual disabilities and CCN, of AAC intervention implemented in an inclusive setting. Fourteen over 17 studies were single-case designs with an average rating of 76% on the Single-Case Experimental Design measure of methodological quality. Less than half of the studies assessed generalization of subject learning. Review of interventions used in the studies, however, revealed the majority of studies utilized packages of interventions, making it difficult to determine the effectiveness of individual approaches. This systematic review indicates there are promising interventions within inclusive settings for improved use of AAC by students with significant intellectual disabilities and CCN. Further research is needed, however, to obtain more data on generalization of student gains as well as to determine which specific interventions might be the most successful for this population of students in inclusive settings.

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.

Identifying Implementation Strategies to Increase Augmentative and Alternative Communication Adoption in Early Childhood Classrooms: A Qualitative Study.

The goal of this study was to identify promising implementation strategies that may increase teachers' and speech-language pathologists' (SLPs) adoption of augmentative and alternative communication (AAC) during routine classroom activities. A grounded theory approach was used to collect and code online, semistructured interviews with six special education teachers and 14 SLPs who taught children aged 3-8 years who used AAC in inclusive and self-contained special education classrooms. Interviews were transcribed and coded verbatim using the constant comparative method. During a member checking process, six participants (n = 30%) confirmed their transcripts and commented on emerging themes. Participants shared a range of implementation strategies to increase AAC use during typical classroom activities, which were organized into seven themes: distribute modern AAC equipment, provide foundational training, share video examples, develop a systematic plan for adoption, deliver practice-based coaching, alter personnel obligations to provide protected time, and connect with professionals. A preliminary thematic map was created to link implementation barriers, strategies, and potential outcomes. AAC interventions effective in clinical research can be difficult to translate into routine practice unless investigators directly explore the needs of and demands on educational professionals. Future research should define implementation strategies clearly, solicit feedback from school-personnel, and match implementation strategies to the needs of local schools to support the uptake of AAC interventions in routine classroom settings. https://doi.org/10.23641/asha.23699757.

Exploring Classroom Factors and Augmentative and Alternative Communication Use in Qualitative Interviews.

This qualitative study explores classroom contextual factors influencing augmentative and alternative communication (AAC) use in early childhood classrooms. Semistructured interviews were conducted with six special education teachers, 13 speech-language pathologists (SLPs), and one SLP assistant. Interviews were analyzed inductively in a systematic, multistep coding process using the constant comparative method with member checking. Seven themes were identified that affected AAC use in the classroom. Each theme was organized into three categories: individual-, classroom-, or school-level factors. Three themes were categorized as individual-level factors: Students' AAC systems are unavailable, professionals face challenges obtaining AAC knowledge and skills, and students' disruptive behaviors reduce access to AAC. One theme was a classroom-level factor: Classroom demands prevent AAC use. Finally, three themes were considered school-level factors: The culture of AAC influences AAC acceptance, team collaboration is essential for successful implementation, and teams need administrative support to deliver AAC interventions effectively. Conclusions: Teachers and SLPs felt that collaborative teams with AAC expertise, a school culture that endorsed AAC, and solid administrative support accelerated AAC adoption by normalizing AAC use in the classroom. Due to classroom demands, they struggled to use strategies such as aided AAC modeling and responsiveness during group instruction. Finally, participants emphasized that while it was necessary to customize AAC systems for each student, this individualization makes it harder for staff to learn each system and integrate them into classroom activities. https://doi.org/10.23641/asha.23681718.

Reported Barriers to Augmentative and Alternative Communication Service Delivery and Learning Preferences Among Speech-Language Pathologists.

Speech-language pathologists (SLPs) report extensive barriers to delivering augmentative and alternative communication (AAC) services, including the knowledge and skills necessary for AAC service delivery. Although nearly all graduate programs report the inclusion of preservice training for SLPs to provide AAC services, existing research on SLPs' characteristics of AAC service provision does not reflect these changes. This study aimed to identify current AAC service delivery characteristics, barriers, and learning preferences reported by SLPs. A survey invitation was distributed to SLPs with American Speech-Language-Hearing Association (ASHA) Certificate of Clinical Competence through social media and the ASHA Community discussion groups. Participants were 530 SLPs who predominantly identified as general practice SLPs. Participants reported 1%-25% of their weekly patient caseload has AAC needs for communication or receives AAC intervention. SLPs reported feeling at least "knowledgeable" in more than half of the targeted competency areas. The reported primary barriers to AAC service provision are knowledge, caseload, and time. Preferences for topic, format, and frequency and duration for AAC-related continuing education were highly variable among SLPs. SLPs' barriers to AAC service delivery are consistent with research from the last 15 years, revealing a lack of systematic, organizational, and informational mechanisms to support SLPs as vital members of the AAC team. Those involved in post-service instruction and training must consider the training needs of SLPs with varying competence and their experience with AAC modalities, clinical practice backgrounds, and learning preferences. AAC-related training and continuing education must reflect SLP's daily practice, learning needs, and preferences. https://doi.org/10.23641/asha.23503809.

Provision of augmentative and alternative communication interventions to Norwegian preschool children with cerebral palsy: are the right children receiving interventions?

Preschool children with cerebral palsy (CP) with no or unintelligible speech need augmentative and alternative communication (AAC), but not all children needing AAC have access to it. This study describes the use and perceived benefit of AAC and explores factors associated with receiving AAC interventions. Using a cross-sectional design, we combined parent-reported data with data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP). Communication, speech and hand function was classified according to the Communication Function Classification System (CFCS), Viking Speech Scale (VSS), and Manual Ability Classification System (MACS), accordingly. The need for AAC was defined as Levels III–V on the CFCS, without simultaneous classification at VSS Level I, and/or Levels III–IV on VSS. Parents reported on child- and family-directed AAC interventions using the Habilitation Services Questionnaire. Of the 95 children (42 females) with CP (M = 39.4 months, SD = 10.3), 14 had communication aids. Of the 35 children (31.4%) defined as needing AAC, 11 had been provided with communication aids. Parents of children with a communication aid reported satisfaction with and frequent use of the aid. Children at MACS Level III–V (OR = 3.4, p = .02) or with epilepsy (OR = 8.9, p < .01) were most likely to have received an AAC intervention. The low proportion of children receiving communication aids indicates an unmet need for AAC interventions among preschool children with CP.

Speech-language pathologists’ perceptions of augmentative and alternative communication in Thailand

Augmentative and alternative communication (AAC) systems are not well-known and broadly used in Thailand. To begin introducing AAC systems and interventions to children with complex communication needs in Thailand, understanding speech-language pathologists’ (SLPs) perceptions toward various AAC systems is an important first step. This study assessed SLPs’ perceptions of three AAC modalities: gestural communication, communication boards, and iPad 1 -based speech-output technologies. A total of 78 SLPs watched three video vignettes of a child using each mode and rated their impressions of intelligibility, ease of learnability and use, effectiveness, and preference. Then they were asked to rate factors on visual analog scales that provided additional insights into their rationales and their preferences for AAC modalities for nonverbal clients and for themselves if they were nonverbal. The results indicated that most of the SLPs rated iPad-based speech-output technologies as being the more intelligible, effective, and preferred mode of communication. Gestural communication was rated as the easiest mode to learn and use for a child with complex communication needs. Despite infrequent use of iPad-based speech-output technologies in Thailand, SLPs’ ratings indicated high social acceptance of this modality for promoting communication abilities of children with complex communication needs. Results also revealed some biases and lack of knowledge about AAC systems in Thailand.

“It’s like a guessing game all the time”: parent insights on barriers, supports, and priorities for children with cortical visual impairment and complex communication needs

Parents of children with both cortical visual impairment (CVI) and complex communication needs offer unique perspectives on their children’s journeys to receiving proper diagnoses, supports, and interventions, such as augmentative and alternative communication (AAC). This study explored the lived experiences, supports, and barriers identified by parents through a qualitative phenomenological approach. Nine parents of children with both CVI and complex communication needs were interviewed virtually. Results indicated five themes descriptive of the parents’ experiences: Challenges Piecing Together a CVI Diagnosis; Dealing with Low Expectations of Others; Parents Empowered to Take Action; Guessing Game to Determine Appropriate AAC to Accommodate CVI; and Aligning Professional Practice with Parent Priorities. Whereas some of these themes echoed the experiences of parents of children with complex communication needs (such as those with cerebral palsy) who were not specifically diagnosed with CVI, other themes were unique to this set of parents including the uncertainty of AAC design and intervention given the challenges of CVI and the necessity of more than one way for children to communicate given their visual challenges. This study highlighted the dire need for continued investigation to determine effective AAC interventions for individuals with CVI.

Reduction in Behavior Problems with Increase in Communication Skills Through Augmentative and Alternative Communication among Special Needs Children

Cerebral Palsy is one of the most prevalent physical handicaps in children. Sensory-motor problems such as communication and cognitive impairment are major symptoms of cerebral palsy. In Pakistan, lack of interventions for cerebral palsy children exists due to low health budget. Consequently, CP children are facing difficulty in having the treatment. The present study aims to implement an augmentative and alternative communication (AAC) approach among nonverbal children with cerebral palsy living in Pakistan. Past research evidence has revealed the co-morbidity of communication problems with behavioral issues among cerebral palsy children. Keeping in view, the present study also aims to examine the behavioral issues of nonverbal children with cerebral palsy. For the said purpose, a pilot study employed the interventional research design (pre and post assessment) which was conducted in Pakistan. 10 nonverbal cerebral palsy children were selected from three different special needs centers by using non-probability sampling technique. Repeated measures, pre and post assessment t-test analysis was conducted to assess the impact of augmentative and alternative communication (AAC) intervention on the communication skills and behavioral problems of the participants. The results showed that AAC intervention has significantly improved the communication skills (t = -11.09, P < .001) and reduced the behavioral problems (t = 2.55, P <.005) of the participants which were nonverbal children with cerebral palsy. Thematic analysis on the open-ended questions from Pragmatic profile reported that participants have started to enjoy indoor and outdoor activities. After the intervention, significant improvement in communication has been observed in participants when they present needs/desire. Thus, this study recommends that implementation of AAC on cerebral palsy population would be effective in improving communication skills and reducing their behavioral problems.

임상간호사의 보완대체 의사소통에 대한 인식, 요구 및 사용 실태에 대한 조사연구

Purpose: The purpose of this study is to identify awareness and needs on augmentative and alternative communication (AAC) in critical care nurses. Methods: 316 critical care nurses from five hospitals participated in the survey. Data were collected using self-reported questionnaires consisting of AAC knowledge, needs, and experience via Google Forms from January to April 2022. The data were presented in frequency and percentage. Results: 28.9% of critical care nurses answered that they knew about AAC, indicating low awareness of AAC. Among critical care nurses, intensive care unit nurse showed high awareness of AAC. The most frequently encountered AAC method was written methods using paper, board, and whiteboard, which took more time compared to other methods. The nurses reported educational needs on AAC interventions and strategies as well as support for AAC devices. Conclusion: The results of this study showed that awareness on AAC in critical care nurses were low. Considering that communication problems can reduce patient safety and treatment satisfaction, it is suggested to improve awareness on ACC by providing educational intervention programs. In addition, institutional support for ACC is needed.