And Alternative Communication Intervention Research Articles

The complexities of AAC intervention research: emerging trends to consider

Augmentative and alternative communication (AAC) is always about intervening and the subsequent effects of the interventions (e.g., on the AAC user, family perspectives, educational outcomes, and vocational outcomes). AAC intervention research is about generating new knowledge by studying some aspect of AAC delivery in a planned manner so that it can be replicated and then translated into clinical/educational practice. This commentary on AAC intervention research highlights the complexities inherent in this type of research and the range of components that contribute to it, and reflects on emerging trends that we must consider as we continue to develop and enhance intervention research. Conducting AAC intervention research is a commitment to understanding how change occurs when an intervention is delivered and its broader impact on the field and the people who use AAC.

Responsiveness of a parent-reported outcome measure to evaluate AAC interventions for children and youth with complex communication needs

Evaluation of the effectiveness of augmentative and alternative communication (AAC) interventions requires reliable measures that are responsive to change. The aim of this study was to explore the potential of the Family Impact of Assistive Technology Scale for AAC (FIATS-AAC) to detect functional change in children and youth with AAC needs, aged 3–17 years, and their families, 6 and 12 weeks after receiving a graphic-based, speech-generating device (SGD). Parents whose children were awaiting a SGD as part of their regular AAC service participated in the study. In all, 45 parents completed the FIATS-AAC during each of three phone interviews: at the time of device delivery, and then 6 weeks and 12 weeks after receiving the device. Children and youth were aged 3–16 years (M = 7.8, SD = 3.3) and were mostly context-dependent communicators. Paired t-tests indicated statistically significant gains in functioning from baseline to both 6 and 12 weeks after receiving the AAC device. Effect sizes were 0.41 and 0.38, respectively. This study provides initial support for the ability of the FIATS-AAC to detect functional changes in children and youth and their families after receiving a graphic-based SGD.

"Augmentative and Alternative Communication (AAC) Will Give You a Voice": Key Practices in AAC Assessment and Intervention as Described by Persons with Amyotrophic Lateral Sclerosis.

The purpose of this study was to describe the perceptions of persons with amyotrophic lateral sclerosis (pALS) who use augmentative and alternative communication (AAC) with the AAC assessment and intervention process. Twenty-one pALS with complex communication needs participated in a multipart survey (and follow-up e-mails) to provide information on their experiences with AAC assessment and intervention. A majority of the participants agreed with the importance of three key AAC intervention principles: appropriate staging of the timing of assessment and intervention activities, inclusion of communication partners, and the use of multiple modalities and strategies as communication supports. Most participants reported that their assessment and intervention experiences included at least some aspect of these three key practices. The results of this study suggest that the identified best practices in AAC should be reviewed and implemented on an individualized basis for pALS with complex communication needs.

An mHealth Platform for Supporting Clinical Data Integration into Augmentative and Alternative Communication Service Delivery: User-Centered Design and Usability Evaluation.

BackgroundThe recent trend of increasing health care costs in the United States is likely not sustainable. To make health care more economically sustainable, attention must be directed toward improving the quality while simultaneously reducing the cost of health care. One of the recommended approaches to provide better care at a lower cost is to develop high-quality data collection and reporting systems, which support health care professionals in making optimal clinical decisions based on solid, extensive evidence.ObjectiveThe objective of this project was to develop an integrated mobile health Augmentative and Alternative Communication (AAC) platform consisting of an AAC mobile app and a Web-based clinician portal for supporting evidence-based clinical service delivery.MethodsA questionnaire and interviews were used to collect clinicians’ ideas regarding what constitutes their desired “clinically relevant” data. In response, a Web-based portal was designed by combining mobile and Web technologies with an AAC intervention to create an integrated platform for supporting data collection, integration, and reporting. Finally, a usability study was conducted with health care professionals.ResultsA Web-based portal was created and integrated with a tablet-based AAC mobile app and data analysis procedures. In the usability study, all participants agreed that the integrated platform provided the ability to collect comprehensive clinical evidence, automatically analyze collected data in real time, and generate clinically relevant performance measures through an easily accessible Web-based portal.ConclusionsThe integrated platform offers a better approach for clinical data reporting and analytics. Additionally, the platform streamlines the workflow of AAC clinical service delivery.

A systematic review of predictors, moderators, and mediators of augmentative and alternative communication (AAC) outcomes for children with autism spectrum disorder

Documented variability in augmentative and alternative communication (AAC) intervention outcomes makes it difficult for clinicians to select systems most likely to be effective for individual children with autism spectrum disorder (ASD). The aim of this study was to identify child-related factors associated with AAC intervention outcomes through a systematic review of the research literature. A search was conducted of peer-reviewed research articles in which AAC intervention outcomes and associated factors were reported for children with ASD. The search yielded 965 titles and abstracts, of which seven articles relating to six studies met criteria for inclusion. In total, 18 factors were examined, of which nine were assessed as predictors (e.g., cognition, ASD severity, language use), three as moderators (e.g., joint attention, object exploration), and six as mediators (e.g., frequency of therapy, communication partner knowledge). Child characteristics associated with communication outcomes were pre-intervention cognition, severity of ASD, verbal imitation, vocabulary comprehension, object use, joint attention, language use, and two multi-dimensional measures of communication competence. This study suggests emerging evidence for predictors, but less is known about what factors moderate and mediate response to AAC interventions.

AAC services for multilingual populations: South African service provider perspectives

BackgroundIn South Africa, many persons in need of augmentative and alternative communication (AAC) come from multilingual backgrounds. There is as yet a limited evidence base (locally and internationally) for the provision of AAC services to multilingual populations. The perspectives of service providers can assist in gaining an understanding of current practices and the factors that influence these. AimsThe study aimed to obtain the perspectives of AAC service providers about practices in providing AAC systems and AAC intervention to clients from multilingual backgrounds. Methods & proceduresFifteen AAC service providers were purposefully chosen to participate in one of three focus groups – two face-to-face and one online focus group. Data from the face-to-face focus groups was transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data. Outcomes & resultsFour overarching themes were identified, namely (a) current practices, (b) factors influencing current practices, (c) service provides’ orientation towards different language options in AAC intervention, and (d) needs and desired developments regarding AAC technology. This paper reports on the first three themes. Service providers reported their practices to range from a focus on L1 exclusively, L2 exclusively, to a multilingual (sequential or simultaneous) approach. The South African language context, family language preferences and choices, service provider skill and knowledge, as well as AAC technology were identified as factors influencing their practices. Although many viewed access to multiple languages through AAC as positive, they also expressed concerns and reservations about providing multilingual AAC services. Conclusions & implicationsAlthough service providers in general saw the need to give clients from multilingual backgrounds access to multiple languages using AAC, this did not always translate into multilingual AAC practices. Both extrinsic factors (e.g. the lack of appropriate AAC devices, software and apps giving access to non-English languages) and intrinsic factors (service providers’ language competency and their beliefs about the cognitive demands of multilingual AAC systems) influenced their practices and choices. Appropriate AAC service delivery to multilingual populations in South Africa would require not only appropriate AAC technology developments, but also research evidence to establish the efficacy of multilingual AAC interventions for clients with a variety of characteristics.

A systematic quality review of high-tech AAC interventions as an evidence-based practice

Although high-tech augmentative and alternative communication (AAC) is commonly used to teach social-communication skills to people with autism spectrum disorder or intellectual disabilities who have complex communication needs, there is a critical need to evaluate the efficacy of this approach. The aim of this systematic review was to evaluate the quality of single-case experimental design research on the use of high-tech AAC to teach social-communication skills to individuals with autism spectrum disorder or intellectual disabilities who have complex communication needs, to determine if this intervention approach meets the criteria for evidence-based practices as outlined by the What Works Clearinghouse. Additionally, information on the following extended methodological standards is reported on all included studies: participant description, description of setting and materials, interventionist description, baseline and intervention description, maintenance, generalization, procedural integrity, and social validity. The results from 18 multiple-baseline or multiple-probe experiments across 17 studies indicate that using high-tech AAC to teach social-communication skills to individuals with autism spectrum disorder or intellectual disabilities and complex communication needs can be considered an evidence-based practice, although the review of comparison (i.e., alternating treatment) design studies did not indicate that high-tech AAC is significantly better than low-tech AAC.

The feasibility of improving discourse in people with aphasia through AAC: clinical and functional MRI correlates

ABSTRACTBackground:The theory of intersystemic reorganization, along with the ability of people with chronic aphasia to recover language function, suggests that a high-tech augmentative and alternative communication (AAC) device could be employed as a dual-purpose tool that simultaneously facilitates language recovery and compensates for deficits. To date, treatments based on intersystemic reorganization have focused on writing, drawing, and gesturing. Further, despite a movement to identify neural mechanisms that support intervention-related recovery, the neurobiological markers of AAC-induced changes have not been established.Aims: The purpose of this study is twofold: (1) to examine the feasibility of providing a high-tech AAC treatment to people with chronic aphasia, with the goal of evoking changes in spoken language; and (2) to identify evidence of AAC-induced changes in brain activation.Method and Procedures: We employed a pre- and post-treatment design with a control (usual care) group to observe the impact of an AAC treatment on aphasia severity and spoken discourse. Further, we used functional magnetic resonance imaging (fMRI) to examine associated neural reorganization.Outcomes and Results: Compared to the usual care group, the AAC intervention trended toward larger treatment effects and resulted in a higher number of responders on behavioral outcomes. Both groups demonstrated a trend toward greater leftward lateralization of language functions via fMRI. Secondary analyses of responders to treatment revealed increased activation in visual processing regions, primarily for the AAC group.Conclusions: This study provides preliminary guidance regarding how to implement AAC treatment in a manner that simultaneously facilitates language recovery across a variety of aphasia types and severity levels while compensating for residual deficits in people with chronic aphasia. Further, this work motivates continued efforts to unveil the role of AAC-based interventions in the aphasia recovery process and provides insight regarding the neurobiological mechanisms supporting AAC-induced language changes.

Teaching Communicative Responses with a Speech-Generating Device Via Telehealth Coaching

Caregivers need support with teaching augmentative and alternative communication (AAC). The purpose of this study was to coach caregivers via telehealth (i.e., live video conferencing with Google Hangout) to implement communication assessments, functional communication training (FCT), and/or navigation training to address either idiosyncratic or problem behavior exhibited by two young boys with developmental delay (age 5.5 years) and autism (age 7 years) who were non-verbal. An adapted multiple probe design and a multiple probe design across three contexts (play, break from demands, help) were used to evaluate acquisition of communicative requests using high tech aided AAC on a speech-generating device (SGD; a Tobii Dynavox T10 device). A forward chain was also introduced to teach symbol selection and navigation on the SGD. Both children acquired the communicative alternatives across each context. Caregiver implementation fidelity was measured with procedural checklists and was acceptable across baseline and intervention sessions for both children. Children with developmental disabilities face many barriers to accessing needed communication intervention and may not have access to interventionists with the expertise in AAC with a SGD. Our findings have potential research implications for the use of telehealth to improve access to expertise in high tech aided AAC communication assessment and intervention.

Instructional strategies used in direct AAC interventions with children to support graphic symbol learning: A systematic review

Augmentative and alternative communication (AAC) refers to a wide range of aided and unaided modes that are employed with a diverse group of people to support a range of language and communication outcomes. Children whose comprehension of spoken language greatly exceeds their ability to express themselves within that modality can be described as expressive users of AAC. Interventions are important in promoting language acquisition and the expressive use of graphic symbols. Instructional strategies employed within interventions have an important impact on treatment effectiveness. A systematic review was undertaken to identify instructional strategies that have demonstrated effectiveness in supporting graphic symbol learning and aided language development in direct interventions with children aged 0–18 years who are expressive users of aided AAC (including children without learning difficulties and those with mild-moderate learning difficulties). A comprehensive search strategy was carried out and all studies meeting the inclusion criteria were quality appraised. A data extraction procedure was conducted on the studies meeting the quality appraisal criteria. Fifteen studies were included in the review investigating four instructional strategies used to support graphic symbol learning. The most studied instructional strategy, aided modeling, can be considered an evidenced-based practice. There is also strong research evidence to support the use of both narrative-based interventions and mand-model procedures to facilitate graphic symbol learning and aided language acquisition in children who are expressive users of aided AAC. However, across the literature reviewed, a lack of consistent terminology hampered the ability to compare studies and draw conclusions. More consistent use of terminology would enhance the utility of the evidence base.

Brain-Computer Interfaces for Augmentative and Alternative Communication: A Tutorial.

Brain-computer interfaces (BCIs) have the potential to improve communication for people who require but are unable to use traditional augmentative and alternative communication (AAC) devices. As BCIs move toward clinical practice, speech-language pathologists (SLPs) will need to consider their appropriateness for AAC intervention. This tutorial provides a background on BCI approaches to provide AAC specialists foundational knowledge necessary for clinical application of BCI. Tutorial descriptions were generated based on a literature review of BCIs for restoring communication. The tutorial responses directly address 4 major areas of interest for SLPs who specialize in AAC: (a) the current state of BCI with emphasis on SLP scope of practice (including the subareas: the way in which individuals access AAC with BCI, the efficacy of BCI for AAC, and the effects of fatigue), (b) populations for whom BCI is best suited, (c) the future of BCI as an addition to AAC access strategies, and (d) limitations of BCI. Current BCIs have been designed as access methods for AAC rather than a replacement; therefore, SLPs can use existing knowledge in AAC as a starting point for clinical application. Additional training is recommended to stay updated with rapid advances in BCI.

Aided AAC for people with severe to profound and multiple disabilities: A systematic review of interventions and treatment intensity

Given the limited evidence, along with a rapidly evolving state of technology, research is needed to drive effective and efficient communication intervention for people with severe to profound and multiple disabilities. The purpose of the current review was to synthesize and evaluate the state of the aided, augmentative and alternative communication (AAC) intervention literature for this population from 1997 to 2016. Results synthesized findings from 25 studies (n = 59) on the extracted participant characteristics, intervention, and dosage parameters from the studies. Results included an under-reporting of sufficient dosage parameters in addition to implications for future directions in the areas of maintenance, generalization, and discriminated use of skills, and bridging aided low and high-tech AAC interventions.

Speech deterioration in amyotrophic lateral sclerosis (ALS) after manifestation of bulbar symptoms.

The symptoms and their progression in amyotrophic lateral sclerosis (ALS) are typically studied after the diagnosis has been confirmed. However, many people with ALS already have severe dysarthria and loss of adequate speech at the time of diagnosis. Speech-and-language therapy interventions should be targeted timely based on communicative need in ALS. To investigate how long natural speech will remain functional and to identify the changes in the speech of persons with ALS. Altogether 30 consecutive participants were studied and divided into two groups based on the initial type of ALS, bulbar or spinal. Their speech disorder was evaluated on severity, articulation rate and intelligibility during the 2-year follow-up. The ability to speak deteriorated to poor and necessitated augmentative and alternative communication (AAC) methods with 60% of the participants. Their speech remained adequate on average for 18 months from the first bulbar symptom. Severity, articulation rate and intelligibility declined with nearly all participants during the study. To begin with speech deteriorated more in the bulbar group than in the spinal group and the difference remained during the whole follow-up with some exceptions. The onset of bulbar symptoms indicated the time to loss of speech better than when assessed from ALS diagnosis or the first speech therapy evaluation. In clinical work, it is important to take the initial type of ALS into consideration when determining the urgency of AAC measures as people with bulbar-onset ALS are more susceptible to delayed evaluation and AAC intervention.

Systematic review of AAC intervention research for adolescents and adults with autism spectrum disorder

Much of augmentative and alternative communication (AAC) research for individuals with autism spectrum disorder has focused on young children. Given that the lives, communication, strengths, and needs of adolescents and adults with autism spectrum disorder are quite different from those of young children, the purpose of the current study was to consolidate current AAC intervention research findings specific to these individuals. A systematic review was conducted to identify and evaluate relevant research. Results indicate that AAC intervention benefits adolescents and adults with autism spectrum disorder. However, more research is urgently needed. Future research focused on supporting communicative functions other than requesting (e.g., social closeness, information transfer) while participating in contexts important to the lives of adolescents and adults may be particularly valuable.

Family Leisure as a Context to Support Augmentative and Alternative Communication Intervention for Young Children with Complex Communication Needs.

AbstractFamilies are often the most significant communication partners for children who require augmentative and alternative communication (AAC). Because family-centered approaches are recommended practice in speech-language pathology, a primary role for speech-language pathologists (SLPs) serving children who require AAC is to support families in integrating communication into highly valued, existing family activities. Family leisure activities can provide a naturally supportive context for AAC, because they provide multiple opportunities for children to interact and practice using AAC with natural communication partners. This article aims to guide SLPs in utilizing family leisure as a context for AAC intervention. We describe the benefits and constraints of engaging in leisure for families with children with disabilities. We define family leisure, which includes two distinct types of leisure activities: core and balance. Finally, we provide a case example of a family that highlights the integration of AAC into both types of leisure activities.

Local service provision of Augmentative and Alternative Communication and communication aids in England

BACKGROUND: Provision of Augmentative and Alternative Communication (AAC) interventions have been acknowledged to be highly variable in England and elsewhere. OBJECTIVE: The aim of the project described in this paper was to provide data to inform service planning and delivery of services delivering AAC including communication aids. METHODS: A survey was developed by an expert group and administered by telephone interview to service managers of primary and secondary services providing AAC interventions at a local level in England and data were included from two hundred and twenty respondents. RESULTS: Services included had mean caseload sizes of 0.09% of the catchment population for AAC provision, with a mean of 0.017% of the catchment population for high tech communication aids. Significantly higher levels of caseload and spend were reported for services working with children and young people as compared to those working with adults. Mean levels of unmet need for AAC equating to approximately one in every eight individuals on services' caseloads were reported. CONCLUSIONS: Although these data should be treated with caution, they suggest a significant level of variation of provision of AAC by local services.

Cognitive Development in a Young Child with Mucolipidosis Type IV: A Case Report.

Mucolipidosis Type IV (ML IV) is an autosomal recessive genetic disorder characterized by severe psychomotor impairments and ophthalmologic abnormalities. Reports on the cognitive development of people with ML IV are limited, but suggest that achievement of language and cognitive milestones varies between a 3- and 18-month level. There is also variability in reports of whether people with ML IV make developmental progress, regress, or remain static after infancy. This study examines the longitudinal development of a young child with ML IV who participated in an augmentative and alternative communication (AAC) intervention.At 26months, the child displayed significant developmental delays on direct assessment, with the exception of a possible relative strength in receptive language. An examination of adaptive behavior over time indicated improvements in raw scores but declines in standard scores across all domains. She learned to use 13 new words with a speech generating device (SGD) by the end of intervention.These results add to literature on the clinical manifestations of ML IV and indicate that although children with this disorder have deficits in many domains, they may be most severely affected in gross motor or oral motor development and have a relative strength in receptive language. Moreover, this child made progress in all domains of adaptive functioning, but at a slower pace than typically developing children. She also gained expressive vocabulary in the AAC intervention, and this may have supported her development in other areas.

A systematic review of research into aided AAC to increase social-communication functions in children with autism spectrum disorder

Augmentative and alternative communication (AAC) interventions have been shown to be effective in supporting children with autism spectrum disorder (ASD) to communicate, particularly to request preferred items and activities. The aim of this systematic review was to examine the effectiveness of AAC interventions in supporting children to produce a broader range of communicative functions and determine the extent to which these interventions have been evaluated beyond immediate effectiveness to address maintenance, generalization, and social validity. A systematic search and application of inclusion criteria yielded 30 interventions that focused on communication functions beyond object requests. In many of the studies, flaws detracted from the certainty of evidence, and maintenance, generalization, and/or social validity were not addressed. Further research is needed to evaluate the extent to which AAC interventions can support children with ASD to communicate using a variety of communication functions, as well as to demonstrate sustained, transferable, and meaningful change.

특수학교 AAC 연구동아리 ‘보통날’의 지도 사례보고

Background and Objectives: Augmentative and Alternative Communication (AAC) study circle’s concept of an ‘ordinary day’ involves two daily experiences. First, special needs students attempt to have a everyday conversation similar to conversation that ordinary people would have. Second, ‘ordinary day’, in Korean, means “to give it wings” and special needs students, using AAC, apply this principle. The purpose of this study is to prove the importance of AAC for special needs students and to provide higher quality interventions through study circle experiences. The overall goal of ACC study circles is to allow special needs students to experience life as similarly to ordinary people as possible. Method: The interventions of script, school schedule, peer tutoring, etc., appropriate for the degree or attribute of disability, were conducted for three special needs students who have difficulty communicating. The interventions were implemented using an ACC application installed on a smart device. Results: After the implementation of interventions, special needs students could express most objective vocabulary through AAC. In addition, it was found that the increase of communication behavior decreased problem behaviors. Conclusion: Special needs students can appear to have behavior problems or limited participation in learning in school. Therefore, we should continue to give attention to the students who have difficulty in expressing their feelings and thoughts due to physical or cognitive problems. AAC study circle’s ‘ordinary day’ will have two AAC interventions for students and looks forward to helping students change in a positive manner, as seen in this case.

A Synthesis of Relevant Literature on the Development of Emotional Competence: Implications for Design of Augmentative and Alternative Communication Systems.

Emotional competence refers to the ability to identify, respond to, and manage one's own and others' emotions. Emotional competence is critical to many functional outcomes, including making and maintaining friends, academic success, and community integration. There appears to be a link between the development of language and the development of emotional competence in children who use speech. Little information is available about these issues in children who rely on augmentative and alternative communication (AAC). In this article, we consider how AAC systems can be designed to support communication about emotions and the development of emotional competence. Because limited research exists on communication about emotions in a context of aided AAC, theory and research from other fields (e.g., psychology, linguistics, child development) is reviewed to identify key features of emotional competence and their possible implications for AAC design and intervention. The reviewed literature indicated that the research and clinical attention to emotional competence in children with disabilities is encouraging. However, the ideas have not been considered specifically in the context of aided AAC. On the basis of the reviewed literature, we offer practical suggestions for system design and AAC use for communication about emotions with children who have significant disabilities. Three key elements of discussing emotions (i.e., emotion name, reason, and solution) are suggested for inclusion in order to provide these children with opportunities for a full range of discussion about emotions. We argue that supporting communication about emotions is as important for children who use AAC as it is for children who are learning speech. This article offers a means to integrate information from other fields for the purpose of enriching AAC supports.