Using the ImPAACT program with preschoolers with Down syndrome: a hybrid service-delivery model.

Three parents of preschool-aged children with Down syndrome using mobile augmentative and alternative communication (AAC) technologies to communicate participated indirect, systematic communication-partner instruction. Intervention featured an adaptation of the ImPAACT Program (Improving Partner Applications of Augmentative Communication Techniques; Kent-Walsh, Binger, & Malani, 2010) that included six face-to-face and three telepractice sessions. Parents learned to use the evidence-based Read-Ask-Answer (RAA) instructional strategy (Kent-Walsh, Binger, & Hasham, 2010) during shared storybook reading with their children. A single-case, multiple-probe across participants design was used to assess parents' accurate implementation of the instructional strategy and children's multimodal communicative turns. All three parents increased their use of the RAA strategy and maintained strategy use over time, and all three children increased their frequency of communicative turns taken and maintained higher turn-taking rates. Results support the use of the ImPAACT Program with parents of children with complex communication needs, including the integration of hybrid learning as part of the instructional approach.

Methodological advances, opportunities, and challenges in AAC research.

Since its inception in 1985, the AAC journal has been publishing scientific articles related to the field of augmentative and alternative communication (AAC) that (a) report research concerning assessment, treatment, rehabilitation, and education of people who use or have the potential to use AAC systems and (b) cover theory, technology, and systems development relevant to AAC. The journal has maintained a consistent focus on the science and practice of AAC while also advancing in varied and impressive ways. Among the many developments apparent in AAC over the years, methodological advancements emerge as pivotal within the evolution of the science of AAC. This report examines the state of the science in behavioral AAC research with specific regard to changes and opportunities in research methodology. Illustrations from articles published in Volume 1 (1985) and Volume 32 (2016) of AAC are used in this paper to frame commentary on (a) contextual consideration in conducting AAC research, (b) types of research design, (c) considerations of procedural rigor, and (d) future methodological directions and resources. If the AAC field is to meet the goal of ensuring that all individuals with complex communication needs achieve their full potential, meaningful questions must be posed to address key problems, and rigorous scientific methods must be employed to answer these questions.

Using dynamic assessment to evaluate the expressive syntax of children who use augmentative and alternative communication.

The developmental readiness of four 5-year-old children to produce basic sentences using graphic symbols on an augmentative and alternative communication (AAC) device during a dynamic assessment (DA) task was examined. Additionally, the ability of the DA task to predict performance on a subsequent experimental task was evaluated. A graduated prompting framework was used during DA. Measures included amount of support required to produce the targets, modifiability (change in participant performance) within a DA session, and predictive validity of DA. Participants accurately produced target structures with varying amounts of support. Modifiability within DA sessions was evident for some participants, and partial support was provided for the measures of predictive validity. These initial results indicate that DA may be a viable way to measure young children's developmental readiness to learn how to sequence simple, rule-based messages via aided AAC.

Effects of Communication Partner Instruction on the Communication of Individuals using AAC: A Meta-Analysis.

The purpose of this study was to conduct a systematic review and meta-analysis of the augmentative and alternative communication (AAC) partner instruction intervention literature to determine (a) the overall effects of partner interventions on the communication of individuals using AAC, and (b) any possible moderating variables relating to participant, intervention, or outcome characteristics. Seventeen single-case experimental design studies (53 participants) met the inclusion criteria and were advanced to the full coding and analysis phase of the investigation. Descriptive analyses and effect size estimations using the Improvement Rate Difference (IRD) metric were conducted. Overall, communication partner interventions were found to be highly effective across a range of participants using AAC, intervention approaches, and outcome measure characteristics, with more evidence available for participants less than 12 years of age, most of whom had a diagnosis of autism spectrum disorder or intellectual/developmental disability. Aided AAC modeling, expectant delay, and open-ended question asking were the most frequently targeted communication partner interaction skills. Providing a descriptive overview, instructor modeling, guided practice, and role plays were the most frequently incorporated communication partner intervention activities within the included studies.

Applying a Developmental Model to Preliterate Aided Language Learning.

PURPOSE: Childhood spoken language interventions and augmentative and alternative communication (AAC) interventions share a common purpose: maximizing communication and language outcomes. To ensure that interventions for children who require AAC also address expressive language acquisition, this clinical focus article focuses on how to apply a developmental model of language acquisition to guide AAC decision making for preliterate aided communicators, with a particular focus on vocabulary selection. METHOD: A brief review of early expressive language development is presented, along with arguments for why relying on a developmental model to guide AAC decision making is so critical. A series of detailed examples of how to apply a developmental model to various AAC vocabulary selection approaches are provided, including analyses of how well each approach aligns with pragmatic, semantic, grammatical, and narrative development. CONCLUSIONS: No single AAC approach for preliterate AAC language learners adequately addresses both immediate and longer-term expressive language needs; every approach has both strengths and weaknesses. Clinical decision making requires an analysis of each approach to ensure that AAC service delivery teams clearly understand the inevitable linguistic gaps, with plans put into place to fill in those gaps with different approaches. Future efforts to improve preliterate AAC service provision should use a developmental model of language as a starting point, in combination with input from families, educators, and clinicians to ensure the feasibility of the chosen approaches.

Personnel roles in the AAC assessment process.

Completing an augmentative and alternative communication (AAC) assessment is a complex process that involves many stakeholders and professionals. To help clarify professional roles and provide assessment guidelines, an AAC Assessment Personnel Framework was developed. This framework was adapted from the work of Beukelman, Ball, and Fager in 2008, which focused on general AAC needs (not just assessment) and concentrated specifically on adults. In contrast, the present model examines the assessment process for all individuals who require AAC. The following AAC assessment personnel are discussed: AAC finders, general practice SLPs, AAC clinical specialists, facilitators and communication partners, collaborating professionals, AAC research and policy specialists, manufacturers and vendors, funding agencies and personnel, and AAC/assistive technology agencies and personnel. Current barriers for successful assessment outcomes are discussed, and suggestions for addressing personnel-related barriers are explored.

Planning for Implementation Science in Clinical Practice Research: An Augmentative and Alternative Communication Example.

PURPOSE: Most evidence-based clinical research findings in communication sciences and disorders never achieve full implementation by practicing clinicians. To address this almost universal problem, this tutorial focuses on the initial planning steps of including implementation methodologies as part of clinical practice research programs. Integrating the principles and methodologies of implementation science can shift the current reality, leading to better uptake of evidence-based interventions. METHOD: A step-by-step approach to integrating implementation science into new or existing research projects is provided, including the construction of a logic model, the selection of an implementation framework, and the selection of research methodologies. A detailed example of an augmentative and alternative communication research program is provided to illustrate the process. CONCLUSIONS: Readily available online tools can help researchers start the process of integrating implementation science into clinical practice research, and existing frameworks can assist with developing and guiding research programs to ensure maximal impact. If the ultimate goal is to improve the daily lives of individuals with communication disorders through the use of evidence-based practices, clinical practice researchers must integrate these approaches into their research programs.

Aided Language Measures: Establishing Observer Agreement for Communicators in Early Language Phases.

PURPOSE: Although many valid, reliable, and developmentally sensitive measures exist to monitor the language gains of children who rely on spoken language to communicate, the same is not true for graphic symbol communicators. This study is a first step in developing such measures by examining the interobserver agreement (IOA) and within-observer agreement of 13 measures designed to monitor the language progress of children who use aided augmentative and alternative communication (AAC). These measures are based on the Graphic Symbol Utterance and Sentence Development Framework (Binger et al., 2020) and are hypothesized to capture various phases of graphic symbol communication. METHOD: Four graduate student observers coded 13 measures across 57 different play-based sessions of children with Down syndrome ages 3;0-5;11 (years;months). For IOA, sessions were coded by two different observers. For within-observer agreement, all sessions were recoded by the same coders. Corpus-level analyses were completed to characterize the nature of the samples (e.g., average mean length of utterance for the samples). IOA and within-observer agreement were examined for each utterance. RESULTS: Across all observers and measures, acceptable levels of IOA and within-observer agreement were achieved, with most measures yielding relatively high levels of agreement. Some differences were noted across measures, with the less experienced coders demonstrating less agreement on select measures. CONCLUSIONS: Results provide initial evidence that many measures based on the Graphic Symbol Utterance and Sentence Development Framework can be reliably coded. These findings are a first step in developing psychometrically sound measures to monitor the expressive language progress of children who use AAC. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19601551.

Tracking Early Sentence-Building Progress in Graphic Symbol Communication.

Purpose As is the case with children who rely on spoken language, speech-language pathologists must support and track the expressive language development of children with complex communication needs who use graphic symbols to communicate. This research note presents a framework of the progression of expressive English sentence development using graphic symbols and introduces possible approaches for measuring and analyzing graphic symbol use. Method Current issues in measuring graphic symbol utterances are explored, and a range of measures designed to analyze individual graphic symbol utterances as well as larger samples of utterances are presented. Results Both the Graphic Symbol Utterance and Sentence Development Framework and suggested measures are based on years of graphic symbol intervention research, including two large ongoing research studies of preschoolers with severe speech impairments. Our framework adapts the work of Hadley (2014) to depict expressive language progression from early symbol combinations to childlike and adultlike sentences and highlights developmental patterns unique to graphic symbol productions. Adaptations of existing measures (such as mean length of utterance) as well as measures unique to graphic symbol analyses are presented and discussed. Conclusion To accurately track changes in early graphic symbol utterance growth and complexity, a multidimensional approach, which includes analyses such as symbol relevance, word class diversity, and lexical diversity, is recommended.

Teaching Latino parents to support the multi-symbol message productions of their children who require AAC.

Many children who require augmentative and alternative communication (AAC) have difficulties shifting from the single- to multi-symbol stage of language development. Ensuring that children who use AAC receive evidence-based interventions to address this problem is critical. Furthermore, there has been little AAC treatment efficacy research to date that addresses the needs of multicultural populations, particularly those of Latino children who use AAC and their families. To address these issues, the current investigation used a mixed methodology, which included a focus group to determine if any changes needed to be made to an existing instructional program; and a single subject, multiple probe, across participants design to evaluate the effects of a caregiver instructional program on the multi-symbol utterance productions of Latino children who used AAC. Specifically, a cognitive strategy instructional approach that has been used to teach turn-taking skills to both Caucasian and African American children who use AAC was modified and used to teach caregivers how to support the production of their children's multi-symbol messages. In order to foster emergent literacy skills, caregivers implemented the strategy during book reading activities. Focus group results revealed that changes to the instructional program may be required for some Latino families. With regard to the instructional program, all caregivers successfully learned to use the instructional strategy, and all children increased their use of multi-symbol messages. Research and clinical implications of the findings are discussed.

Dynamic Assessment for 3- and 4-Year-Old Children Who Use Augmentative and Alternative Communication: Evaluating Expressive Syntax.

Purpose: The developmental readiness to produce early sentences with an iPad communication application was assessed with ten 3- and 4-year-old children with severe speech disorders using graduated prompting dynamic assessment (DA) techniques. The participants' changes in performance within the DA sessions were evaluated, and DA performance was compared with performance during a subsequent intervention. Method: Descriptive statistics were used to examine patterns of performance at various cueing levels and mean levels of cueing support. The Wilcoxon signed-ranks test was used to measure changes within the DA sessions. Correlational data were calculated to determine how well performance in DA predicted performance during a subsequent intervention. Results: Participants produced targets successfully in DA at various cueing levels, with some targets requiring less cueing than others. Performance improved significantly within the DA sessions-that is, the level of cueing required for accurate productions of the targets decreased during DA sessions. Last, moderate correlations existed between DA scores and performance during the intervention for 3 out of 4 targets, with statistically significant findings for 2 of 4 targets. Conclusion: DA offers promise for examining the developmental readiness of young children who use augmentative and alternative communication to produce early expressive language structures.

Early Sentence Productions of 3- and 4-Year-Old Children Who Use Augmentative and Alternative Communication.

Purpose: This study investigated the early rule-based sentence productions of 3- and 4-year-old children with severe speech disorders who used single-meaning graphic symbols to communicate. Method: Ten 3- and 4-year-olds requiring the use of augmentative and alternative communication, who had largely intact receptive language skills, received instruction in producing up to four different semantic-syntactic targets using an Apple iPad with a communication app. A single-case, multiple-probe, across-targets design was used to assess the progress of each participant and target. Generalization to new vocabulary was assessed, and a subgroup also was taught to produce sentences using grammatical markers. Results: Some targets (primarily possessor-entity) were mastered in the baseline phase, and the majority of the remaining targets were mastered during intervention. All four children who completed intervention for grammatical markers quickly learned to use the markers accurately. Conclusions: Expressive language potential for preschoolers using graphic symbol-based augmentative and alternative communication systems should not be underestimated. With appropriate presentation and intervention techniques, some preschoolers with profound speech disorders can readily learn to produce rule-based messages via graphic symbols.

Teaching children who use augmentative and alternative communication to ask inverted yes/no questions using aided modeling.

PURPOSE: This study investigated the effects of a direct intervention program involving aided modeling and the presentation of contrastive targets on the aided production of inverted yes/no questions and possible generalization to other sentence types by children using augmentative and alternative communication (AAC). METHOD: A single-case, multiple-probe, experimental design across participants was used to evaluate the effects of the instructional program with 3 children who had motor speech disorders and used AAC (ages 4;10 [years;months], 6;2, and 4;9). The treatment involved aided modeling of treatment and contrastive targets through concentrated modeling and interactive play activities. Direct treatment outcomes were examined by measuring the accuracy of producing inverted yes/no questions and to be declaratives through probes. RESULTS: All 3 participants showed a direct treatment effect, producing a greater number of inverted yes/no questions and to be declaratives within the probes following treatment compared with before treatment. All 3 participants evidenced some generalization to novel sentences. CONCLUSIONS: Results provide initial evidence that instruction involving aided modeling with contrastive targets holds promise in targeting specific linguistic rules with children using AAC. Patterns of generalization may depend on participants' specific language deficits and acquisition patterns during intervention.

Using aided AAC models, recasts, and contrastive targets to teach grammatical morphemes to children who use AAC.

PURPOSE: The purpose of the investigation was to evaluate the effects of using aided augmentative and alternative communication (AAC) modeling and recasting on the expression of grammatical morphemes with children who used AAC. METHOD: A single-subject, multiple-probe, across-targets design was used for the study. Three participants were each taught to use 3 grammatical structures. Intervention consisted of aided AAC models and recasts during storybook reading tasks. RESULTS: All three children readily began using the targeted grammatical morphemes. However, none of the participants maintained use of the first morpheme. Error analyses revealed that the children either omitted the targeted morpheme or replaced it with another morpheme. To address this issue, a second intervention phase was implemented for the targets that were not maintained. During this phase, various grammatical morphemes were contrasted with each other (e.g., past tense -ed vs. possessive 's). Following the second intervention phase, participants maintained all targets. CONCLUSIONS: Aided AAC models and recasts may be used as part of intervention packages designed to help children acquire production of grammatical morphemes; however, it is important to provide contrasts of grammatical forms to ensure acquisition. Theoretical and clinical implications are discussed.

Effects of parent instruction on the symbolic communication of children using augmentative and alternative communication during storybook reading.

PURPOSE: This study investigated the effects of a communication partner instruction strategy for parents of children using augmentative and alternative communication (AAC) on the communicative turn taking of their children. Instruction was provided within storybook-reading contexts. METHOD: Two single-subject multiple-probe-across-participants designs were used to evaluate the effects of parent instruction on (a) 3 European American parents and (b) 3 African American parents. Changes in turn-taking rates and the expression of different semantic concepts in children using AAC were assessed in storybook-reading activities. RESULTS: All 6 parents learned to implement the communication partner interaction strategy accurately. All 6 children who used AAC increased their communicative turn taking and their language use as reflected by different semantic concepts expressed. CONCLUSIONS: Results provide evidence that the communication partner instruction program applied within storybook-reading contexts holds significant promise in improving parent-child interaction patterns and facilitating communicative expression and turn taking in children who use AAC.

Teaching educational assistants to facilitate the multisymbol message productions of young students who require augmentative and alternative communication.

PURPOSE: Many classroom educational assistants (EAs) have a significant amount of responsibility in carrying out educational plans for children who use augmentative and alternative communication (AAC), but they receive little instruction on how to do so (Kent-Walsh & Light, 2003). This study investigates the impact of using a communication partner instructional program to teach EAs how to teach their students to produce symbol combinations on their speech-generating devices. METHOD: A single-subject multiple-probe-across-participants design was used to evaluate the effectiveness of the instructional program on (a) the EAs' implementation of an interaction strategy with their students who used AAC and (b) the rates of multisymbol message productions for the students who used AAC. RESULTS: All 3 participating EAs learned to use the interaction strategy appropriately, and all 3 participating students who used AAC increased their multisymbol message production rates. CONCLUSIONS: Results provide further evidence (a) of the viability of using a communication partner instructional program for teaching partners how to facilitate the communication skills of children who use AAC and (b) that the interaction strategy can be an effective tool for increasing expressive multisymbol message rates for children who use AAC.

Tales from school trenches: AAC service-delivery and professional expertise.

School-based speech-language pathologists work with a broad spectrum of students with varying needs. Recent reports indicate that ~50% of speech-language pathologists working in school settings have students who use augmentative and alternative communication (AAC) on their caseloads. Therefore, AAC service-delivery continues to emerge as an area of great interest and concern in the school setting. As researchers and clinicians strive to validate and provide high-quality AAC services, it is important to examine current AAC service-delivery issues in the schools. Several recent investigations include data that describe current trends and issues in AAC service provision. This article will use findings from several recent reports and investigations as a basis for (a) presenting contemporary issues relating to AAC service-delivery and professional expertise in the schools and (b) exploring practical future directions for AAC clinicians and researchers.

The effects of aided AAC interventions on AAC use, speech, and symbolic gestures.

Augmentative and alternative communication (AAC) service provision can be time-consuming, and it is important to ensure that the time invested in aided AAC interventions is worth the costs. As children who use AAC are multimodal communicators, it is important to understand the effects that aided AAC interventions may have not only on AAC use but also on other communication modes, including speech and symbolic gestures. Toward these ends, this article contains a review of commonly used AAC intervention techniques, a discussion of how use of these techniques affects aided AAC use, and an examination of the effect that AAC interventions have on other communication modes, including speech and various types of gestures. Overall, current research findings indicate that aided AAC interventions can be highly effective for teaching students who use AAC to become more effective communicators and that such interventions do not have a negative effect on speech-and may, in some cases, have a positive effect on speech.