Enseñanza de funciones comunicativas orientadas a la interacción social en un caso de síndrome de Rett / Teaching of social interaction-oriented communication functions in a case of Rett syndrome

Antecedentes y objetivo: La elección y las peticiones han sido tradicionalmente los objetivos de la intervención de la comunicación aumentativa y alternativa (CAA) en el síndrome de Rett (SR). Sin embargo, hay escasos antecedentes sobre la enseñanza de otras funciones de la comunicación. El objetivo de este estudio es la enseñanza de funciones comunicativas orientadas a la interacción social usando símbolos de CAA. Materiales y métodos: Mediante un diseño de caso único de línea base entre conductas se investigó hasta qué punto una niña con SR de 11 años podría aprender funciones comunicativas orientadas a la interacción social, específicamente, a realizar cumplidos, protestar de forma asertiva y pedir favores seleccionando símbolos de CAA en un tablero de comunicación por medio de la mirada. La intervención consistió en la creación de oportunidades para el aprendizaje de estas funciones y la aplicación de incitaciones. La línea base, la intervención y el mantenimiento se implementaron en un aula de un colegio de educación especial, con diferentes personas y materiales para promover la generalización. Resultados: Después de la intervención la participante mostró su capacidad de realizar cumplidos («¡Qué guapa eres», «Eres buena» y «Me gusta tu adorno»), de pedir favores («Me dejas ver Dora la exploradora», «¿Me prestas tu juguete?» y «Me gustaría descansar») y de protestar asertivamente («No me apetece», «Mejor más tarde» y «Prefiero hacerlo luego») sin incitaciones; además fue capaz de realizar comentarios espontáneos y demostró aprendizaje sostenido en el tiempo. Conclusiones: Se concluye que esta intervención comunicativa ha tenido el potencial de mejorar la comunicación social y ayudar al desarrollo de relaciones sociales entre la participante y sus compañera/os, maestras y terapeutas.(AU)

Background and aims: Choice making and requesting have traditionally been the focus of Augmentative and Alternative Communication (AAC) intervention in Rett syndrome (RS). However, scant literature exists about some other communication functions teaching. The aim of this study is to teach the social interaction function of communication using AAC symbols. Materials and methods: A multiple baseline study was carried out to investigate to what extent a girl with Rett syndrome aged 11 would learn to communicate for social interaction making compliments, asking for favours, and protesting assertively selecting AAC symbols using an eye-gaze system. The intervention consisted of the creation of opportunities for learning these communication functions and the application of prompts. Baseline, intervention, and maintenance were all implemented within a special education classroom in a public school, with different people and different materials, from the very onset, to promote generalization. Results: After intervention, the participant displayed the ability to make compliments («How pretty you are!»; «How nice you are!» and «I like your costume jewellery!»), to ask for favours («Let me see Dora the explorer»; «May I borrow your toy?»; «I would like to rest»), and to protest assertively («I don’t fancy it»; «Later the better» and «I’d rather do it later») without any prompting, learning generalization outside the learning contexts and sustained learning over time. Conclusions: It is concluded that this communication intervention had the potential to improve social communication and assist in the development of social relationships between the participant and her peers, teachers, and therapists.(AU)

A Follow-Up Study of Cognitive Development in Low Risk Preterm Children.

The results of a longitudinal study on the cognitive development of one group of full-term and three groups of low risk preterm children with different gestational ages (GA) are presented. The 181 participants were divided into four GA groups of similar size. The aims were: 1) To check if there are differences in cognitive development (measured through the Batelle scale) among the GA groups. 2) To establish the predictive factors of cognitive development at 22 and 60 months of age, taking into account biomedical, environmental and individual factors. The results of the repeated measures ANOVA performed at 22 and 60 months of age indicated that the cognitive trajectories of the four GA groups were similar. Linear regression analyses showed that the effect of the different predictors changed in relation to the time of measurement of cognitive development. Biological factors and the quality of home environment had a moderate effect on the cognitive development at 22 months of age. Cognitive results obtained at 22 months of age, and, to a lesser extent, working memory had the greatest effect on cognitive development at 60 months. GA does not predict cognitive development. Preterm children do not show cognitive delay if they are healthy.

Estrategia de matrices y jerarquía creciente de incitaciones para expresar relaciones semánticas combinando símbolos en la discapacidad intelectual / A matrix strategy and an increasing prompt hierarchy to express semantic relationships combining symbols in intellectual disability

Introducción. Apenas se ha explorado la aplicación conjunta de la estrategia de matrices y de jerarquía de incitaciones para el aprendizaje de la expresión de relaciones semánticas combinando símbolos en adultos con discapacidad intelectual. El objetivo de este estudio es investigar el efecto de estas estrategias en la producción de combinaciones de símbolos en el contexto de la lectura compartida a tres adultos con discapacidad intelectual moderada y severa. Metodología. Se utilizó un diseño de caso único de pruebas múltiples entre tres clases de relaciones semánticas generadas a partir de una matriz de combinaciones. Se aplicó a tres personas con DI la jerarquía creciente de incitaciones para la producción de las combinaciones simbólicas. Resultados. Los resultados mostraron que la aplicación de las estrategias de intervención fue eficaz para enseñar a los participantes a producir las relaciones semánticas combinando símbolos, para la generalización a ejemplares no entrenados y para el mantenimiento de habilidades al finalizar la intervención. Conclusiones. Incluso adultos con discapacidad intelectual significativa pueden aprender a combinar símbolos para expresar relaciones semánticas cuando se aplican intervenciones apropiadas (AU)

Introduction. There are few studies on the expression of semantic relationships using graphic symbol combinations by the application of the matrix strategy and a hierarchy of increasing prompts to intellectually disabled adults. The aim of this study is to investigate the effect of the matrix strategy and an increasing prompt hierarchy in the context of shared story reading on the production of graphic symbol combinations in three adults with moderate to severe intellectual disability. Methods. A single subject, multiple probe design across different types of semantic relationships generated from a matrix combination was used. A hierarchy of increasing prompts for the production of symbol combinations was applied to three individuals. Results. It was shown that the application of the training strategies was successful in teaching the participants to produce targeted semantic relationships combining symbols, in order to extrapolate to untrained models, and for the maintenance of post-intervention skills. Conclusions. Even significant intellectually disabled adults may learn to combine symbols for the expression of semantic relationships when appropriate interventions techniques are applied (AU)

Una revisión sobre la aplicación de estrategias para aumentar el input de la comunicación aumentativa y alternativa asistida en personas con trastornos del desarrollo / A revision about the application of augmentative and alternative communication's augmented input strategies on people with developmental disabilities

Los niños y adultos que usan la comunicación aumentativa y alternativa (CAA) no obtienen la misma clase de input lingüístico con los sistemas de CAA que el que reciben los niños de desarrollo común. Entre las principales razones se encuentran la asimetría entre modalidades y la falta de modelos comunicativos en el entorno que enseñen cómo usar con eficacia los sistemas. Ahora bien, el input lingüístico se puede mejorar «aumentándolo» para facilitar el desarrollo del lenguaje y la comunicación mediante el empleo de estrategias de input aumentado (del inglés, augmented input), como el modelado del lenguaje asistido o la estimulación del lenguaje asistido, para enseñar los símbolos gráficos a los usuarios de CAA. El objetivo principal del input aumentado es proporcionar un modelo para el uso de los símbolos gráficos como modo de comunicación viable. En este artículo se tratarán aspectos cruciales para el aprendizaje y uso de sistemas de CAA como son la importancia de aumentar el input, las principales técnicas de intervención basadas en el aumento del input para la enseñanza de la comprensión y la expresión comunicativa, y los resultados más relevantes de la investigación en la aplicación de estas técnicas a niños y adultos con diferentes trastornos del desarrollo que necesitan aprender a usar un sistema de CAA (AU)

Children and adults who use Augmentative and Alternative Communication (AAC) do not acquire the same kind of linguistic input with their AAC systems as typical development children do. Asymmetry between communication modes and the lack of communication models in their environment that may teach them how to effectively use their systems are among the main reasons. Nevertheless, linguistic input may be enhanced by ‘augmenting’ it in order to facilitate language and communication development. This may be accomplished by using augmented input strategies, such as aided language modeling or aided language stimulation to teach graphic symbols to AAC users. The main goal of augmenting input is to provide a model for graphic symbols use as a viable communication mode. In this article some crucial aspects of learning and use of AAC systems such as the importance of augmenting input, the main intervention techniques based on augmenting input for receptive and expressive communication, as well as the most relevant research results in the application of this techniques for children and adults with different kind of developmental disabilities will be addressed (AU)

Does temperament influence language development? Evidence from preterm and full-term children.

The aims of this study are: (1) to describe language and temperament characteristics of one group of low risk preterm (PR) children and a group of full-term (FT) children and (2) to identify those factors which can predict language outcomes at 30 months of age, with special attention on temperament. There is evidence of differences between very or extremely PR and FT children in relation to characteristics of temperament and language development. However, not many studies have been carried out with healthy PR children. The participants were 142 low risk PR children (mean gestational age (GA): 32.60 weeks) and 49 FT children (mean GA 39.84 weeks). The temperament of the children was assessed at 10 months of age through the Infant Behavior Questionnaire-Revised (IBQ-R). At 22 months of age the cognitive development of the children was assessed through the Spanish adaptation of the Batelle Developmental Inventory (BDI). In order to assess the children's language development the Galician adaptation of the MacArthur-Bates CDI was applied at 30 months of age. In addition, socio-demographic information about the children and their families was gathered at birth. The results indicate that there were no significant differences in the language measures of interest (word production, MLU3, and sentence complexity) between groups. The only differences found between the PR and the FT children in the IBQ-R were restricted to the smiling and laughter and the fear subscales. Hierarchical regression analyses performed indicate that GA did not have any predictive effect on language measures taken at 30 months. Cognitive scores were an important predictor of language measures, although certain temperament subscales contributed in a significant way to the variance of language measures, particularly low intensity pleasure, approach, high intensity pleasure, sadness, and vocal reactivity. Therefore, extroverted (positive affectivity) temperament seems to be beneficial for language development.

Language development of low risk preterm infants up to the age of 30 months.

PURPOSE: To compare the lexical and grammatical development of a group of low risk preterm children with a group of full-term children at 10, 22, and 30 months of corrected age. In addition, the effect of possible determinant factors on linguistic development was investigated. METHOD: An initial group of 150 low-risk PR children (mean GA: 32.62) and 49 FT children (mean GA: 39.70) recruited at birth were assessed at 10, 22, and 30 months of age. Communicative and linguistic abilities were measured at these three points in time through the CDI. Cognitive development and quality of family environment of the children, among other variables, were also assessed at 22 months of age. Hierarchical regression analyses were performed in order to test those factors which may contribute to prediction of language outcomes. RESULTS: There was no significant delay in communicative, lexical or grammatical development of PR children. Even when comparisons were performed between fullterm and very preterm children, differences were not significant. Regression analyses indicate that gestures and early word comprehension predict very early word production development, but their effect disappears with time. The most important factors which predict language development at 30 months of age are previous cognitive scores and word production at 22 months of age. The results coming from group comparisons and from hierarchical regression analyses indicate that GA does not significantly affect language development from 10 to 30 months of age. CONCLUSIONS: Low risk preterm toddlers do not seem to be delayed in their linguistic development.

Conversations about self-identity in Alzheimer disease: augmentative and alternative Communication memory books as an aid / Conversaciones sobre la propia identidad en la Enfermedad de Alzheimer: ayuda de los libros de memoria de Comunicación Aumentativa y Alternativa

Alzheimer disease (AD) is a progressive and degenerative neurological disorder that affects memory, language and communication, thinking, and social skills. The inability to recall incidents and events, especially when symptoms become more prevalent and severe, can cause a person to experience a loss of self or to have doubts about his or her identity. One approach to helping these patients with their memory and language problems is to use memory books, a kind of Augmentative and Alternative Communication (AAC) tool. The aim of this study was to verify whether the introduction of AAC books could have an impact on conversations about self-identity through an increase of ‘self’-positive conversational contents and on improving conversational skills. Three single case studies were carried out with three elderly women with mild, moderate and severe AD, respectively. Each participant was involved in a conversation about their ‘selves’ in an alternating treatment design (ABAB) without a memory book in phase A and with the aid of this AAC tool in phase B. The results showed a similar conversational response pattern in all participants. AAC aids increased the number of ‘self’-positive conversational statements with a reduction in negative, ambiguous and repetitive utterances. In conclusion, AAC memory tools seemed to help participants with dementia to focus their attention on relevant personal information, allowing them to centre the conversation on core positive identity contents, thus improving the quality of the conversations with fewer ambiguous utterances (AU)

La Enfermedad de Alzheimer es una enfermedad neurológica degenerativa y progresiva que afecta a la memoria, el lenguaje y la comunicación, el pensamiento y las habilidades sociales. La incapacidad para recordar incidentes y acontecimientos, cuando los síntomas son más prevalentes y severos, puede causar que la persona experimente una pérdida del self o tenga dudas sobre su identidad. Un enfoque que ayuda con los problemas de memoria y de lenguaje es el uso de los libros de memoria, herramientas de Comunicación Aumentativa y Alternativa (CAA). El objetivo de este estudio es comprobar si la introducción de libros de CAA tiene un impacto en las conversaciones sobre la propia identidad, a través del incremento de contenidos conversacionales positivos sobre "si mismo", y en la mejora de habilidades conversacionales. Se llevaron a cabo tres estudios de caso único con tres mujeres mayores con enfermedad de Alzheimer, leve, moderada y severa, respectivamente. Se implicó a cada participante en una conversación sobre "si misma" en un diseño de tratamientos alternos (ABAB) sin libro de memoria en la fase A y con apoyo de la CAA en B. Los resultados muestran un patrón de respuesta conversacional similar para las tres participantes. Con las ayudas de CAA se incrementaron las frases positivas sobre "si misma" en la conversación y se redujeron las declaraciones negativas, ambiguas y repetitivas. La conclusión es que parece que las herramientas de memoria han ayudado a enfocar la atención sobre información personal relevante, permitiendo centrar la conversación en contenidos básicos de su identidad y mejorando su calidad con menos ambigüedades (AU)

Desarrollo lingüístico y comunicativo temprano de niños prematuros / First language and communication development of preterm children

Esta investigación intenta: a) comparar el primer desarrollo lingüístico y comunicativo de niños prematuros (PR) con el de niños nacidos a término (NT), y b) investigar las posibles relaciones entre antecedentes biológicos, ambientales y personales y los resultados del desarrollo del lenguaje a los 10 meses. La investigación se llevó a cabo con 150 niños prematuros y un grupo control de 49 niños nacidos a término. Se estudió a los participantes cuando tenían 15 días de edad y, nuevamente, cuando tenían 10 meses (edades corregidas para los prematuros). A los 15 días se aplicó la escala Brazelton y se recogió información biomédica y de las características del ambiente. A los 10 meses se aplicó la versión gallega de los inventarios MacArthur-Bates (IDHC) (Pérez-Pereira y García, 2003; Pérez-Pereira y Resches, 2011) para evaluar su primer desarrollo lingüístico y comunicativo. Además, se han aplicado el CES-D y el IBQ-R para evaluar la depresión materna y el temperamento de los niños, respectivamente. No se han encontrado diferencias en las medidas del IDHC a los 10 meses de edad en relación con la edad gestacional o el peso al nacer. Se han hallado diferencias en el desarrollo comunicativo y lingüístico de los niños PR en relación con algunas variables, como la puntuación Apgar, la duración de la estancia en la unidad de cuidados intensivos (UCI) o la necesidad de atención psiquiátrica o psicológica de las madres. Otras variables, como el sexo o el orden de nacimiento, no parecen haber tenido ningún efecto en las puntuaciones en el IDHC. Los análisis de regresión lineal indican que el estado de salud y la educación materna parecen tener un mayor efecto predictivo en los niños PR que en los NT. Distintos factores de temperamento entran también en juego para los niños PR y NT como predictores de las habilidades lingüísticas y comunicativas (AU)

The present study intends: a) to compare first linguistic and communicative development of preterm (PR) children to that of full term (FT) children, and b) also to investigate possible relationships between biological, environmental and personal antecedents and language development outcomes at 10 months of age. The study has been carried out with 150 preterm children and a control group of 49 full term children. Participants were studied when they were 15 days old, and, again, when they were 10 months of age (corrected age for premature children). Neurobehavioral assessment and information on children's biomedical and environmental characteristics were gathered at 15 days of age. The Galician version of the MacArthur-Bates inventories (IDHC) (Pérez-Pereira & García, 2003; Pérez-Pereira & Resches, 2011) was applied when the children were 10 months of age to assess first linguistic and communicative development of the children. In addition, the CES-D and the IBQ-R were applied in order to assess the mothers' depression and children's temperament. No differences in any of the IDHC measures were found at 10 months of age in relation to birth weight and gestational age. Differences in communicative and language development of PR children were found in relation to a few variables such as Apgar scores, length of stay in the intensive care unit (ICU) or mothers receiving (or not) psychiatric attention. Gender and birth order do not seem to have any effect on IDHC scores. Linear regression analyses indicate that PR and FT children's results on the IDHC are predicted by different factors. Health and maternal education seem to have a greater predictive effect on PR children than FT children. Different temperament factors are also in play for PR and FT children as predictors of linguistic and communicative abilities (AU)

An exploratory study of phonological awareness and working memory differences and literacy performance of people that use AAC

Twelve cerebral palsied adolescents and young adults with complex communicative needs who used augmentative and alternative communication were studied. They were classified according to their working memory capacity (high vs. low) into two groups of 6 participants. They were also divided into two groups of 6 participants according to their high vs. low phonological skills. These groups were compared on their performance in reading tests -orthographic knowledge, a word test and a pseudoword reading test- and in the spelling of words, pseudowords and pictures’ names. Statistical differences were found between high vs. low phonological skills groups, and between high and low working memory groups. High working memory capacity group scored significantly higher than low working memory group in the orthographic and word reading tests. The high phonological skills group outperformed the low phonological skills group in the word reading test and in the spelling of pseudowords and pictures’ names. From a descriptive point of view, phonological skills and working memory, factors known to be highly predictive of literacy skills in people without disabilities, also hold as factors for the participants that used AAC in our study. Implications of the results are discussed (AU)

En nuestro estudio participaron doce adolescentes y adultos jóvenes con parálisis cerebral con necesidades comunicativas especiales, usuarios de comunicación aumentativa y alternativa. Éstos fueron clasificados según su capacidad de memoria operativa (alta vs. baja) en 2 grupos de 6 participantes, y en otros dos, también de 6 participantes de acuerdo a sus habilidades fonológicas (altas vs. bajas). Todos ellos fueron comparados según sus habilidades lectoras (conocimiento ortográfico, lectura de palabras, de pseudopalabras, capacidad de deletreo de palabras, de pseudopalabras y deletreo de nombres de dibujos. Los resultados mostraron diferencias significativas entre los grupos de altas y bajas capacidades fonológicas así como entre los grupos de alta y baja capacidad de memoria en algunas de las medidas estudiadas. Los sujetos con alta capacidad de memoria obtuvieron puntuaciones significativamente mejores en la tarea ortográfica y en la lectura de palabras. Por otra parte, los sujetos con mejores habilidades fonológicas rindieron significativamente mejor en las tareas de lectura de palabras, deletreo de pseudopalabras y de nombres de dibujos. Desde un punto de vista descriptivo, podemos afirmar que las habilidades fonológicas y de memoria operativa se mostraron como buenos predictores del éxito lector en sujetos usuarios de CAA, del mismo modo que sucede en el resto de la población sin trastornos. Las implicaciones de estos resultados se discuten en este trabajo (AU)

An exploratory study of phonological awareness and working memory differences and literacy performance of people that use AAC.

Twelve cerebral palsied adolescents and young adults with complex communicative needs who used augmentative and alternative communication were studied. They were classified according to their working memory capacity (high vs. low) into two groups of 6 participants. They were also divided into two groups of 6 participants according to their high vs. low phonological skills. These groups were compared on their performance in reading tests -orthographic knowledge, a word test and a pseudoword reading test- and in the spelling of words, pseudowords and pictures' names. Statistical differences were found between high vs. low phonological skills groups, and between high and low working memory groups. High working memory capacity group scored significantly higher than low working memory group in the orthographic and word reading tests. The high phonological skills group outperformed the low phonological skills group in the word reading test and in the spelling of pseudowords and pictures' names. From a descriptive point of view, phonological skills and working memory, factors known to be highly predictive of literacy skills in people without disabilities, also hold as factors for the participants that used AAC in our study. Implications of the results are discussed.

Un procedimiento de instrucción eficaz para la comunicación y el mantenimiento de peticiones específicas / An effective instructional procedure for communicating specific requesting and its maintenance

Se presentan los resultados de dos estudios. El objetivo del primer estudio ha sido aplicar un procedimiento de instrucción basado en una jerarquía decreciente de claves instruccionales para enseñar a un niño con retraso mental severo a pedir acceso a un objeto preferido mediante una petición específica activando una casilla de un dispositivo de comunicación aumentativa y alternativa con salida de voz usando una fotografía como símbolo. Asimismo, se comprobó la validez ecológica de la intervención. En un segundo estudio relacionado, se evaluó el papel de la salida de voz digitalizada en el mantenimiento de la petición para este mismo participante. Los resultados del primer estudio indicaron que el procedimiento de instrucción para la sustitución de los actos comunicativos prelingüísticos ha sido eficaz para enseñar la nueva conducta comunicativo-simbólica, conducta que ha sido funcionalmente equivalente a los actos prelingüísticos utilizados para pedir elementos preferidos. Además, se produjo la generalización de la conducta comunicativa aprendida en presencia de diversos interlocutores y en lugares variados. En el segundo estudio, una vez enseñada la nueva conducta comunicativa simbólica, y comparadas las tasas de adquisición en dos condiciones alternas, con la función de salida de habla del comunicador encendida y con la función de habla apagada, a lo largo de sucesivas sesiones, la nueva conducta de petición se mantuvo con independencia de la salida de voz (AU)

Results of two studies are presented. The aim of the first study has been the application of an instructional procedure, based on a top down hierarchy of instructional keys, to teach a boy with severe mental retardation to request access to a preferred item by means of a specific requesting and activating a cell of an augmentative and alternative communication device with voice output using a photograph as a symbol. Ecological validity of the intervention was assessed. In a second related study the effect of digitized voice output in the maintenance of requesting for the same boy was assessed. Results for the first study showed that the instructional procedure for the substitution of prelinguistic communicative acts has been an effective one in order to teach the new symbolic communicative behaviour. This symbolic communicative behaviour has been functionally equivalent to the prelinguistics acts the boy used to employ to request favourite items. Generalization of the new learnt communicative behaviour was observed with different communicative partners and in varied settings. In the second study, once the new symbolic communicative behaviour was taught and acquired by the boy, rates of requesting were compared across two conditions, speech output on versus speech output off, that were alternated on a session by session basis, and results showed that the new requesting behaviour was maintained regardless speech output (AU)