There is a critical need to understand the early vocabulary of young children with autism who have limited language, defined in this study as producing fewer than 20 different spontaneous and functional spoken or augmented words, to better inform educational targets and vocabulary selection for spoken as well as augmentative and alternative communication (AAC) interventions, particularly given the lack of evaluation tools designed for children with limited language. The spontaneous words and gestures produced by 66 preschoolers with autism (ages 3.5-5) during a natural language sample are compared with words in two early vocabulary tools including the MacArthur Communicative Development Inventories (MCDI) and a list of core words compiled from research studies of early AAC vocabulary. Participants' expressive words and gestures were coded from the transcripts of 20-min natural language samples. Forty-nine children (74.24%) used spoken words, gestures, or a combination of both, with six children (9.09%) communicating using a speech-generating device (SGD). Spoken words were primarily used for commenting, while gestures, especially pointing, were used for requesting. Although more than half of the unique words expressed by the children during the natural language sample overlapped with those in the MCDI, only 32% of unique words expressed by the children overlapped with Laubscher's and Light's core word lists, suggesting that young children with autism who have limited language may use more fringe words related to their personal interests or experiences. The study's limitations as well as implications for vocabulary selection for AAC systems and intervention goals are discussed.

Autistic people with communication support needs can benefit from the use of augmentative and alternative communication. While research has considered the use of AAC to supplement communication and improve communication effectiveness, less is known about other potential outcomes across the lifespan such as wellbeing and social interaction. The aim of this systematic review was to synthesise current research regarding the use of AAC for autistic adults and children; exploring how AAC supports the individual's communication, adaptive functioning and quality of life. A systematic search was conducted across six databases; PsychINFO, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Educational Resources Information Centre (ERIC), and Google Scholar. Eligibility criteria included experimental design, peer-reviewed publications and papers published in English after 2013. Relevant papers were exported to Covidence; screening, full text review and data extraction were conducted in duplicate and quality appraisal was completed for all papers using the Scientific Merit Rating Scales (SMRS). Included studies were grouped by age, intervention types, AAC types and reported outcomes, and described qualitatively. The 69 included papers focused on a range of AAC types. The majority investigated speech-generating devices and low-tech picture exchange. Most used behavioural intervention techniques. Most papers focused only on children, with only three papers investigating outcomes of AAC use with adults. The results were largely descriptions of proximal outcomes, such as simple requests, with few considering generalisation of skills or distal outcomes such as quality of life. The quality of the papers was generally low, with limitations in study design and diagnostic ascertainment noted. AAC has the potential to be an important support for autistic people, however, evidence regarding the impact on the broad range of communication functions and quality of life is very limited. A greater focus on the impact of AAC on these areas is needed in both research and practice along with a stronger focus on adults and a greater range of AAC types. PROSPERO number: CRD42023473247 WHAT THIS PAPER ADDS: What is already known on this subject The use of augmentative and alternative communication (AAC) with autistic adults and children is an established practice. Previous research has shown some effectiveness related to the specific goals being studied but it has centred mostly on children, and most research has focused on making requests, rather than broad communication or life outcomes. What this paper adds to existing knowledge This study explores the literature about autism and AAC and seeks to specifically examine the range of outcomes reported. We found that most of the research on this topic continues to focus on children, aided rather than unaided communication, and on outcomes related directly to the intervention, such as making requests. Very few studies included measures of generalisation or considered broader outcomes of AAC supports, such as quality of life, or enhanced social interactions. What are the potential or actual clinical implications of this work? Clinicians and researchers should consider the potential for broader impacts of AAC and ensure that goals focus on skills beyond immediate functions to areas such as quality of life, well-being, learning and employment, and the development of social relationships. Clinicians and researchers should also ensure that AAC interventions are offered to not only children, but also to autistic adults who may benefit from communication supports.

Facilitators and barriers to augmentative and alternative communication (AAC) adoption for children with autism spectrum disorder (ASD): Teachers' perspectives.

<p style="text-align: justify;"><strong>Context and relevance. </strong>A substantial proportion of children with autism spectrum disorder (ASD) have limited functional speech, which increases the relevance of augmentative and alternative communication (AAC). This article is the first part of a broader work analysing AAC tools used with children with ASD. <strong>Objective</strong>. To identify the AAC systems most commonly used with children with ASD, define key developmental domains relevant to AAC system selection, and describe selection criteria and indicators for specific AAC systems. <strong>Methods</strong>. A systematic literature review was conducted in PubMed, MEDLINE, and eLibrary.ru. Search terms included autism spectrum disorder/ASD, augmentative and alternative communication/AAC, and speech impairment. Thirty-four domestic and international publications meeting the topic relevance criteria were included. <strong>Results</strong>. The AAC systems most relevant for children with ASD were identified: the Picture Exchange Communication System (PECS), communication boards, natural gestures, single- and multi-message speech-generating devices, and AAC mobile applications. Evidence-based selection requires consideration of five developmental domains: expressive communication, visual perception, cognition, motor skills, and self-regulation. For each AAC system, selection criteria are described to accommodate the heterogeneity of children with ASD and different functional profiles. <strong>Conclusions</strong>. AAC systems address diverse needs of children with ASD. AAC selection should be individualized and based on the child’s asynchronous developmental profile and skill level, which may facilitate more effective AAC acquisition and potentially reduce social-communication difficulties.</p>

Voices Beyond Silence presents a comparative biographical analysis of Professor Sara Ahlin Doljak (Slovenia) and Professor Matthew Wangeman (United States), two pioneering academics who transform the role of augmentative and alternative communication (AAC) technologies in higher education. Drawing on the medical and social models of disability, posthumanist theory and the concept of technological embodiment, the study examines how eye-gaze systems, speech-generating devices and predictive text software enable full academic participation, authority and professional identity. Using a qualitative comparative case study based exclusively on triangulated secondary sources, the article demonstrates that AAC functions not merely as an assistive aid but as a “technological voice” that reshapes epistemic inclusion by legitimizing diverse communication modalities within academic environments. The findings show that Doljak and Wangeman challenge the long-standing association between vocal speech and intellectual credibility, revealing AAC as a tool of empowerment, dignity and pedagogical innovation. The article concludes by highlighting institutional implications for universities and outlining future research needs regarding digital voice ethics and cross-cultural implementation of AAC in higher education. Ultimately, the study argues that the future of academic communication will be judged by the content of one’s voice, not by its physical carrier.

Objectives This study examines how affective resistance to Augmentative and Alternative Communication (AAC) technologies emerges in parent-child interaction, and how affective communication and play influence communication engagement. Methods Using a reflexive case study design, the research draws on naturalistic observation, diary entries, and autoethnographic reflection by the first author, based on lived experience with her nonspeaking autistic child. The analysis is informed by practical interaction with AAC systems, including speech-generating devices and symbol-based applications, within the Croatian public education context. Results Findings reveal a relational misalignment between standardized AAC practices and children’s emotional-cognitive needs, leading to affective resistance. While AAC offers expressive potential, institutional rigidity, lack of cultural adaptation, and the marginalization of parental knowledge often hinder its success. Emotionally safe, play-based interaction proved more effective in supporting vocalization than structured AAC standardized approaches. Conclusions The study advocates for a paradigm shift in AAC implementation – from tool-centered compliance to relational, child-centered engagement – and contributes to AAC discourse by integrating embodied caregiver experience with communication theory.

This study reports on a series of workshops on Augmentative and Alternative Communication (AAC) conducted in the Sekhukhune District of Limpopo Province with teachers from five special education schools. The purpose of the study was to examine the integration of AAC tools in special education schools and assess their impact on inclusivity. It was established that AAC tools are changing special education schools by providing learners with Complex Communication Needs (CCN) techniques to express themselves. These tools, ranging from non-verbal communication systems to advanced speech-generating devices (SGDs), aim to enhance inclusivity and learner participation in classroom activities. Following a qualitative research approach, the study focused on teacher perspectives and classroom practices regarding AAC implementation. Seventeen (17) special education teachers from five schools who attended an AAC training workshop were purposively selected to participate in the study. Data were collected through interviews and analysed using thematic content analysis based on Creswell’s model. Findings indicated that a lack of structured training programs prevents teachers from effectively implementing AAC tools, forcing them to rely on gestures and picture-based communication due to limited access to advanced technologies.Discussions highlighted the urgent need to improve teacher capacity and resource availability.To address these challenges, the study recommends comprehensive teacher training, policy support, and the integration of AAC tools into classrooms. This study contributes to scholarship by providing evidence on how AAC tools can redefine teaching methods and promote inclusivity in special education schools across the Sekhukhune District, offering insights for policymakers, teacher educators, and practitioners in inclusive education.

This is a systematic review investigating factors that influence children's learning of speech-generating devices (SGDs) for manding with a single icon. The review addressed three questions: (1) the demographic characteristics of participants involved in SGD studies, (2) the effectiveness of different teaching strategies, and (3) the impact of intervention dosage on the acquisition of manding responses using Tau-U. This review focused on peer-reviewed journal articles that studied Mand learning with SGDs in children with autism, employing a single-case design and behavioral teaching procedures. ProQuest, the Education Resources Information Center (ERIC), and PsycINFO were accessed in September 2023 for this review. Through a comprehensive analysis of 14 peer-reviewed studies from these databases, the progress of 42 participants was compared across different instructional methods. The review contrasted three major instructional methods with time delays: least-to-most prompting, most-to-least prompting, and full physical prompting. Participants' demographics aligned with statistics from the Centers for Disease Control and Prevention. The settings of the studies indicated a potential literature gap in teaching manding in naturally occurring settings. The Tau-U scores suggested similar effectiveness between the most-to-least and least-to-most prompting procedures, but peer mediation was recommended. No linear relationship was found between the effectiveness of the treatment and treatment dosage based on Tau-U scores. Several research trends were identified. This study noted an uneven distribution of intervention methods across the studies, and the total number of participants was limited. The findings could inform practitioners on teaching manding with a single icon from an SGD and suggest directions for future research on teaching the use of SGDs for manding in children with autism.

Augmentative and alternative communication (AAC) systems provide individuals without speech, or with limited speech, a way to functionally communicate. Current practitioner recommendations emphasize the value of multimodal communication, yet limited research exists on teaching two AAC systems simultaneously. The purpose of the current study was to evaluate the effects of simultaneously teaching two AAC systems, picture exchange (PE) and the activation of a speech generating device (SGD), to preschoolers with autism. Using a concurrent multiple probe across participants design with embedded adapted alternating treatment designs, we evaluated the Picture Exchange Communication System (PECS) instructional protocol for teaching each modality and assessed: (a) participants’ rate of acquisition, (b) preference of modality, (c) occurrence or emergence of vocalizations, and (d) maintenance of each modality. Researchers found that three of the four participants reached mastery criteria for PE and SGD during simultaneous training at similar rates of acquisition and preference varied across participants and across PECS phases.

Digital technology interventions for communication skills in persons with neurodevelopmental disorders: a scoping review.

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disorder that progressively impairs motor and communication abilities. Globally, the prevalence of ALS was estimated at approximately 222,800 cases in 2015 and is projected to increase by nearly 70% to 376,700 cases by 2040, primarily driven by demographic shifts in aging populations, and the lifetime risk of developing ALS is 1 in 350–420. Despite international advancements in assistive technologies, a recent national survey in Saudi Arabia revealed that 100% of ALS care providers lack access to eye-tracking communication tools, and 92% reported communication aids as inconsistently available. While assistive technologies such as speech-generating devices and gaze-based control systems have made strides in recent decades, they primarily support English speakers, leaving Arabic-speaking ALS patients underserved. This paper presents SOUTY, a cost-effective, mobile-based application that empowers ALS patients to communicate using gaze-controlled interfaces combined with a text-to-speech (TTS) feature in Arabic language, which is one of the five most widely spoken languages in the world. SOUTY (i.e., “my voice”) utilizes a personalized, pre-recorded voice bank of the ALS patient and integrated eye-tracking technology to support the formation and vocalization of custom phrases in Arabic. This study describes the full development life cycle of SOUTY from conceptualization and requirements gathering to system architecture, implementation, evaluation, and refinement. Validation included expert interviews with Human–Computer Interaction (HCI) expertise and speech pathology specialty, as well as a public survey assessing awareness and technological readiness. The results support SOUTY as a culturally and linguistically relevant innovation that enhances autonomy and quality of life for Arabic-speaking ALS patients. This approach may serve as a replicable model for developing inclusive Augmentative and Alternative Communication (AAC) tools in other underrepresented languages. The system achieved 100% task completion during internal walkthroughs, with mean phrase selection times under 5 s and audio playback latency below 0.3 s.

Purpose: This study evaluated the communicative efficiency of an alternative display design for speech-generating devices using eye gaze. It compared sentence production efficiency with identical communicative symbols in a traditional grid design versus a novel circular display, focusing on production times and error rates. Materials and Methods: Participants produced two different sets of three-symbol sentences on two displays containing the same communicative symbols, grouped into semantic units by background color. One display used a standard grid design, while the other arranged symbols circularly around the screen’s center. Participants completed the sentences consecutively on both displays, with sentence production times and error rates recorded for comparison. Results: The circular display yielded significantly faster sentence production times compared to the grid design. However, error rates for sentence completion were similar between the two display types. Conclusions: The findings suggest that a circular display orientation may enhance communicative efficiency for speech-generating devices controlled by eye gaze, potentially improving communication outcomes. These results advocate for exploring alternative display designs beyond the conventional grid format.

The aim of this study was to determine whether animation improved symbol identification accuracy and activation time in consistent and variable grids. A 2 x 2 counterbalanced factorial design was used to determine the effects of symbol format (animated and static) and placement (variable and consistent) on identification accuracy, averaged activation time (s), and activation time change (s) from trial one to trial four in 42, 18- to 58-year-old adults without disabilities. A repeated measures ANOVA was conducted, and analyses revealed significant main effects for symbol format and placement and a significant interaction. Animated symbols were identified with greater accuracy than static symbols, while static symbols were selected on average .26 s faster than animated symbols. However, animated symbols in the consistent placement condition had greater identification accuracy and faster activation time by the 4th trial compared to all other conditions. The synergistic effects of animation and consistent symbol placement suggest that speech-language pathologists should use these features as tools to facilitate speed and accuracy of word production on speech-generating devices.

Despite the need to improve preservice training in AAC, there is a limited understanding of what teaching and learning methods are effective in developing preservice speech-language pathologists’ (SLPs’) competence in AAC. One component of professional preparedness to provide AAC services includes competence with AAC systems. This study aimed to determine if a self-guided hands-on learning opportunity with a speech-generating device (SGD) was effective in developing preservice SLPs’ competence with that system. Fifteen undergraduate students majoring in speech-language hearing spent up to 75-minutes exploring an SGD and related support materials. Following self-guided hands-on learning, they were asked to demonstrate a variety of operational and linguistic features of the SGD to assess their learning. Learning outcomes were analyzed descriptively. Participants demonstrated most of the SGD features that were assessed in this study, though they demonstrated fewer linguistic features than operational features. There were no significant differences in performance for participants who had previous clinical experience. Results indicated that self-guided hands-on learning opportunities facilitated students’ knowledge and skills with features of SGDs. The paper concludes with implications and recommendations for facilitating hands-on learning with SGDs during preservice training.

This study aimed to investigate the effects of removing synthetic speech output from speech-generating devices (SGDs) and incorporating delayed reinforcement on verbal requests in children with autism spectrum disorder (ASD) and intellectual disabilities. Additionally, we examined how participants' receptive and expressive language abilities influenced vocal requests by comparing items categorized as easier or more difficult to name based on pre-assessment results. Three children with ASD and intellectual disabilities participated. An alternating treatment design was used to compare two conditions: (1) synthetic speech output with immediate reinforcement and (2) no synthetic speech output with delayed reinforcement. Preferred items were classified into two sets based on pre-assessed receptive and expressive language abilities. The dependent variable was the number of verbal and SGD-based requests. Results showed that verbal requests increased in the no synthetic speech output with delayed reinforcement condition across both item sets, while SGD-based requests remained high. Post-intervention language assessments indicated significant improvements in expressive language abilities. These findings suggest that removing synthetic speech output and incorporating delayed reinforcement may effectively promote vocal requests in children with ASD and intellectual disabilities. This intervention provides a novel approach to facilitate speech communication while continuing the use of AAC tools.

Effective communication remains a significant challenge for individuals with paralysis or severe physical disabilities. Existing communication aids such as sign language and speech-generating devices often face limitations related to complexity, cost, and the requirement of prior training. This research introduces a novel “IoT and cloud enabled Motion Communication and ML Assisted Recovery system for Paralytics,” a wearable, gesture-based communication system integrated with Internet of Things (IoT) technology. The device employs a glove embedded with five flex sensors to detect finger movements and translate these into binary signals corresponding to predefined messages. An ESP32 microcontroller processes these signals and transmits messages via Wi-Fi using the Blynk IoT platform to caregivers’ mobile applications in real time.

This study aimed to evaluate the impact of a speech-generating device (SGD) application on manding skills in Chinese children with autism spectrum disorder (ASD). Given the communication challenges faced by many individuals with ASD, alternative methods for expressing needs are crucial. The SGD utilized speech synthesis technology to provide visual cues and vocal sounds for selected items. Employing a multiple probe design across participants, the study comprised baseline, intervention, generalization, and maintenance phases. Throughout these phases, the SGD was introduced to facilitate manding for toys of interest. A most-toleast prompting procedure with a 3-s time delay was employed during the intervention phase. After intervention, all participants demonstrated an increase in both the frequency and variety of items manding using the SGD. Furthermore, participants successfully generalized and maintained their manding skills.

Purpose AI and, more specifically, large language models (LLMs) have great scope for use in voice output communication aids (VOCAs), and this is being realised as the technology finds a greater foothold in mainstream systems. Design/methodology/approach In this paper we examine what we know is important in VOCA design and use the approach of casuistry to examine the potential ethical implications of the use of LLMs in VOCAs. Findings We suggest that there is relevant similarity between some potential applications of LLMs and the discredited technique of facilitated communication (FC). We highlight risks related to authorship and authenticity of the message produced by LLM-enabled VOCAs and discuss the importance of a holistic view of communication, which is multi-modal and co-constructed by all participants, generating agreed meaning with a shared understanding of where that meaning originates. We also draw attention to the potential impact of LLMs on language and communication development, where they may remove important opportunities for co-construction, correction and non-VOCA interactions that are so vital to development. Originality/value Ultimately, we recognise the potential benefits of LLMs in VOCAs but counsel against a technoableist, technology-led implementation of LLMs without due consideration of the communication needs of VOCA users. We counsel against the uncritical inclusion of LLMs within new and existing VOCAs, and encourage a deeper engagement with the ethical risks of doing so, as well as with important concepts such as authorship, humanness and user-centred design.

Evaluating the correspondence between tangible and pictorial-based preference assessments via speech-generating device.

<p class="HeaderAbs"><em>The main challenge faced by children with autism is difficulty in social communication. Appropriate early intervention is crucial to help autistic children develop their communication skills. One increasingly popular tool in communication intervention for autistic children is Speech Generating Devices (SGD). This study aimed to explore the urgency of using SGD in social communication enhancement therapy for autistic children to improve social interaction and reduce maladaptive behaviour. This study employs a mixed-method research design to explore the urgency of using SGD in treatment to enhance the social communication of autistic children. The sample was taken using proportional random sampling, consisting of 80 teachers for autism and speech therapists in Surakarta. Data collection techniques in this study to explore the urgency of using SGD in therapy to improve the social communication of autistic children were conducted in two ways: through a questionnaire using Google Forms and interviews. The analysis results show that SGD is an essential tool for enhancing the social communication of autistic children, with 66.7% agreeing and 33.3% expressing a neutral stance. The interview results stated that SGD is needed to support autistic social communication. The conclusion drawn from these results indicates that SGD is a crucial element that can be used to improve the communication of autistic children in schools rapidly. The opinions of teachers and speech therapists suggest that the use of SGD can reduce communication challenges in autistic children. This is evident from the questionnaire results filled out by respondents, showing that 95% strongly agree and 5% agree. The use of speech generating devices (SGD) is of high urgency in supporting therapy to enhance the social communication of autistic children in inclusive schools, such as training in social interaction and reducing maladaptive behaviour in autistic children.</em></p>