Examining the Family-Centeredness of Speech-Language Pathologists Working With Children Who Use Augmentative and Alternative Communication.

PURPOSE: Family-professional partnerships are important for youth learning to use aided augmentative and alternative communication (AAC). This study examined the family-oriented beliefs and practices of speech-language pathologists (SLPs) working with preschool and school-aged children learning to use aided AAC (aged 3-21 years), specifically during the COVID-19 pandemic. METHOD: Participants were 25 SLPs who participated in an individual semistructured interview. Qualitative analysis was used to identify and describe groups of SLPs based on commonalities and differences in their beliefs and practices working with families. The characteristics of SLPs in each group was also explored descriptively (e.g., race/ethnicity, work setting, caseload). RESULTS: SLPs clustered into three groups based on their beliefs and practices: (a) professionally centered, (b) family-allied, and (c) family-focused. SLPs varied across these groups in how they planned services, offered training/coaching, communicated, shared resources, offered emotional support, and adapted to and with different families. CONCLUSIONS: Findings indicate the need to support greater family-centeredness in AAC services by building on the strengths of SLPs in the field. Promoting strong family-professional partnerships could in turn improve outcomes for students who use AAC. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25044125.

Emergency and Disaster Preparedness for Individuals Who Use Augmentative and Alternative Communication: A Pilot Study on Supported Planning Using a Toolkit.

PURPOSE: When emergencies or disasters arise, individuals who use augmentative and alternative communication (AAC) are particularly vulnerable. It is critical that individuals who use AAC are supported to make decisions that impact their own lives and are able to communicate during such a crisis. Preparedness efforts that include a plan around communication needs and supports are necessary for ensuring that individuals who use AAC are able to understand options that ensure personal safety and express their needs during a time of crisis. METHOD: Qualitative methods were used to identify and describe the experiences of two young adults who use AAC and their caregivers when engaging in person-centered planning intervention sessions to complete the activities of the United States Society for Augmentative and Alternative Communication (USSAAC) emergency/disaster preparedness toolkit. Pre-intervention interviews and subjective, objective, assessment, and plan (SOAP) notes taken after each intervention session were done to describe their preparedness and experiences completing the toolkit. Themes were identified to describe participant experiences and change in their perceived preparedness. RESULTS: Five themes and 18 subthemes emerged from the pre-intervention interviews and the SOAP notes across 14 intervention sessions that captured each participant and their caregiver's awareness of needs, barriers in emergency situations, challenges in completing the toolkit, and actions during person-centered planning with the toolkit (e.g., personalizing communication boards, making a go bag, and scheduling visits with local emergency agencies). CONCLUSIONS: This study highlights the need for preparedness activities that are person-centered and account for the communication support needs of individuals who use AAC if faced with an emergency/disaster. Outcomes suggest that these methods were feasible and supported positive change in perceived preparedness in the young adults who used AAC and their caregivers. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24415567.

Augmentative and Alternative Communication Services During the COVID-19 Pandemic: Contextual Determinants of the Parent-Speech-Language Pathologist Partnership.

PURPOSE: The COVID-19 pandemic caused significant changes for family-professional interactions. Many services shifted to telepractice, with new opportunities for parents and speech-language pathologists (SLPs) to partner for service delivery. Parent-coached models of augmentative and alternative communication (AAC) intervention provide positive outcomes for children; however, SLPs have reported difficulty building strong partnerships with families. The shift to telepractice during the COVID-19 pandemic provided a unique context to examine factors influencing parent-SLP partnerships, particularly for parents with children who use aided AAC. METHOD: Twenty-five parents and 25 SLPs who engaged in services with children and youth from 3 to 21 years of age who used aided AAC during the initial stages of the COVID-19 pandemic in June 2020 participated. Semistructured interviews were conducted individually with parents and SLPs to understand perspectives on whether the change in service delivery facilitated or hindered family-oriented practice. Inductive qualitative analysis was used to analyze information about the factors impacting parent-SLP partnerships. RESULTS: The parent-SLP partnership was influenced by setting and systemic determinants, and intrinsic determinants to the parent and the SLP that included their history and rapport, beliefs about partnering, and knowledge and skills. These determinants served as barriers or facilitators to their partnership. CONCLUSIONS: It is essential to consider the relationship, expectations, and knowledge and skills that SLPs and parents bring to the partnership, along with extrinsic structural factors that can impact this partnership. Positive rapport, valued partnership, and an openness to sharing knowledge through teaming and collaboration provided for positive parent-SLP partnerships.

Parent-implemented augmented communication intervention and young children with Down syndrome: an exploratory report.

Introduction: Young children with Down syndrome (DS) present with speech and language impairments very early in childhood. Historically, early language intervention for children with DS included manual signs, though recently there has been an interest in the use of speech-generating devices (SGDs). This paper examines the language and communication performance of young children with DS who participated in parent-implemented communication interventions that included SGDs. Specifically, we compared the functional vocabulary usage and communication interaction skills of children with DS who received augmented communication interventions (AC) that included an SGD with those children with DS who received spoken communication intervention (SC). Methods: Twenty-nine children with DS participated in this secondary data analysis. These children were part of one of two longitudinal RCT studies investigating the effectiveness of parent-implemented augmented communication interventions in a larger sample of 109 children with severe communication and language impairments. Results: There were significant differences between children with DS in the AC and SC groups in terms of the number and proportion of functional vocabulary targets used and the total vocabulary targets provided during the intervention at sessions 18 (lab)and 24 (home). Discussion: Overall, the AC interventions provided the children with a way to communicate via an SGD with visual-graphic symbols and speech output, while the children in the SC intervention were focused on producing spoken words. The AC interventions did not hinder the children's spoken vocabulary development. Augmented communication intervention can facilitate the communication abilities of young children with DS as they are emerging spoken communicators.

A scoping review of the playground experiences of children with AAC needs.

Unstructured play on playgrounds is beneficial to children's development, but children with disabilities are often unable to use playgrounds in the same ways as their peers without disabilities. No research to date has focused exclusively on the playground experiences of children who use augmentative and alternative communication (AAC). Therefore, in this scoping review, information from 10 studies published between 1990 and 2020 that investigated the playground experiences of children with disabilities, including those with limited speech, is synthesized. Included studies used experimental or non-experimental designs and involved the collection of either quantitative or qualitative data. The findings indicate that children with limited speech have diverse playground experiences and can benefit in some of the same ways as children with typical development from playground play but that they encounter barriers to participation that go beyond a lack of physical access. Additional research focusing specifically on understanding the communication experiences of children who use AAC on playgrounds is essential to address the complex issues associated with playground participation, including access to aided AAC systems on the playground. To foster more inclusive playgrounds, accessibility standards must address the unique needs of children with limited speech to support participation and access to communication on the playground.

Augmentative and alternative communication services during the COVID-19 pandemic: impact on children, their families and service providers.

The closure of schools and healthcare facilities across the United States due to COVID-19 has dramatically changed the way that services are provided to children with disabilities. Little is known about how children who use augmentative and alternative communication (AAC), their families and their service providers have been impacted by these changes. This qualitative study sought to understand the perspectives of parents and speech-language pathologists (SLPs) on how COVID-19 has affected children, families, services providers and the delivery of AAC-related communication services. For the study, 25 parents and 25 SLPs of children who used aided AAC participated in semi-structured interviews, with data analyzed using qualitative thematic analysis. Parents and SLPs highlighted wide disparities in how children have been impacted, ranging from views of children making more progress with communication and language than before the pandemic to worries about regression. A complex system of factors and processes may explain these differences. COVID-19 will have lasting impacts on the lives of children with complex communication needs. This research highlights the crucial role of family-service provider partnerships and access to quality AAC services for children during the pandemic and into the future.

It's Never Too Late: Debunking Myths About Communication and Adults With Severe Disabilities.

Communication infuses all dimensions and stages of life, influencing one's self-determination and quality of life. A number of empirical studies have demonstrated that people with severe disabilities continue to develop communication and language skills well into their adult years and make measurable gains when provided with appropriate communication services and supports. Several myths about age, ability, and experiences limit opportunities for persons with severe disabilities. In this paper, we confront and address these myths.

Prologue: Implementation Science in CSD and Starting Where You Are.

In this prologue, we introduce readers to the Forum: Clinicians and Researchers Navigating Implementation Science in CSD. Implementation science (IS), or the study of the adoption of evidence-based practice in real-world settings, is a key area of development in communication sciences and disorders (CSD). The goal of this forum was to show by example how researchers and clinicians are collaborating to begin to apply IS in CSD. This goal culminated in a scoping review of IS in CSD, a tutorial on incorporating IS into clinical practice research, three articles on stakeholder engagement, and three examples of IS studies in CSD included in this forum. We hope this forum helps clinicians and researchers to begin wherever they are in their knowledge and understanding of IS in CSD.

Reading Skills in Down Syndrome: Implications for Clinical Practice.

Though children with Down syndrome can learn to read, they may have difficulty developing some component skills, including phonological awareness and word decoding. Given reading's foundation in language, speech-language pathologists (SLPs) should play a central role in supporting access to and providing reading instruction for children with Down syndrome. This article reviews the available research on reading in Down syndrome and offers guidance for SLPs working with this population. We start by reviewing the Down syndrome phenotype, highlighting physical features and cognitive and linguistic patterns of strength and weakness that impact reading development. Next, we define different reading subskills and outline typical reading development, including stages of prereading, learning to read, and transitioning to using reading as a tool for learning. We then use these stages to review what is known about reading in Down syndrome, including relevant intervention work. We also incorporate considerations for clinical practice. In particular, we encourage SLPs to advocate for supporting reading development in children with Down syndrome, to work with families to develop rich home literacy environments, and to work with educators to promote phonological awareness and decoding skills. Lastly, we note limitations in our current knowledge and include a call for more research.

Augmentative and Alternative Communication Supports for Language and Literacy in Preschool: Considerations for Down Syndrome and Autism Spectrum Disorder.

Children with Down syndrome and children with autism spectrum disorder have a range of speech abilities during preschool that impacts access to both language and literacy instruction. It is the responsibility of the speech-language pathologist to advocate for and provide intervention using augmentative and alternative communication (AAC) through individualized assessment. This article provides a review of the literature supporting the use of AAC during preschool for both language and literacy development in children with Down syndrome and children with autism spectrum disorder who have limited speech. A small scale exploratory report is discussed to highlight differences in early literacy skills found in children in each group. Implications for AAC intervention during preschool to support both language and literacy are discussed.

Maternal Input and Child Language Comprehension During Book Reading in Children With Down Syndrome.

Purpose Communication interactions between parents and children during shared book reading impact a child's development of both language and literacy skills. This study examined maternal language input and child expressive communication during a shared book reading activity in children with Down syndrome (DS) and children with typical development (TD). Additionally, children's receptive language was examined to understand the relationship between maternal language input and child receptive language ability. Method Participants included 22 children with DS and 22 children with TD between 22 and 63 months of age and their mothers. Each mother-child dyad participated in a 7-min naturalistic shared book reading activity. Results Compared to mothers of children with TD, mothers of children with DS used significantly more utterances with less grammatical complexity, but a similar range of vocabulary diversity. Mothers of children with DS used more questions, descriptions, gestures, and labels, whereas mothers of children with TD used nearly half of their utterances to read directly from books. Children with DS communicated at a similar frequency compared to their peers with TD; however, they produced significantly fewer spoken words. Conclusions This study reveals important differences between early shared book reading interactions and provides implications for future research targeting parent-coached intervention strategies that may enhance children's learning during shared book reading by providing access to expressive language and print instruction.

Grammatical judgment and production in male participants with idiopathic autism spectrum disorder.

This study examined grammatical judgment and production in 22 male participants with idiopathic autism spectrum disorder (ASD) who had a range of nonverbal IQ from 44 to 111 (mean = 72.23) and were between 9.42 and 16.75 years of age (mean = 13.45). Relationships between grammatical judgment and production and nonverbal IQ were examined. Participants completed the Test of Early Grammatical Impairment (TEGI) to describe relative strengths and weaknesses in their ability to judge and produce grammatical tense. Participants also completed the Leiter-R to assess the relationship between nonverbal IQ and grammatical judgment and production. Relative strengths were found across participants in judging correct use of subject-verb agreement in sentences, and correctly producing verbs that linked sentences (e.g., auxiliaries and copulas of be "Is she resting?"). Participants had the greatest difficulty judging the correctness of a sentence using a dropped verb tense marker (e.g., "He look happy now") and producing irregular verb tense markers. Nonverbal IQ did not contribute to the variance in performance on any tasks of grammaticality judgment or production. Grammatical markers that mark tense in past tense verbs as well as the production of auxiliary do may be an important focus of language intervention for boys with ASD.

Executive Functioning and Narrative Language in Children With Dyslexia.

Purpose Children with dyslexia often struggle with nonphonological aspects of language and executive functioning. The purpose of this study was to investigate the impact of executive functioning on language abilities at both structural (e.g., grammar in sentences) and functional (e.g., narrative) levels in 92 third- and 4th-grade students with dyslexia. Additionally, we asked if working memory updating contributed a significant amount of variance in narrative language ability beyond what would be expected by students' structural language skills alone. Method Students' language and executive functioning skills were evaluated using a range of language and cognitive measures including the Clinical Evaluation of Language Fundamentals-Fourth Edition (Semel, Wiig, & Secord, 2003), the Peabody Picture Vocabulary Test-Fourth Edition (Dunn & Dunn, 2007), the Test of Narrative Language (Gillam & Pearson, 2004), the Delis-Kaplan Executive Function Scale (Kaplan, Kramer, & Delis, 2001), and the Corsi Block-Tapping Test (WISC-IV Integrated; Kaplan, Fein, Kramer, Delis, & Morris, 2004). Results Low correlations between the language measures suggested that each of these assessments captures a unique element of language ability for children with dyslexia. Hierarchical regression analysis indicated that working memory updating accounted for a significant amount of unique variance in oral narrative production beyond what would be expected by structural language ability. Conclusions The range of performance found across language measures suggests that it may be important to include a variety of language measures assessing both structural and functional language skills when evaluating children with dyslexia. Including cognitive measures of executive functioning may also be key to determine if deficits in working memory updating are contributing to functional expressive language difficulties.

Visual-graphic symbol acquisition in school age children with developmental and language delays.

Augmented language systems have become both an integral component of communication intervention programs for children with severe communicative impairments and spurred research on their language and communication development. This study examined intrinsic and extrinsic factors that may influence the language development process for children with developmental disabilities, by exploring the relationship between varying degrees of symbol arbitrariness and extant speech comprehension skills in the discrimination, learning, and use of symbols for communication. For the study, 13 school-aged participants (M = 8.24 [years; months]), with both developmental and language delays, were provided experience with iconic Blissymbols and an arbitrary symbol set of lexigrams via observational computerized experience sessions. There was a modest difference in their ability to learn arbitrary versus iconic symbols. There were no differences if the vocabulary item was unknown prior to the symbol learning experience. These findings suggest that iconicity of a symbol may not be a critical factor in learning a symbol-referent relationship if a target referent is not yet known in comprehension.

Adapting and translating the Mullen Scales of Early Learning for the South African context.

BACKGROUND:  South African speech-language therapists have identified the need for culturally valid and sensitive assessment tools that can accommodate multiple languages and cover a reasonable age range. The Mullen Scales of Early Learning (MSEL) extend from birth to 68 months, contain five separate subscales including receptive language, expressive language, gross motor, fine motor and visual reception scale, are straightforward to administer and have been successfully used in other African countries, such as Uganda. It also identifies a child's strengths and weaknesses and provides a solid foundation for intervention planning. OBJECTIVES:  This research aimed to demonstrate the appropriateness and usefulness of the translated and culturally and linguistically adapted MSEL across four South African languages (Afrikaans, isiZulu, Setswana and South African English) through two sub-aims: (1) to describe differences, if any, in MSEL performance across language groups and (2) to describe differences, if any, in MSEL performance between age groups. METHOD:  A total of 198 typically developing children between the ages of 21 and 68 months spread across the four language groups were individually assessed with the culturally and linguistically adapted and translated MSEL. RESULTS:  A one-way analysis of variance (ANOVA) showed no statistically significant differences between the four language groups for total MSEL scores. A Welch's one-way ANOVA showed that the total MSEL scores were significantly different between age groups. CONCLUSION:  The translation and adaptation of the MSEL was successful and did not advantage or disadvantage children based on their home language, implying that linguistic equivalence was achieved. The MSEL results differed between age groups, suggesting that the measure was also successful in differentiating the performance of children at different developmental levels.

The Relationship Between Speech, Language, and Phonological Awareness in Preschool-Age Children With Developmental Disabilities.

Purpose: A number of intrinsic factors, including expressive speech skills, have been suggested to place children with developmental disabilities at risk for limited development of reading skills. This study examines the relationship between these factors, speech ability, and children's phonological awareness skills. Method: A nonexperimental study design was used to examine the relationship between intrinsic skills of speech, language, print, and letter-sound knowledge to phonological awareness in 42 children with developmental disabilities between the ages of 48 and 69 months. Hierarchical multiple regression was done to determine if speech ability accounted for a unique amount of variance in phonological awareness skill beyond what would be expected by developmental skills inclusive of receptive language and print and letter-sound knowledge. Results: A range of skill in all areas of direct assessment was found. Children with limited speech were found to have emerging skills in print knowledge, letter-sound knowledge, and phonological awareness. Speech ability did not predict a significant amount of variance in phonological awareness beyond what would be expected by developmental skills of receptive language and print and letter-sound knowledge. Conclusion: Children with limited speech ability were found to have receptive language and letter-sound knowledge that supported the development of phonological awareness skills. This study provides implications for practitioners and researchers concerning the factors related to early reading development in children with limited speech ability and developmental disabilities.

Language Assessment for Children With a Range of Neurodevelopmental Disorders Across Four Languages in South Africa.

Purpose: The purpose of this study is (a) to examine the applicability of a culturally and linguistically adapted measure to assess the receptive and expressive language skills of children with neurodevelopmental disorders (NDDs) in South Africa and then (b) to explore the contributions of 2 additional language measures. Method: In Part 1, 100 children with NDD who spoke Afrikaans, isiZulu, Setswana, or South African English were assessed on the culturally and linguistically adapted Mullen Scales of Early Learning (MSEL). Clinicians independently rated the children's language skills on a 3-point scale. In Part 2, the final 20 children to be recruited participated in a caregiver-led interaction, after which the caregiver completed a rating scale about their perceptions of their children's language. Results: Performance on the MSEL was consistent with clinician-rated child language skills. The 2 additional measures confirmed and enriched the description of the child's performance on the MSEL. Conclusions: The translated MSEL and the supplemental measures successfully characterize the language profiles and related skills in children with NDD in multilingual South Africa. Together, these assessment tools can serve a valuable function in guiding the choice of intervention and also may serve as a way to monitor progress.

Gaze avoidance and perseverative language in fragile X syndrome and autism spectrum disorder: brief report.

Gaze avoidance and perseverative language impact pragmatics in autism spectrum disorder (ASD) and fragile X syndrome (FXS). We examined these features during conversation samples in boys with ASD (n = 10) and boys with FXS and ASD (FXS+ASD; n = 10). Both groups had similar high rates of gaze avoidance and topic and conversation device perseverations, yet these features were not correlated with one another. Boys with FXS+ASD produced a higher proportion of single utterance perseverations. Results from this study highlight the need for future research to identify potential mechanisms influencing the presence of language perseverations and gaze avoidance.