A scoping review of AAC interventions for children and young adults with simultaneous visual and motor impairments: Clinical and research Implications.

Individuals with multiple disabilities are among the most challenging to serve and AAC teams often lack direction in determining effective interventions. The purpose of this scoping review was to summarize the research evidence on AAC interventions for individuals with complex communication needs and simultaneous motor, and visual impairments as part of their multiple disabilities; to consider implications for practice; and to determine gaps and directions for future research. A total of 27 studies were identified and reviewed, involving 55 unique participants with multiple disabilities. Most studies focused on direct intervention to increase requesting or choice-making, with little focus on social communication. Only two studies focused on training communication partners. Results indicated that AAC interventions can be highly effective to increase communication for individuals with multiple disabilities. However, there is an urgent need for increased rigor and more detailed participant information in future AAC intervention research with this population. Future research should investigate AAC intervention to improve social communication and increase language development, not just expression of needs and wants. Future research should focus on the needs of individuals with multiple disabilities from culturally and linguistically diverse backgrounds and on implementation of AAC within natural environments.

"It's like a guessing game all the time": parent insights on barriers, supports, and priorities for children with cortical visual impairment and complex communication needs.

Parents of children with both cortical visual impairment (CVI) and complex communication needs offer unique perspectives on their children's journeys to receiving proper diagnoses, supports, and interventions, such as augmentative and alternative communication (AAC). This study explored the lived experiences, supports, and barriers identified by parents through a qualitative phenomenological approach. Nine parents of children with both CVI and complex communication needs were interviewed virtually. Results indicated five themes descriptive of the parents' experiences: Challenges Piecing Together a CVI Diagnosis; Dealing with Low Expectations of Others; Parents Empowered to Take Action; Guessing Game to Determine Appropriate AAC to Accommodate CVI; and Aligning Professional Practice with Parent Priorities. Whereas some of these themes echoed the experiences of parents of children with complex communication needs (such as those with cerebral palsy) who were not specifically diagnosed with CVI, other themes were unique to this set of parents including the uncertainty of AAC design and intervention given the challenges of CVI and the necessity of more than one way for children to communicate given their visual challenges. This study highlighted the dire need for continued investigation to determine effective AAC interventions for individuals with CVI.

Lessons for the AAC field: a tribute to Dr. David Beukelman.

On February 5, 2022, the field of augmentative and alternative communication (AAC) lost a giant when Dr. David "Dave" Beukelman passed away. As the readership of this journal is aware, Dave was one of the principal founders of the AAC field and devoted his career to providing a voice to those without one. Before AAC became a field, people who could not talk were invisible or seldom noticed, unless they were in the way. For more than 40 years, he was a catalyst for change in AAC clinical practice, research, dissemination, teaching, and public policy development. This tribute aims to honor Dave's lifelong mission of serving others by sharing some of his most timeless and valued lessons. Each lesson begins with one of Dave's most enduring quotes that is then followed by a brief synopsis of the lesson Dave hoped to convey.

Supporting Peer Interactions for Students with Complex Communication Needs in Inclusive Settings: Paraeducator Roles.

Purpose: This clinical focus article presents a review of literature supporting the importance of fostering positive peer interactions for students with complex communication needs. A resulting template is included to help guide educational teams, including speech-language pathologists (SLPs), in planning for paraeducator training specific to supporting peer interactions for children with CCN. This article summarizes the current literature available on inclusion and peer relationships for students with CCN in general education classrooms, and paraeducator roles and training. The World Health Organization (WHO) International Classification for Functioning, Disability and Health Children and Youth (ICF-CY) framework was consulted to help establish considerations relevant to paraeducator training. With many demands on the time of SLPs throughout the school day, paraeducators may offer an often untapped resource to help support positive peer relationships for students with CCN. Conclusions: This article provides an overview of challenges that may impede positive peer relationships from developing in inclusive classroom settings, including ones related to: (1) the student with CCN, (2) the peers, (3) the AAC systems, or (4) the environment. The readers will be provided with a template to guide educational teams and SLPs in collaborating with paraeducators to foster positive peer interactions, including the following steps: (1) define goals for the student with CCN and determine supports required from paraeducators; (2) determine content of training for paraeducators; (3) choose an effective instructional approach; (4) establish a feasible training format; (5) implement the paraeducator training and evaluate outcomes to ensure benefits for students with CCN and their peers.

The effects of explicit instruction in academic vocabulary during shared book reading on the receptive vocabulary of children with complex communication needs.

The purpose of this study was to evaluate the effect of explicit vocabulary instruction during shared reading experiences on the acquisition of receptive academic vocabulary for children with complex communication needs. A single-subject, multiple-probe design was used. Three preschool-aged children (i.e., one with autism spectrum disorder, one with developmental delay, and one with a rare genetic disorder) were each taught two sets of vocabulary words. Intervention consisted of explicit vocabulary instruction associated with shared reading of academic texts. All three children acquired 10 targeted academic vocabulary items receptively and maintained vocabulary knowledge for at least 4 weeks. Data also suggest probable generalization to new representations. Additionally, participants became more adept at learning via this method, acquiring the second vocabulary set in significantly less time. Results indicate that explicit vocabulary instruction during shared reading experiences can be effective for teaching receptive vocabulary to children with complex communication needs.

Promoting Peer Interaction for Preschool Children With Complex Communication Needs and Autism Spectrum Disorder.

Purpose: This study investigates the impact of a multicomponent intervention on the social communication and engagement of preschool children with complex communication needs (CCN) and autism spectrum disorder (ASD) and peers without disabilities. Method: Five dyads of children participated in this research. A multiple probe design across dyads was used to evaluate the effects of intervention on the frequency of communicative turns expressed by children with CCN and ASD in interactions with peers. Frequency of peer turns, percentage of turns taken by peers, and joint engagement were investigated to assess the quality of the interaction. The intervention included (a) provision of a communication app on an Apple iPad Air 2 and (b) dyadic turn-taking training. Results: Four of the 5 participants with CCN completed training and increased independent communicative turn-taking with peers. The 5th participant showed increased turn-taking during training but little change in independent turn-taking. All peers took more turns in intervention than in baseline, with no negative impact on the turn balance between participants. Average joint engagement increased for all dyads, although session-to-session variability was high. Conclusion: The results from this study provide support for the use of this intervention to promote peer interaction for children with CCN and ASD. Supplemental Material: https://doi.org/10.23641/asha.5829678.

Factors affecting computer mouse use for young children: implications for AAC.

More than 12% of preschoolers receiving special education services have complex communication needs, including increasing numbers of children who do not have significant motor impairments (e.g., children with autism spectrum disorders, Down syndrome, etc.). In order to meet their diverse communication needs (e.g., face-to-face, written, Internet, telecommunication), these children may use mainstream technologies accessed via the mouse, yet little is known about factors that affect the mouse performance of young children. This study used a mixed factorial design to investigate the effects of age, target size, and angle of approach on accuracy and time required for accurate target selection with a mouse for 20 3-year-old and 20 4-year-old children. The 4-year-olds were generally more accurate and faster than the 3-year-olds. Target size and angle mediated differences in performance within age groups. The 3-year-olds were more accurate and faster in selecting the medium and large targets relative to the small target, were faster in selecting the large relative to the medium target, and were faster in selecting targets along the vertical relative to the diagonal angle. The 4-year-olds were faster in selecting the medium and large targets relative to the small target. Implications for improving access to AAC include the preliminary suggestion of age-related threshold target sizes that support sufficient accuracy, the possibility of efficiency benefits when target size is increased up to an age-related threshold, and identification of the potential utility of the vertical angle as a context for training navigational input device use.

A comparison of the performance of 5-year-old children with typical development using iconic encoding in AAC systems with and without icon prediction on a fixed display.

Iconic encoding, or the use of a sequence of icons to retrieve a word or phrase from augmentative and alternative communication (AAC) technologies, has previously been shown to be challenging for young children to learn to use. It is possible that the use of icon prediction may facilitate learning in such systems by providing additional visual cues. The goal of the current study was to determine the effect of using icon prediction on the performance of 5-year-old children with typical development who were learning to locate and generalize vocabulary prestored in AAC technologies using iconic encoding. Twenty 5-year-old children were introduced to 30 vocabulary items and asked to locate them using iconic encoding during four learning and testing sessions. Ten of the children completed this task without iconic prediction, and 10 completed the task with icon prediction. They were also asked to locate an additional 30 vocabulary items, not previously introduced, during one generalization session. The results indicated that the children in the icon prediction group did not perform more accurately than the children who did not have prediction available. There was some evidence, however, that using icon prediction may help to facilitate generalization of the use of iconic encoding to novel vocabulary. Potential implications, limitations, and future directions for research are discussed.

The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: a research review.

PURPOSE: This article presents the results of a meta-analysis to determine the effect of augmentative and alternative communication (AAC) on the speech production of individuals with developmental disabilities. METHOD: A comprehensive search of the literature published between 1975 and 2003, which included data on speech production before, during, and after AAC intervention, was conducted using a combination of electronic and hand searches. RESULTS: The review identified 23 studies, involving 67 individuals. Seventeen of these studies did not establish experimental control, thereby limiting the certainty of evidence about speech outcomes. The remaining 6 studies, involving 27 cases, had sufficient methodological rigor for the "best evidence analysis" (cf. >R. E. Slavin, 1986). Most of the participants (aged 2-60 years) had mental retardation or autism; the AAC interventions involved instruction in manual signs or nonelectronic aided systems. None of the 27 cases demonstrated decreases in speech production as a result of AAC intervention, 11% showed no change, and the majority (89%) demonstrated gains in speech. For the most part, the gains observed were modest, but these data may underestimate the effect of AAC intervention on speech production because there were ceiling effects. CONCLUSIONS: Future research is needed to better delineate the relationship between AAC intervention and speech production across a wider range of participants and AAC interventions.

Learning of dynamic display AAC technologies by typically developing 3-year-olds: effect of different layouts and menu approaches.

The present study investigated the learning demands of dynamic display augmentative and alternative communication (AAC) technologies that differed in system layout and menu page approaches for 3-year-old children. Ten typically developing children were randomly assigned to each of 3 technology approaches and were asked to located vocabulary items within a play context. Results indicated that the children had difficulty with all of the technologies on initial exposure. After the 1st learning session, children performed significantly better with AAC technologies in a contextual scene format than in a grid format. Some limited generalization to new vocabulary was evident. AAC technologies for young children need to be redesigned to better reflect the developmental models of children. Results are discussed with implications for practice and suggestions for future research.

The performance of typically developing 2 1/2-year-olds on dynamic display AAC technologies with different system layouts and language organizations.

The current generation of augmentative and alternative communication (AAC) technologies is largely based on conceptual models of adults who are not disabled (J. Light & P. Lindsay, 1991). As a result, there is a large "cost of learning" placed on young children. This paper presents the results of a study designed to investigate the learning demands of dynamic display systems that differed in system layout and language organization for children approximately 2 1/2 years old (2 years 5 months to 2 years 11 months). Thirty typically developing children were asked to locate 12 vocabulary items within a play context of a birthday party. Ten children were randomly assigned to each of 3 system approaches: vocabulary in a grid format organized taxonomically, vocabulary in a grid format organized schematically, and vocabulary in an integrated scene organized schematically. The children participated in 4 learning and testing sessions and 1 generalization session. Results indicated that the children performed poorly in all conditions but were able to locate more vocabulary items in the schematic scene condition than the taxonomic grid or schematic grid conditions. There was evidence that the children failed to generalize their knowledge of the vocabulary to facilitate learning of novel vocabulary items. The current design of AAC dynamic display systems appears to be inappropriate for very young children. Rather than relying solely on technology for these young children, early intervention should target multiple modes of communication. AAC technologies should be redesigned to reduce learning demands. Results are discussed with implications for practice and suggestions for future research.

Improving the design of augmentative and alternative technologies for young children.

If children with significant communication disabilities are to attain the power of language, literacy, and communication early in their development, they must have access to appropriate augmentative and alternative communication (AAC) systems. AAC technologies for young children should (a) be highly appealing, capturing, and sustaining of their interest; (b) be seamlessly integrated into all aspects of daily living; (c) provide access to the magical power of communication, language, and literacy; (d) be synchronous with children's diverse cultural and linguistic backgrounds; (e) be easy for children to learn and effortless for children to use; (f) grow easily and seamlessly with children as they develop; and (g) be efficient for families and professionals to learn, maintain, and develop. The design specifications to realize these requirements may vary across children given the diversity of skills, characteristics, and interests. This article summarizes what we know about young children and AAC technologies as related to each of these requirements and also discusses priorities to improve the design of AAC technologies in order to maximize outcomes for young children with significant communication disabilities.