Guessability of Indian picture symbols for communication (IPSC) and picture communication symbols (PCS) among Malayalam-speaking typical adults.

The purpose of this study was to investigate the perceived symbol referent relationship for selected symbols in typical adults for two different symbol sets: Indian Picture Symbols for Communication (IPSC) and Picture Communication Symbols (PCS) to identify cultural influences on symbol recognition. A total of 240 typical adults, including 120 nonprofessionals, and 120 health professionals, from Kerala, a southern state in India, participated in the study. A guessability task involving IPSC and PCS symbols for 30 target referents was utilized. Guessability scores for each participant as well as each symbol stimuli across two symbol sets were determined. The guessability scores for IPSC were significantly (p <.001) higher than PCS. For both symbol sets, nouns were the most accurately guessed, followed by verbs, adjectives, and prepositions. The results also revealed that prompting and previous exposure to symbols tend to influence the transparency of symbols. Error analyses revealed that visual and conceptual cues within a symbol tend to influence guessability. The results indicate that cultural and linguistic factors play a role in symbol guessability. The study highlights the importance of investigating the iconicity of IPSC and PCS symbols across different populations within India, before using symbols for educational/clinical purposes.

Advances in augmentative and alternative communication research for individuals with Autism spectrum disorder: moving research and practice forward.

Augmentative and alternative communication (AAC) approaches offer expressive and receptive supports for the segment of the population of individuals with autism spectrum disorder (ASD) who have little or no functional speech. The National Center for Autism Evidence and Practice (NCAEP) declared augmentative and alternative communication (AAC) interventions for individuals with autism an "evidence-based practice." Following a brief analysis of the breakdown of studies included in NCAEP by dependent variable, we introduce each of the four papers published as part of this special issue on Advances in Augmentative and Alternative Communication Research for Individuals with Autism Spectrum Disorder. In addition to elucidating the contributions and advances of each paper to the research base, including the NCAEP report, we provide a critical commentary as applicable in the hopes of stimulating and guiding further research.

Attitudes Toward and Perceived Communicative Competence of Individuals with Aphasia Using Speech-Generating Devices.

The purpose of this study was to investigate the effects of interface display and respondent group on listener attitudes toward and perceived communicative competence of persons with aphasia. The Attitudes Toward Nonspeaking Persons scale and the Communicative Competence Scale was used to measure listener attitudes and communicative competence, respectively. A 2 × 3 mixed factorial design was used. Interface display videos served as the within-subjects variable (i.e., grid and scene displays), and the respondent group served as the between-subjects variable. A total of 113 respondents (i.e., undergraduate lower-division students, undergraduate upper-division students, and family caregivers of individuals with aphasia) watched an individual with aphasia using a grid display in one video and a scene display in another video. The respondents completed the two scales. Significant main effects (p < .05) were found for interface display and respondent group. The use of scene displays had a more favorable impact on competence ratings than the use of grid displays. Family caregiver ratings were significantly (p < .05) more favorable than ratings from other groups. The Communicative Competence Scale was found to be a reliable measure of perceived communicative competence. Scene displays have the potential to enhance the perceived communicative competence of this population.

The effect of augmented input on the auditory comprehension of narratives for people with aphasia: a pilot investigation.

Augmented input is the strategy of supplementing expressive language with visuographic images, print, gestures, or objects in the environment. The goal of augmented input is to facilitate comprehension of spoken language. The purpose of this study was to evaluate the relative effectiveness of two different augmented input conditions in facilitating auditory comprehension of narrative passages in adults with aphasia. One condition involved the communication partner (clinician) of the adult with aphasia actively pointing (AI-PP) out key content words using visuographic supports. The second condition involved no active pointing (AI-NPP) by the communication partner (i.e., attention was not drawn to the visuographic supports). All 12 participants with aphasia listened to two narratives; one in each condition. Auditory comprehension was measured by assessing participants' accuracy in responding to 15 multiple-choice cloze-type statements related to the narratives. Of the 12 participants, seven gave more accurate responses to comprehension items in the AI-PP condition, four gave more accurate responses in the AI-NPP condition, and one scored the same in both conditions. These differences were not statistically significant (p > 0.05). Communication-partner-referenced augmented input using combined high-context and PCS symbol visuographic supports improved response accuracy for some participants. Continued research is necessary to determine partner involvement with and frequency of augmented input that improve auditory comprehension.

Teaching children with autism spectrum disorder and other developmental disabilities to perform multistep requesting using an iPad.

Many children with autism spectrum disorders (ASD) and/or developmental disabilities are unable to meet their daily communication needs with speech alone. These individuals are considered potential candidates for speech-generating devices (SGDs) and mobile technologies with AAC-specific applications. The purpose of this study was to determine the effectiveness of systematic instruction on teaching multistep requesting skills using an iPad loaded with Proloquo2Go to children with ASD and other developmental disabilities. The participants in this study were four children between the ages of 8 and 10 years diagnosed with ASD and/or other developmental disabilities. The results indicated that for these participants, the intervention was effective in increasing multistep requesting using the iPad. All participants were successful to varying degrees in navigating across pages and combining symbols to request preferred items. Additionally, the participants demonstrated generalization of newly acquired skills by requesting different preferred items and activities during the generalization probes. Results are discussed and implications for research and practice are presented.

Speech Output Technologies in Interventions for Individuals with Autism Spectrum Disorders: A Scoping Review.

The purpose of this scoping review was to (a) map the research evidence on the effectiveness of augmentative and alternative communication (AAC) interventions using speech output technologies (e.g., speech-generating devices, mobile technologies with AAC-specific applications, talking word processors) for individuals with autism spectrum disorders, (b) identify gaps in the existing literature, and (c) posit directions for future research. Outcomes related to speech, language, and communication were considered. A total of 48 studies (47 single case experimental designs and 1 randomized control trial) involving 187 individuals were included. Results were reviewed in terms of three study groupings: (a) studies that evaluated the effectiveness of treatment packages involving speech output, (b) studies comparing one treatment package with speech output to other AAC modalities, and (c) studies comparing the presence with the absence of speech output. The state of the evidence base is discussed and several directions for future research are posited.

Effect of Number of Graphic Symbols, Levels, and Listening Conditions on Symbol Identification and Latency in Persons with Aphasia.

This study investigated the ability of persons with aphasia to complete a series of experimental tasks involving single symbol and subject-verb-object sentence identification on a speech-generating device (SGD) in the presence/absence of competing stimuli. In all, 10 persons with Broca's aphasia and 10 persons in the control group were compared on accuracy and response latency of symbol identification across three listening conditions. Persons with aphasia identified fewer symbols accurately and had longer response latencies than persons in the control group. Number of symbols on the screen and location level had a significant effect on accuracy and latency for both groups. Persons with aphasia perceived tasks to be more difficult than persons in the control group. Results indicate that effective use of SGDs by persons with aphasia may depend on several message organization factors including location and number of symbols per screen.

Effects of an Augmentative and Alternative Communication Intervention Package on Socio-Communicative Behaviors Between Minimally Speaking Autistic Children and Their Peers.

PURPOSE: The purpose of this study is to investigate the effectiveness of an augmentative and alternative communication (AAC) intervention package consisting of systematic instruction and aided modeling with speech-output technologies on the acquisition, maintenance, and generalization of socio-communicative behaviors-initiating a request for a turn, answering questions, and commenting-in four, minimally speaking (MS) autistic children between the ages of 6 and 9 years. METHOD: A multiple-probe design across behaviors replicated across participants was implemented to evaluate the effects of systematic instruction and aided modeling on initiating requests for a turn, answering questions, and commenting behaviors. Additionally, a pre- and posttreatment multiple-generalization-probes design was used to assess generalization across peers. RESULTS: Visual analyses demonstrated experimental control for two participants (i.e., Derek, Ajay) showing a functional relationship between the intervention and outcomes across all social communicative behavior. For one participant (i.e., Matthew), experimental control could not be established because he did not reach the learning criterion for commenting. The fourth participant (i.e., John) transferred to a different school after making some progress on requesting. Effect size indicator analyses corroborated these findings, indicating medium-to-strong effects for initiating requests for a turn strong effects for answering questions, and medium-to-strong effects for commenting. Generalization of socio-communicative behaviors from researcher to a typically developing peer was variable across participants. Participants maintained socio-communicative behaviors 3 weeks after the last intervention session with varying degrees of success. CONCLUSION: The outcomes of this study suggest that aided modeling and systematic instruction using speech-output technologies may lead to gains in socio-communicative behaviors in some MS autistic children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25799935.

Socio-Communicative Behaviors Involving Minimally Speaking Autistic Preschoolers and Their Typically Developing Peers: Effects of an Augmentative and Alternative Communication Intervention Package.

PURPOSE: The purpose of this study was to examine the effectiveness of an augmentative and alternative communication (AAC) intervention package consisting of systematic instruction and aided AAC modeling with speech-output technology on the acquisition, maintenance, and generalization of socio-communicative behaviors in four minimally speaking, preschool-aged, autistic children. METHOD: A multiple-probe design across behaviors (i.e., initiating a request for a turn, answering questions, and commenting) replicated across participants was implemented to evaluate the effects of the intervention package on socio-communicative behaviors. Furthermore, a pretreatment and posttreatment multiple-generalization-probe design was used to assess generalization across typically developing peers who were not a part of the intervention. Maintenance data were collected 3 weeks post intervention. RESULTS: Visual analysis, corroborated by nonoverlapping of all pairs statistics, established a strong functional relationship between the AAC intervention package and all targeted socio-communicative outcomes for two participants. For the other two participants, inconsistent intervention effects were observed. In terms of generalization from interacting with the researcher to typically developing peers, a functional relationship between the intervention and generalization outcomes for all targeted behaviors was established for only one participant (i.e., Aiden). CONCLUSION: The outcomes of this study suggest that aided AAC modeling and systematic instruction using a speech-output technology may lead to gains in socio-communicative behaviors in some minimally speaking, preschool-aged, autistic children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.27091879.

Augmentative and Alternative Communication Interventions in Critical and Acute Care With Mechanically Ventilated and Tracheostomy Patients: A Scoping Review.

PURPOSE: Communication with nonspeaking patients is a critical challenge of person-centered care. This scoping review aimed to map the literature on augmentative and alternative communication (AAC) interventions for nonspeaking mechanically ventilated and tracheostomy patients in critical and acute care settings. METHOD: Electronic database, ancestry, and forward citation searches were conducted using eligibility criteria established a priori. Data were extracted, synthesized, and summarized according to scoping review methodology. Studies were categorized by type of intervention and summarized in terms of purpose, participants, design, quality appraisal (including validity and reliability of selected efficacy measures), and efficacy. RESULTS: Small-to-large treatment effect sizes indicated demonstrable impact on patient health and communication efficacy with high-tech and no-tech visual interface-based interventions and systematic nurse training interventions. Treatment effects primarily pertained to dependent variables of patient anxiety, communication satisfaction, comfort, symptom self-reporting, and nursing practice changes. CONCLUSIONS: There is a paucity of high-quality AAC intervention research for mechanically ventilated and tracheostomy patients in critical and acute care settings. Emergent evidence suggests that select visual interface and nurse training interventions can impact efficacy of patient-provider communication and patients' overall health. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26506102.

Exploring Communication Needs and Challenges in the Intensive Care Unit: A Survey Study From Providers' and Patients' Perspectives.

PURPOSE: Effective communication between nonspeaking patients and providers is critical for the quality of care in intensive care units (ICUs). This study aims to evaluate perspectives of health care providers and nonspeaking patients on effective communication and communication barriers in the ICU. METHOD: Qualitative and quantitative survey methodologies were employed to evaluate providers' and patients' perspectives on effective communication. Rating scales were utilized to measure patients' frustration levels and communication effectiveness. Open-ended questions were employed to reflect on barriers to communication in the ICU, instances of ineffective communication, and recommendations for enhancing effective communication. RESULTS: The results of the study suggest that nonspeaking patients experienced high levels of frustration due to ineffective communication. However, the data reveal that access to appropriate augmentative and alternative communication (AAC) strategies and materials could help mitigate patients' frustration. Providers mainly communicated via asking yes/no questions, which largely limited the information patients conveyed, leading to frequent communication breakdowns. Providers expressed a desire to participate in training programs to utilize appropriate AAC strategies and promote effective communication. CONCLUSIONS: This study provides preliminary survey results on perspectives of patients and providers on effective communication in the ICU. Both providers and patients reported experiencing challenges and frustration during their communication, due to barriers such as providers' insufficient training experience and lack of access to AAC materials. Skill training is warranted to promote effective patient-provider communication in intensive care settings. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26339623.

QuickPic AAC: An AI-Based Application to Enable Just-in-Time Generation of Topic-Specific Displays for Persons Who Are Minimally Speaking.

As artificial intelligence (AI) makes significant headway in various arenas, the field of speech-language pathology is at the precipice of experiencing a transformative shift towards automation. This study introduces QuickPic AAC, an AI-driven application designed to generate topic-specific displays from photographs in a "just-in-time" manner. Using QuickPic AAC, this study aimed to (a) determine which of two AI algorithms (NLG-AAC and GPT-3.5) results in greater specificity of vocabulary (i.e., percentage of vocabulary kept/deleted by clinician relative to vocabulary generated by QuickPic AAC; percentage of vocabulary modified); and to (b) evaluate perceived usability of QuickPic AAC among practicing speech-language pathologists. Results revealed that the GPT-3.5 algorithm consistently resulted in greater specificity of vocabulary and that speech-language pathologists expressed high user satisfaction for the QuickPic AAC application. These results support continued study of the implementation of QuickPic AAC in clinical practice and demonstrate the possibility of utilizing topic-specific displays as just-in-time supports.

Implementing directives that involve prepositions with children with autism: a comparison of spoken cues with two types of augmented input.

Some children with autism face considerable challenges with comprehension, including difficulties following spoken directives involving prepositional relations. The use of augmented input through visual modalities might be an effective means for supplementing spoken language. The purpose of this preliminary study was to compare spoken input with two augmented input modalities (i.e., speech + visual cues) in terms of children's ability to follow directives involving prepositions. The augmented input modalities consisted of static scene cues (i.e., photographic or pictorial visual scenes that portray relevant concepts and their relationships) and dynamic scene cues (i.e., full-motion video clips that depict the actions underlying relevant concepts and their relationships). A within-subjects design involving nine children with autism or pervasive developmental disorders-not otherwise specified was used to examine the effectiveness of the three input conditions. Results indicated that both static scene cues and dynamic scene cues were more effective than spoken cues, but there were no differences between static scene cues and dynamic scene cues. Results are discussed in terms of appropriate instructional inputs for children with autism. Limitations are noted and directions for future research are posited.

Effect of clear speech intervention program on speech intelligibility in persons with idiopathic Parkinson's disease: A pilot study.

Purpose: This preliminary study was designed to assess the feasibility of Clear Speech Intervention Program (CSIP) on improving speech intelligibility of persons with idiopathic Parkinson's disease (PD). Clear Speech is a behavioural approach which focuses on improving speech intelligibility of persons with PD within a relatively short frame of time.Method: A single group pretest-posttest design was used to assess the effectiveness of CSIP. Fifteen adults diagnosed with PD participated in 8 sessions of CSIP with each session lasting 45-50 minutes over a period of 4 weeks in South Korea. All the data were collected in a quiet room with an ambient noise level of equal to or less than 40 dB SPL. Data on acoustical/aerodynamic, auditory-perceptual, and self-perceptual measures were obtained pre- and post-intervention. The Phonatory Aerodynamic System (PAS) was used to analyse acoustical/aerodynamic data.Result: The acoustical/aerodynamic assessment revealed statistically significant (p < 0.01) improvements in habitual pitch, pitch range, speaking rate, and number of respirations. In the auditory-perceptual assessment, statistically significant (p < 0.01) improvements were observed in overall speech intelligibility, tone, intonation, intensity, and articulation. Medium to large effect sizes were observed for significant results. The Pearson correlation analysis showed significant (p < 0.01) and strong correlation between articulation and speech intelligibility.Conclusion: The preliminary data has provided promising results and warrants future large-scale studies with suitable controls. Additionally, future research must focus on investigating long term effects of the intervention.

Effects of Interventions Involving Speech Output Technologies on Communication Outcomes for Individuals With Developmental Disabilities: A Scoping Review.

PURPOSE: This scoping review aimed to map the literature on the effects of interventions involving speech output technologies on communication outcomes for individuals with developmental disabilities other than autism spectrum disorder. METHOD: A scoping review methodology was used to limit bias in searching, selecting, coding, and synthesizing relevant intervention studies. This involved a multifaceted search for studies conducted between 1991 and March 2021 using various electronic databases, ancestry searches, and forward citation searches from selected articles. Studies had to meet stringent inclusion criteria. Each study was summarized in terms of authors, purpose, participants, design, speech output, outcomes, effectiveness, and quality appraisal. RESULTS: Twenty-five single-case experimental design studies (88 participants) and one group design studies (62 participants) qualified for inclusion. Most of the participants had multiple diagnoses followed by a diagnosis of cerebral palsy and Down syndrome. Most studies focused on requesting behaviors and to a much lesser extent on syntactic structure and word identification. A dearth of high-quality studies was identified. CONCLUSIONS: Overall, there is a paucity of high-quality research investigating the effects of speech output technologies for children with developmental disabilities. Additionally, several directions for future research are posited. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20468928.

Identifying performing and under performing graphic symbols for verbs and prepositions in animated and static formats: a research note.

The purpose of this study was to identify graphic symbols for verbs and prepositions that were performing and underperforming in static and animated formats in a recent experiment on the effects of animation on transparency, name agreement, and identification of graphic symbols. Variable-specific criteria were developed in order to define when a symbol is considered to be performing in terms of its transparency, name agreement, and identification accuracy. Additionally, across-variable heuristic criteria were developed that allowed classification of symbols into four categories: (a) performing exceptionally, (b) performing effectively, (c) performing adequately, and (d) performing inadequately. These criteria were applied to 24 symbols for verbs and 8 symbols for prepositions in both animated and static formats. Results indicated that the vast majority of the symbols performed adequately or better while a few did not. Potential reasons as to why some of the symbols may have underperformed are discussed. Where appropriate, implications for modifying existing symbols and future research are drawn. Although the fact that the heuristic criteria were developed post-hoc is discussed as a limitation, the benefits of the proposed categories bode well for future applications.

Effects of a Systematic Augmentative and Alternative Communication Intervention Using a Speech-Generating Device on Multistep Requesting and Generic Small Talk for Children With Severe Autism Spectrum Disorder.

Purpose The purpose of this study was to determine the effects of augmentative and alternative communication (AAC) intervention using a speech-generating device (SGD) on acquisition, maintenance, and generalization of multistep requesting and generic small talk in three children with severe autism spectrum disorder (ASD) between the ages of 7 and 13 years. Method A multiple-baseline design across participants combined with a posttreatment multiple-generalization-probe design was used to assess acquisition, generalization, and maintenance of target communicative behaviors with the experimenter and the participants' familiar communication partners (FCPs). Intervention was composed of systematic instruction in the use of an SGD using least-to-most prompting, constant time delay, error correction, and reinforcement. Results Visual analysis established a strong functional relationship between the independent variable and the two dependent variables (i.e., requesting preferred activities, engaging in generic small talk) for all three participants. Effect size indicator analyses corroborated these findings, indicating strong effects for performing multistep requesting and medium effects for engaging in generic small talk. All participants were able to generalize the acquired communicative behaviors to request new and untrained snacks and activities and engage in generic small talk with FCPs who were not part of the training. Maintenance of acquired communicative behaviors was demonstrated 3 weeks post completion of intervention. Conclusion This study provides preliminary evidence that AAC intervention using an SGD and incorporating least-to-most prompting, constant time delay, error correction, and reinforcement is effective in terms of multistep requesting and generic small talk behaviors in children with severe ASD. Supplemental Material https://doi.org/10.23641/asha.16663630.

Video modelling interventions to teach spontaneous requesting using AAC devices to individuals with autism: a preliminary investigation.

This multiple baseline study investigated to what extent individuals with autism would learn to operate a speech generating device (SGD) to request a preferred object by observing a video model. The intervention consisted of each participant viewing a 10- to15-s video model that demonstrated the requesting of a preferred object using a SGD. Baseline, intervention and generalisation were all implemented within a public school, special education classroom. After viewing the video model, two participants displayed the ability to request preferred items using the SGD without prompting or cues. However, the participants did not generalise requesting using the SGD to a second preferred object. The study provides preliminary evidence that video modelling can be used to teach individuals with autism and severe cognitive disabilities requesting skills using an SGD.

The Effects of Systematic Instruction in Teaching Multistep Social-Communication Skills to Children with Autism Spectrum Disorder Using an iPad.

Objective: Tablets have successfully been used with individuals with autism spectrum disorder (ASD) and other developmental disabilities to request preferred items, label objects, share information, and engage in social interactions. However, there are limited data on the efficacy of utilizing such devices to teach multistep social-communication skills. Method: We used nonconcurrent multiple baseline design across behaviors to examine the effectiveness of systematic instruction on teaching multistep social-communication skills using an iPad® loaded with Proloquo2Go™. Three children between the ages of 7 and 10 years diagnosed with ASD and other developmental disabilities participated in the study. Results: To varying degrees, the participants were successful in using the iPad® to perform a multistep sequence in requesting, saying "thank you," and answering personal questions. Procedural modifications were made during the intervention phase for two participants so that they were able to acquire social-communication skills using AAC. Conclusions: The findings indicate that systematic instruction is effective in developing advanced social-communication skills.

Nurses' perspectives about communication with patients in an intensive care setting using a communication board: A pilot study.

BACKGROUND: Communication in the intensive care setting (ICS) is critical for both the patient and the medical staff to provide efficient care and thus alleviate possible patient adverse effects. Persons with complex communication needs are particularly vulnerable in ICSs and therefore require additional communication support. AIM: This study focused on the perspectives of nurses about communication with patients with communication needs in ICSs using paper-based communication boards, namely the translated Vidatak EZ Board, before and after a training session. SETTING: A 1650-bed public hospital with a 26-bed ICS in a semi-urban, low socio-economic area in South Africa served as the research setting. METHODS: A quasi-experimental pre-test post-test group design with withdrawal and a control group was used. Data were gathered using a custom-designed questionnaire completed by ICS nurse participants recruited from a public hospital. RESULTS: Responses of some nurses did not change in post-test 1, but their responses did change in post-test 2. Some of the nurses' perspectives changed, as expected from the pre-test to post-test 1. Nurses recommended specific adaptations to the communication board. CONCLUSIONS: Most nurses agreed that communication is crucial in ICSs and that a communication board can be implemented; however, limited success was observed implementing the board following a short training. The inter-professional collaboration between nurses and speech-language therapists to provide optimal health care to patients in ICS is emphasised.