Complex Communication Needs Research Articles

Online Parent Training to Support Children With Complex Communication Needs

Parent training can help support the development of communication skills for young children with complex communication needs (CCN). Online delivery of such training may alleviate some of the burden on families, thereby increasing participation and outcomes. To determine the effectiveness of online parent training in communication partner strategies, a single-subject, multiple-probe design study was conducted with four parents and their children with developmental disabilities and CCN. Parents completed an interactive online training and then participated in live sessions to demonstrate trained skills. Results indicate that online parent training resulted in higher levels of communication opportunities provided by parents to their children with CCN. Increases were also noted for child communication and responses provided by parents to child communication. Results varied for participants. Parent evaluations of the training, limitations, and future research directions are discussed.

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.

A Pilot Study to Teach Siblings to Support Children With Complex Communication Needs

Siblings play an important role in the lives of children with disabilities, especially those with complex communication needs (CCN). However, children with CCN require support to learn social and communication skills. Like other communication partners, typically developing (TD) siblings may struggle to understand how to best interact with a child with CCN and may benefit from training to learn communication strategies. This pilot study evaluated a newly created sibling communication partner training program to help TD siblings learn the strategy Plan, Talk, Wait, and Respond to support the communication of their siblings with CCN. A single-subject multiple probe design was used with three TD siblings and their siblings with CCN. Although results varied for sibling pairs, an increase in communication supports from TD siblings and communication gains for children with CCN were noted with all sibling pairs. Limitations, adjustments to the training, and future research directions are discussed.

Addressing the Needs of Children With Complex Communication Needs and Their Partners in Areas of Poverty: To Haiti and Back

An estimated 1 billion people (15% of the world's population) experience a disability, such as a communication disability. Individuals with disabilities have an increased likelihood of living in poverty and often experience decreased access to medical, educational, and rehabilitation services (Danquah et al., 2014; World Health Organization & The World Bank, 2011) with approximately two-thirds of the world's poor living in low-and middle-income nations such as Haiti (Rank & Yadama, 2007). The aim of this article is to describe augmentative and alternative (AAC) service delivery considerations for speech-language pathologists (SLPs) who work with individuals who live in poverty. Case examples of AAC services within areas of poverty in Haiti and the United States are provided to illustrate practice recommendations. To achieve best-practice standards, SLPs who provide AAC services must consider how poverty might influence a family's socio-historic context, access to resources and services, and community participation goals. Furthermore, it is critical that SLPs recognize individuals' and families' strengths, evaluate the sustainability of AAC services, and work within a team to empower individuals with complex communication needs to participate in desired roles within the community.

Efficacy of Peer Support Arrangements to Increase Peer Interaction and AAC Use.

Supporting interaction in inclusive settings between students with complex communication needs (CCN) and their peers requires careful planning and support. We used a multiple-probe-across-participants design to investigate the efficacy of collaborative planning and peer support arrangements to increase peer interaction in inclusive classrooms. Participants were four middle school students with CCN who had an intellectual disability and used an iPad with Proloquo2Go as augmentative and alternative communication (AAC). Educational teams comprised of a special educator, general educator, paraprofessional, and speech-language pathologist participated in collaborative planning for the intervention. For all four students, the intervention substantially increased communication to and from their peers. AAC use increased for one student. We offer implications for research and practice on supporting social interaction in general education settings.

New Car, Same Principles: Using Language Development Theories to Drive the Design of Supportive Augmentative and Alternative Communication System Interfaces

Innovations in technology have resulted in increased use of tablets, mobile devices, and applications as augmentative and alternative communication (AAC) systems for children with complex communication needs (CCN). Although research has been conducted on the specific characteristics of AAC technologies, many interfaces remain replications of prior communication devices with little consideration of the features of newer platforms. A greater concern is that these interfaces may not be based on empirical evidence or derived from key developmental language theories. As such, these interfaces may place additional demands on children with CCN instead of supporting their development of language content, form, and use. The purpose of this paper is to discuss potential interface supports for AAC systems that capitalize on current technologies and draw upon key tenets of developmental theory.

Educational Assistants’ Use of ImPAACT for Increasing Message Selection and Turn-Taking with Children with Complex Communication Needs

Context : Educational assistants (EAs) provide extensive and individualized support for many students who require augmentative and alternative communication (AAC) in school systems. An important factor related to student’s success is EA training and skill development for effective communication with children who use AAC. Case Report : This case series examined ImPAACT: Improving Partner Applications of Augmentative Communication Techniques with three EA and student dyads. The study investigated whether a comparable treatment effect as found in Binger et al. (2010) could be demonstrated. Three phases of intervention (i.e., baseline, instruction, and generalization) were investigated. All phases were completed in the public school setting in which the students were enrolled and the EAs were employed. EA’s correct application of instructional strategies, student’s multi-symbol selections, and student’s turns were calculated. Type and form of student’s turn were calculated as well. Conclusions : All EAs increased correct application of strategies and all students increased use of multi-symbol selections and overall number of turns taken. Students’ type of turn (i.e., response, comment, initiation) and form of turn (i.e., vocalization, gesture, symbol selection) increased and diversified. Variable rates of behavior were noted across EAs and students. Potential explanations for these findings are discussed.

An Examination of VSD-based AAC Intervention for Children with Complex Communication Needs

An Examination of VSD-based AAC Intervention for Children with Complex Communication Needs

Supporting people with complex communication needs through community capacity building: the Communication Access Network

Purpose – The purpose of this paper is to describe specific features of a Victorian (Australia) state-wide hub and spoke model of speech pathology provision established for adults with complex communication needs (CCN). Two case studies highlighting successful examples of services developed to enhance community inclusion will be described and the challenges discussed. Design/methodology/approach – The route to community inclusion is described through a case study illustration of one communication accessible community site and one disability service study. The disability service research involved focus groups, survey and interview data and demonstrated the efficacy and sustainability of a support worker training model. Findings – Sustainable change in the community and in disability services can occur through partnerships, training, and long-term commitment. Support workers who can facilitate interactions for people who have cognitive and communicative disabilities are an essential component of building the capacity of communities to include people with CCN. Collaboration between community members, specialised supports and people with disabilities enhances active community participation. Originality/value – This innovative, state-wide model has the capacity to be replicated elsewhere. On-going speech pathology services are integral to support adults with CCN providing both short-term individualised services, sustainable staff training and community engagement.

Communication changes experienced by adults with cerebral palsy as they age

Purpose: Adults with cerebral palsy (CP) experience multiple, functional changes as they age, including changes to communication modes and methods that enable development and maintenance of relationships, communicative participation and quality-of-life. Little is known about the nature of communication changes experienced by this group. The aim of this study was to better understand how adults with CP experience changes in their communication abilities as they age and the subsequent psychosocial impact.Method: Twenty adults with cerebral palsy aged 40–72 years with complex communication needs (CCN) participated in a series of in-depth interviews, framing their experiences of loss and grief throughout their lives. The impact of changing communication abilities emerged as an important area of focus. Data were analysed using constructivist grounded theory methodology.Result: Themes arising from the participants’ perceptions of their communication included experiencing communication change as a loss with subsequent impact on self-concept; and how communication is integral to the process of managing losses associated with older age.Conclusion: Implications for speech-language pathologists working with older people with cerebral palsy and CCN include the need to understand the psychosocial impact of communication changes on social interaction, relationships and communicative participation. It is important to promote positive and meaningful communication options that maintain a coherent sense of self in addition to promoting functional communication skills and communicative participation.

Guiding Student Clinicians as They Develop AAC Goals and Monitor Progress During School-Based Externship

Student clinicians find goal writing and progress monitoring to be difficult tasks to learn, especially when children on the caseload have complex communication needs (CCNs). School-based externship supervisors play an important role in developing students' understanding and competence in these skills. This article provides supervisors with strategies for instructing student clinicians to write goals and evaluate the effectiveness of services for children who use augmentative and alternative communication (AAC). Additionally, the authors adapt the Continuum of Supervision Model (Anderson, 1988) for supervisors who train students to write goals and monitor progress for children who use AAC.

Guiding Student Clinicians as They Develop AAC Goals and Monitor Progress During School-Based Externship

Student clinicians find goal writing and progress monitoring to be difficult tasks to learn, especially when children on the caseload have complex communication needs (CCNs). School-based externship supervisors play an important role in developing students' understanding and competence in these skills. This article provides supervisors with strategies for instructing student clinicians to write goals and evaluate the effectiveness of services for children who use augmentative and alternative communication (AAC). Additionally, the authors adapt the Continuum of Supervision Model (Anderson, 1988) for supervisors who train students to write goals and monitor progress for children who use AAC.

“You Get More Than You Give”: Experiences of Community Partners in Facilitating Active Recreation with Individuals who have Complex Communication Needs

Recreation is an essential part of life that provides enriching experiences that may define one’s life course similar to careers or other interests. An understanding of the role of volunteers in active community-based recreational programs can help to generate ways to enhance participation and contribute to additional communication opportunities with people who have complex communication needs. Nine volunteers from two adaptive ski programs and one therapeutic horseback-riding program in the Northeast region of the United States participated in semi-structured interviews. Audio-recordings were transcribed and analyzed and resulted in five thematic areas: (a) benefits, (b) why individuals volunteer, (c) barriers, (d) successful program supports, and (e) who are the riders and skiers using AAC. The findings provided insight to support the notion that active community-based recreational activities foster an environment for communication, meaningful engagement, and social relationships between volunteers and people with complex communication needs.

The Communication Supports Inventory-Children & Youth (CSI-CY), a new instrument based on the ICF-CY

Purpose: Two studies are presented that evaluated the Communication Supports Inventory-Children & Youth (CSI-CY), an instrument designed to facilitate the development of communication-related educational goals for students with complex communication needs (CCN). The CSI-CY incorporates a code set based on the ICF-CY. The studies were designed to determine the effect of using the CSI-CY on IEP goals for students with CCN and to evaluate consumer satisfaction.Method: In Study 1, sixty-one educators and speech–language pathologists were randomly assigned to either (a) provide a student’s current IEP (control group) or (b) complete the CSI-CY prior to preparing a student’s next IEP and to submit the new IEP (experimental group). Study 2 was a field test to generate consumer satisfaction data.Results: Study 1 showed that IEP goals submitted by participants in the experimental group referenced CSI-CY-related content significantly more frequently than did those submitted by control participants. Study 2 revealed high satisfaction with the instrument.Conclusions: The code set basis of the CSI-CY extends the common language of the ICF-CY to practical educational use for children with CCN across diagnostic groups. The CSI-CY is well regarded as an instrument to inform the content of communication goals related to CCN.Implications for RehabilitationThe CSI-CY will guide rehabilitation professionals to develop goals for children with complex communication impairments.The CSI-CY is a new instrument that is based on the ICF-CY for documentation of communication goals.

Perspectives of a mobile application for people with communication disabilities in the community

Purpose To determine the perceptions of people with complex communication needs (CCN) and business staff regarding the uses and functionality of a mobile application to aid communication access. Method A qualitative study using thematic analysis of transcripts and field notes from focus groups and interviews of 19 people with CCN and nine business staff. Results Four themes and 10 subthemes were drawn from the data. Themes highlighted the desire for: increased communication strategies to support customer interactions, increased access to information, functionality of a mobile application to increase its utility, and preferred technical and visual features of mobile applications. Conclusion People with CCN and business staff perceived a mobile application as a useful tool to aid communication access. This research highlighted the importance of facilitating strategies to communicative interactions and information in the community as the fundamental goal of a mobile application developed to support communication access.Implications for RehabilitationMobile applications are widely accepted and used in modern customer service industries and have been identified as tools to increase communication access for people with complex communication needs (CCN).People with CCN identified accessibility, presentation, and customisation as important features of mobile applications for communication access.The diversity of user preferences and needs, and the rapid development of new technologies limit the applicability of a single design for mobile applications for people with CCN. People with CCN should be involved in application design and development.A mobile application for communication access would support customer-business interactions as well as enable more accessible information sharing about disability needs and services.

Parental directiveness and responsivity toward young children with complex communication needs

Purpose: The aim of the present study was to determine if parent responsiveness to their children with complex communication needs (CCN) during naturalistic play changed over an 18-month period and determine if any such changes were influenced by the child’s overall level of receptive and expressive language development, motor development or differing play contexts. This longitudinal information is important for early intervention speech-language pathologists and parents of children with developmental disabilities for whom the use of parent-directed responsivity interventions may be encouraged.Method: Over an 18-month period, 37 parents of young children who had physical and/or neurological disabilities participated in three home-based parent–child play episodes. Videotapes of each play episode were extracted and coded.Result: Results indicated parents who were initially responsive showed a significant tendency to continue to be so. Early on, parents were significantly more likely to be directive during object play than social play and significantly more likely to interact responsively during social play than object play.Conclusion: Parents of children with developmental disabilities were not consistently less responsive to their children based on motor or language capabilities. Previous reports of higher parental directiveness with children who have developmental disabilities may be attributable to object-based play interactions.

An Adapted Assessment Model for Emergent Literacy Conducted via Telepractice

Children with complex communication needs (CCN) exhibit multiple needs in a variety of domains, including language, literacy, and speech. Children with CCN often require augmentative/alternative communication (AAC), a mode of communication designed to compensate for the communication and related disability patterns of individuals with CCN (Light, Beukelman, & Reichle, 2003). Given the diverse needs of this population, service provision presents challenges to teachers and therapists alike. Telepractice service provision offers solutions to guide service delivery for children with CCN, who may be located in remote settings with limited access to AAC specialists. The tele-AAC working group of the International Society on Augmentative and Alternative Communication (ISAAC) 2012 Research Symposium highlighted a need for increased information on telepractice service delivery for children with CCN in the area of literacy. To date, evidence-based practices for assessment of literacy skills in children with CCN are limited. In addition, literacy assessment for children with CCN via telepractice presents challenges requiring adaptation for telepractice service delivery. This paper summarizes existing literature examining literacy assessment and intervention, and applies these principles to development and implementation of adapted literacy assessment methods conducted via telepractice for a child with CCN.

Towards Advancing Knowledge Translation of AAC Outcomes Research for Children and Youth with Complex Communication Needs

The production of new knowledge in augmentative and alternative communication (AAC) requires effective processes to leverage the different perspectives of researchers and knowledge users and improve prospects for utilization in clinical settings. This article describes the motivation, planning, process, and outcomes for a novel knowledge translation workshop designed to influence future directions for AAC outcomes research for children with complex communication needs. Invited knowledge users from 20 pediatric AAC clinics and researchers engaged in the collaborative development of research questions using a framework designed for the AAC field. The event yielded recommendations for research and development priorities that extend from the early development of language, communication, and literacy skills in very young children, to novel but unproven strategies that may advance outcomes in transitioning to adulthood.

Beyond Legal

The Individualized Education Program (IEP) is a legal document developed for each student with a disability. The IEP outlines the student’s learning needs and associated educational goals, as well as the program placement and services required to support the attainment of these goals in the least restrictive environment. Most IEPs include all legally required elements; however, there is a gulf between meeting legal requirements and writing a high-quality IEP that results in educational benefit for the individual student. We collected a large number of IEP documents focused on interventions for children with complex communication needs (CCN) who may use augmentative and alternative communication (AAC). These documents suggested the need for a tool to describe the subtle and specific qualities that characterize high-quality IEPs for children with CCN. We describe a 28-item IEP quality guide created to serve as a clinical resource for educators and therapists who develop educational goals.

Early Differences in Pre-Intentional Communication Patterns between Children with Typical Development and Children with Complex Communication Needs

Although children with complex communication needs (CCN) may be identified during infancy, there is little information on systematic differences in social and communicative interaction patterns from typical expectations, particularly during the pre-intentional period. This article summarizes conclusions drawn from a research study (Cress et al., 2013) that contrasted pre-intentional communication behaviors in typically developing infants at 6–7 months with pre-intentional communication behaviors in children with CCN at an average of 20 months chronological age, and average 6–7 months receptive language age equivalence scores. Behaviors in both groups were analyzed from structured play video samples using coding from the Infant Social and Communication Behavior Scales (ISCBS), a prototype assessment of pre-intentional communication in infants (Cress, Olsen, Sabers, & Wetherby, 2012). Multiple differences emerged in communication patterns between these two groups at similar points in receptive language development that indicate very early divergence of social and communication patterns demonstrated by young children with CCN from typical expectations.