Speech-generating Device Research Articles

Autism Spectrum Disorder in Children: Early Signs and Therapeutic Interventions

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by challenges in communication, social interaction difficulties, and repetitive behaviors that can hinder a child’s development. The growing prevalence of autism necessitates early detection and effective intervention strategies. This review summarizes the current knowledge of early indicators of ASD, including brain development markers and behavioral signs visible in infants. It investigates diagnostic processes, emphasizing the importance of timely detection at 18 to 24 months using established screening tools. We discuss a variety of therapeutic approaches, including behavioral interventions, educational strategies such as music therapy, and technological advancements such as speech-generating devices. Furthermore, we investigate pharmacological options for treating associated symptoms, emphasizing the lack of targeted medications for core ASD symptoms. Finally, we present evidence highlighting the positive effects of early intervention on developmental outcomes, advocating for individualized treatment plans to enhance the well-being of children with ASD. This comprehensive overview aims to inform ongoing ASD research and clinical practices.

Delivering Enhanced Milieu Teaching to Toddlers With Down Syndrome via Hybrid Telepractice: A Single-Case Experimental Design.

This pilot study investigated delivering enhanced milieu teaching tailored for children with Down Syndrome (EMT-DS) through hybrid telepractice. In this multiple-baseline design across behaviors study, a speech-language pathologist (SLP) taught EMT-DS to three caregivers and their children with DS (22-40 months) using a hybrid service delivery model. Sessions were conducted in person and via telepractice. The SLP taught caregivers EMT-DS, emphasizing the use of (a) four target EMT strategies: matched turns, expansions, time delays, and milieu teaching episodes; (b) augmentative and alternative communication (AAC; manual signs, speech-generating device); and (c) aided AAC modeling. The SLP provided caregiver instruction following the teach-model-coach-review approach. Caregiver outcomes were the accuracy (primary) and frequency (secondary) of EMT strategy use. Child outcomes were exploratory and included the rate of symbolic communication acts, weighted number of communication acts, and number of different words (NDW). There was a functional relation between the intervention and the accuracy and frequency of EMT strategy use for all three caregivers. All caregivers showed an increase in the accuracy for all four target strategies. Caregivers also increased the frequency of the three EMT strategies: expansions, time delays, and milieu teaching episodes. There were no changes in the frequency of matched turns. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the rate of symbolic communication acts and NDW occurred for all three children. Results demonstrate the preliminary efficacy of using a hybrid service delivery model to teach caregivers EMT-DS. https://doi.org/10.23641/asha.27115252.

Teaching Parents via Online Asynchronous Training to Use Speech-Generating Devices with Their Autistic Children: A Pilot Study.

Background/Objectives: Telepractice interventions have been found to alleviate barriers families face when seeking communication interventions. This study is a multiple-baseline single-subject design that measures parent communication opportunities and parent responsiveness to determine if parent training through online modules created for parents of children with communication support needs can be effective for training parents of autistic children with communication support needs. Methods: This study replicates work by utilizing online training used as well as the same variables and definitions. This study expands the original study by providing the children with speech-generating devices (SGDs). SGDs are an assistive technology tool to increase language production and give access to language to minimally verbal autistic people. A central difference between this study and study is that the only training parents received was the online modules and written instructions to set up the SGD. Results: Overall, the POWR modules appear to positively impact the communication opportunities provided by the parent during play and activities, increase child communication, and improve parent proficiency in implementing the POWR strategy. Conclusions: There is a need for a larger single-case study or a randomized control trial to replicate these findings. Additional instruction may be needed for parents of children with autism around responsive interactions. This study adds to innovative ways of providing family-centered training and access to AAC for those with barriers to service.

The role of the body in SGD-mediated interactions

Most research about augmentative and alternative communication (AAC) has focused on improving use of and access to speech generating devices (SGDs). However, many adults with significant physical and developmental disabilities express a preference for unaided, embodied forms of communication. This study used conversation analysis (CA) techniques to analyze the forms and functions of embodied communication that occurred during interactions between a young man who used unaided, embodied communication and an SGD to communicate with a familiar communication partner. Close analysis revealed that embodied resources were required for both unaided and aided forms of communication. Furthermore, both participants used their bodies to establish interactional spaces with different focal points during interaction, which placed different demands on the aided speaker. Unfortunately, when the SGD was the focal point, problematic demands were placed on the aided speaker, which in turn resulted in increased embodied effort on his part. The forms and functions of the body, differences in the participants’ interactions when communication did and did not involve the SGD, and implications for research and practice are all reported and discussed.

Use of artificial intelligence (AI) in augmentative and alternative communication (AAC): community consultation on risks, benefits and the need for a code of practice

PurposeThis paper reports on a workshop discussing the views of the augmentative and alternative communication (AAC) community on the opportunities and risks posed by the integration of artificial intelligence (AI) into voice output communication aid systems. The views of the community on whether a Code of Practice was needed for the use of this new technology were also sought.Design/methodology/approachThis was an explorative, qualitative study in which members of the AAC community attending a session at a UK national conference were invited to discuss the topic, responding to structured questions from the research team. The use of AI for both novel language generation and rate enhancement was discussed within the session.FindingsMany potential opportunities and benefits of AI to AAC users were discussed by the group. Risks associated with new and existing biases in AI language models were raised, as was the need to ensure that outputs generated by AI were authentically authored by users. Whilst there was broad support for the idea of a Code of Practice, questions were posed about how it would be designed and what it should contain.Originality/valueThis study presents a unique insight into the views of the AAC community on the benefits and risks of incorporating AI into AAC systems. The views of the community on the need for a Code of Practice may support how the field moves forward with this complex technology.

Professional Networks and Self-Efficacy of Paraeducators Working with Students with Learning to Use Augmentative and Alternative Communication (AAC)

Paraeducators often work with special education teachers and school teams to support students with disabilities who have complex communication needs (CCN), including students who use augmentative and alternative communication (AAC) such as speech-generating devices. This study involved surveying 258 paraeducators working with students with disabilities who had CCN (grades PreK–12, along with community-based transition classrooms). Social network analysis was used to examine paraeducators’ professional networks and collaboration patterns, along with how paraeducator professional network size related to their self-efficacy beliefs about working with students with CCN. Findings revealed wide variability in the size and function of paraeducators’ professional networks and their self-efficacy beliefs. Paraeducators generally reported few mutual collaborative relationships with other professionals, receiving support more than they gave support. Many had small networks with few trusted collaborators. Paraeducators’ network size was the strongest predictor of self-efficacy beliefs, beyond their personal characteristics and whether they received AAC-related training. This study informs future research and practice by underscoring the need for paraeducators to work within well-connected teams, and by revealing ways social network analysis can be used to examine issues related to self-efficacy and collaboration.

The Impact of Parent-Mediated Naturalistic Interventions with the Addition of Speech-Generating Devices on Vocalizations of Children with Autism Spectrum Disorder and Complex Communication Needs

The Impact of Parent-Mediated Naturalistic Interventions with the Addition of Speech-Generating Devices on Vocalizations of Children with Autism Spectrum Disorder and Complex Communication Needs

Extended repair in SGD-mediated conversation involving speakers with dysarthria

Background: The ability to engage successfully in repair is central to accomplishing shared conversational activities. Based on two case studies, this paper describes one strategy individuals with dysarthria who use speech generating devices (SGD) may engage in to manage extended repair in multiparty conversation. Method: Conversation Analysis was applied to video data of two extended repair interactions involving an aided speaker and two interlocutors, one familiar, the other less familiar. Results: Aided speakers took an agentive role in the organization of repair when dyadic repair with the less familiar conversant was unsuccessful by selecting the more familiar partners to participate in repair. Aided speakers capitalized on the partner shift by immediately switching to use of idiosyncratic communication modalities and by making reference to past shared experiences relevant to the repair. Conclusion/Discussion: The use of this strategy warrants further exploration as a means for managing extended repair in SGD-mediated conversation.

‘I just stopped pushing’

Background: Previous studies have demonstrated that communication partner training is an effective means to alter the use of communication aids. Partners use many types of facilitative strategies and practices during aided interaction. Despite the study findings, communication aids are often unused, and communication partners feel that using them is challenging. Aim and method: This article describes the positive change that occurs in a mother’s practices during aided conversation with her son after a video-based intervention. The research method is conversation analysis. Results: The analysis demonstrates how before the intervention, the mother pushed her son to use a speech-generating device, and how after the intervention she facilitated his use of the device by using it together with her son, and by positioning herself as an equal conversationalist who shared her thoughts. Conclusion: The results of this study contribute to a deeper understanding of different communication partner practices and offer new ideas for updating the general recommendations for facilitating aided conversations.

Aided-speaking students’ unsolicited questions in teacher-fronted classroom talk: the use of speech-generating devices to ask questions

ABSTRACT Using the framework of conversation analysis, this paper examines aided-speaking students’ unsolicited speech-generating device (SGD)-mediated questions in teacher-fronted classroom talk. The analysis draws on a corpus of 18 h of video-recorded classroom interactions including 23 aided-speaking students using SGDs or picture-based communication boards. In all, 5% of the students’ contributions were unsolicited questions, produced by three students. The students were found to orient to turn transition relevance places, but due to prolonged production time their questions risked sequential and topical misplacement in the ongoing classroom talk and were vulnerable to misunderstandings. To address this problem, students activated the synthetic voice before finalising the question, claiming the interactional floor while securing time to complete their utterance. They also refrained from activating the synthetic voice and instead made the question visually available for the teacher to read, thereby transferring the responsibility for answering the question to the teacher when sequentially and topically relevant. The study demonstrates the complex interactional process of formulating SGD-mediated questions, sometimes requiring that the teacher, assistants, and students engage in repair work and scaffolding to establish the meaning of a student’s utterance. The findings imply that the treatment of non-speaking students’ contributions as questions requires designated teacher work.

Shifting Paradigms

Shifting Paradigms

Augmentative and alternative communication and deaf children with disabilities

ABSTRACT With recent data reporting approximately 40–50% of Deaf or hard of hearing (DHH) individuals as having a diability, complex communication needs are not uncommon within this population and can present unique communicative challenges. Implementing augmentative and alternative communication (AAC) systems can provide this population with an effective means of communication, assist them in developing specific language skills, and support them in effectively accessing their social environment. The purpose of this scoping review was to (a) identify the facilitators and barriers to AAC provision for this group of individuals, (b) discuss observable trends throughout studies, and (c) highlight areas for further research in AAC for this group of learners. This review compiles the results from seven studies within the last 10 years and focuses on the facilitators and barriers when implementing AAC systems for DHH individuals with a disability (DWD) and complex communication needs. The facilitators and barriers are categorised as interpersonal, intervention and assessment related. The trends that were identified included (a) the overall success of AAC, (b) the prevalence of speech-generating devices (SGD) use, (c) the lack of communication within interdisciplinary teams, (d) the lack of DHH-specific research, and (e) the lack of standardised methods for AAC selection.

Increasing the mand repertoire of a child with autism using a speech-generating device with a time-delay procedure: A practical case study.

Increasing the mand repertoire of a child with autism using a speech-generating device with a time-delay procedure: A practical case study.

Expanding the phenotype of Kleefstra syndrome: speech, language and cognition in 103 individuals

ObjectivesSpeech and language impairments are core features of the neurodevelopmental genetic condition Kleefstra syndrome. Communication has not been systematically examined to guide intervention recommendations. We define the speech, language and...

Supplemental Material for Increasing the Mand Repertoire of a Child With Autism Using a Speech-Generating Device With a Time-Delay Procedure: A Practical Case Study

Supplemental Material for Increasing the Mand Repertoire of a Child With Autism Using a Speech-Generating Device With a Time-Delay Procedure: A Practical Case Study

Teacher perspectives on the use of augmentative and alternative communication systems for learners with complex communication needs

For learners with complex communication needs (CCN), teachers in special schools are encouraged to use a variety of communication techniques to help them participate in various classroom activities. Studies show limited data on the use of effective augmentative and alternative communication (AAC) strategies in special schools. The primary purpose of this study was to describe teacher perspectives on the use of AAC devices that they use in their classrooms in rural areas. We employed a qualitative methodology that included in-person interviews and focus groups. The focus group and face-to-face sessions each had 3 and 8 participants, respectively. Three main themes, namely modes of communication, training, and challenges and 12 subthemes were identified. We found that teachers employed pictures to improve communication of learners with CCN. We also discovered that since teachers didn’t use speech generating devices (SGD) frequently, they had trouble using them. The use of SGDs, one of the assistive technology tools that could be used to improve communication of learners with CCN, requires extensive teacher training, according to research. Further research is required to establish the efficacy on the use of AAC devices in special schools in rural areas.

Effects of Interventions Involving Tablet-Based Speech-Generating Devices for Individuals with ASD: A Meta-analysis.

The purpose of this review was to assess the effectiveness of tablet-based speech-generating devices (SGDs) in improving communication skills for individuals with autism spectrum disorder (ASD). A total of 31 single-case design intervention studies involving 84 individuals with ASD were reviewed and included in the analysis. We calculated Tau-U to evaluate the impact of interventions involving tablet-based SGDs on four different communication responses: specifically, mands, intraverbals, tacts, and vocalizations. To explore potential moderating variables for mand outcomes, we used the Kruskal-Wallis one-way test. The analysis revealed that interventions utilizing tablet-based SGDs led to improvements in communication responses. Specifically, large to very large changes were observed in mand and intraverbal responses, whereas moderate changes were noted in tact responses and vocalizations. The findings of this review underscore the potential of tablet-based SGDs in enhancing communication among individuals with ASD. We discuss the findings and provide implications for future research and practice.

Assessing Language and Literacy of Students with Developmental Disabilities and Complex Communication Needs

Students with developmental disabilities and complex communication needs are impacted by assessments that may not show their ability or address their needs. Multiple modes of assessment presentation and response formats, augmentative and alternative communication approaches, and assistive technology may help students engage more equitably in literacy assessment activities. The Nonverbal Literacy Assessment (NVLA) is an example of a tool used to assess the language and literacy skills of students with disabilities in various formats. Augmentative and Alternative Communication (AAC), eye-gazing, and speech-generating device (SGD) technology are also used to make assessment more accessible to students with developmental disabilities and speech difficulties.

Vocabulary Selection and Implementation in Vocabulary Interventions for Speech-Generating Devices: A Scoping Review

Purpose: Intervention studies contribute to evidence-based practice in speech-language pathology. With individuals who use speech-generating devices (SGDs), it is important to determine what vocabulary to teach during intervention. However, it is unclear whether researchers are reporting the vocabulary selection techniques they used in intervention studies so that they may be replicated in clinical practice. The purpose of this scoping review was to examine the vocabulary selection techniques and other aspects of intervention studies focused on vocabulary acquisition in early symbolic communicators who use SGDs. Method: Eight databases (PsycINFO, PubMed, Scopus, Web of Science, Educational Resources Information Center, Linguistics and Language Behavior Abstracts, Educational Research Complete, and CINAHL) were systematically searched for articles that were intervention studies targeting single-word vocabulary acquisition in early symbolic communicators who use SGDs. Data were extracted from each article and charted in Excel. Results: We found 5,405 unique articles, 18 of which met the inclusion/exclusion criteria for this review. All of the studies used a single-case design with three participants on average. Approximately half took place in the child's school, and most of the interventions were conducted by members of the research team. Eight studies targeted requesting or manding, six studies used preference assessments to select vocabulary, and seven articles used adults as informants to select the vocabulary. Conclusions: There are a limited number of studies investigating vocabulary acquisition in early symbolic communicators who use SGDs. Furthermore, the studies inconsistently used a range of methods that align with best practices for vocabulary selection.

A large-scale comparison of two voice synthesis techniques on intelligibility, naturalness, preferences, and attitudes toward voices banked by individuals with amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) commonly results in the inability to produce natural speech, making speech-generating devices (SGDs) important. Historically, synthetic voices generated by SGDs were neither unique, nor age- or dialect-appropriate, which depersonalized SGD use. Voices generated by SGDs can now be customized via voice banking and should ideally sound uniquely like the individual’s natural speech, be intelligible, and elicit positive reactions from communication partners. This large-scale 2 x 2 mixed between- and within-participants design examined perceptions of 831 adult listeners regarding custom synthetic voices created for two individuals diagnosed with ALS via two synthesis systems in common clinical use (waveform concatenation and statistical parametric synthesis). The study explored relationships among synthesis system, dysarthria severity, synthetic speech intelligibility, naturalness, and preferences, and also provided a preliminary examination of attitudes regarding the custom synthetic voices. Synthetic voices generated via statistical parametric synthesis trained on deep neural networks were more intelligible, natural, and preferred than voices produced via waveform concatenation, and were associated with more positive attitudes. The custom synthetic voice created from moderately dysarthric speech was more intelligible than the voice created from mildly dysarthric speech. Clinical implications and factors that may have contributed to the relative intelligibilities are discussed.