Leveraging Communication Partner Speech to Automate Augmented Input for Children on the Autism Spectrum Who Are Minimally Verbal: Prototype Development and Preliminary Efficacy Investigation.

PURPOSE: Augmentative and alternative communication (AAC) technology innovation is urgently needed to improve outcomes for children on the autism spectrum who are minimally verbal. One potential technology innovation is applying artificial intelligence (AI) to automate strategies such as augmented input to increase language learning opportunities while mitigating communication partner time and learning barriers. Innovation in AAC research and design methodology is also needed to empirically explore this and other applications of AI to AAC. The purpose of this report was to describe (a) the development of an AAC prototype using a design methodology new to AAC research and (b) a preliminary investigation of the efficacy of this potential new AAC capability. METHOD: The prototype was developed using a Wizard-of-Oz prototyping approach that allows for initial exploration of a new technology capability without the time and effort required for full-scale development. The preliminary investigation with three children on the autism spectrum who were minimally verbal used an adapted alternating treatment design to compare the effects of a Wizard-of-Oz prototype that provided automated augmented input (i.e., pairing color photos with speech) to a standard topic display (i.e., a grid display with line drawings) on visual attention, linguistic participation, and (for one participant) word learning during a circle activity. RESULTS: Preliminary investigation results were variable, but overall participants increased visual attention and linguistic participation when using the prototype. CONCLUSIONS: Wizard-of-Oz prototyping could be a valuable approach to spur much needed innovation in AAC. Further research into efficacy, reliability, validity, and attitudes is required to more comprehensively evaluate the use of AI to automate augmented input in AAC.

Increasing linguistic and prelinguistic communication for social closeness during naturalistic AAC instruction with young children on the autism spectrum.

This study examined the effects of an intervention package using high-tech augmentative and alternative communication (AAC) with Naturalistic Instruction (NI), time delay, and prompting during social routines for preschoolers on the autism spectrum. The AAC was a communication application on a tablet programmed with color photo representations of participants and communication partners engaged in social routines. The primary dependent measure was a linguistic communication turn on the AAC device completing the instructor's cloze phrase related to the routine. A secondary dependent measure was prelinguistic communication -nonspecific vocalizations and smiling - within each turn of the routine. Results indicated that all communication types increased and maintained for all three participants with two participants meeting mastery criteria within the minimal number of sessions. These results are significant in providing additional evidence for the effectiveness of AAC intervention beyond teaching simple object requests and in teaching more socially meaningful communication to children on the autism spectrum. Additionally, this study supports the use of color photo representations to promote social interaction. Future research should continue to evaluate such interventions on a larger scale and include naturally occurring communication partners, such as siblings and peers.

Effects of Interaction Approaches and Added High-Tech Augmentative and Alternative Communication on Prelinguistic and Linguistic Communication from School-Age Beginning Communicators.

INTRODUCTION: Augmentative and alternative communication (AAC) intervention research is rarely focused on school-age beginning communicators despite the urgent need to ensure individuals in this population have access to the fundamental human right of communication. METHOD: Four school-age children with multiple disabilities who were primarily prelinguistic communicators participated in the current study. The study used a single subject research design to explore the effects of two interaction approaches - a social routine approach and a directive approach - on prelinguistic communication, compared to independent play and to one another. This study then evaluated the added effects of high-tech AAC within the most effective interaction approach for each participant. RESULTS: All participants demonstrated prelinguistic communication indicating positive affect most frequently when interacting within a social routine. Furthermore, all participants increased linguistic communication while either maintaining or increasing prelinguistic communication when high-tech AAC was added to the social routine interaction. DISCUSSION/CONCLUSION: Clinicians should consider building accessible, predictable, engaging, and age-respectful social routines into leisure contexts to promote prelinguistic communication from school-age beginning communicators. Clinicians should also provide access to linguistic communication through high-tech AAC while continuing to honor and promote prelinguistic communication.

Effects of an AAC feature on decoding and encoding skills of adults with Down syndrome.

Literacy skills can assist in the navigation and enjoyment of adult life. For individuals who have reached adulthood without strong literacy skills, opportunities for continued literacy learning are few. Redesigning AAC technologies to support literacy skill development could extend literacy learning opportunities for adults with developmental disabilities who have limited speech. The current preliminary study evaluated an AAC technology feature designed to support literacy development. The study used a multiple probe across participants design. Three adults with Down syndrome who had limited speech and only basic decoding skills participated. Results suggest the participants made modest gains in decoding accuracy after interacting using the AAC app with the literacy supportive feature, though performance was highly variable. Results also offer emerging evidence that, for two participants, some generalization to encoding performance may have also been achieved. Results showed that, for all the participants, interacting using the literacy supportive feature increased their reading confidence. Altogether, the study's results show preliminary evidence that the feature can support adults with Down syndrome in their ongoing literacy learning, though access to formal instruction is still critical. Future research is needed to continue to explore this and other AAC technology redesigns to increase learning opportunities for the people who use the technology every day to communicate.

Effect of Low-Tech Augmentative and Alternative Communication Intervention on Intentional Triadic Gaze as Alternative Access by School-Age Children With Multiple Disabilities.

PURPOSE: Students with multiple disabilities who are beginning communicators require augmentative and alternative communication (AAC) to communicate during school and participate in its academic and social aspects. Triadic gaze is a method for accessing low-tech AAC that minimizes physical demands on access for students with limited mobility, such as students with multiple disabilities. Thus, this study evaluated an instructional protocol for teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities. METHOD: Three students with multiple disabilities who were beginning communicators participated in a multiple baseline across participants design with three phases: baseline, treatment, and generalization and maintenance. Participants engaged in instruction around using triadic gaze to communicate by making selections on an eye gaze board. RESULTS: Visual analysis showed that all three participants acquired the use of triadic gaze as a method of accessing low-tech AAC in response to instruction. Effect size estimations suggested instruction was effective. The participants also demonstrated that the newly acquired skill generalized to interactions with familiar communication partners after instruction ended. CONCLUSIONS: These findings show that instruction can be effective in teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities. Future research should explore the effects of using this access method on communicating across school contexts.

Effects of an Augmentative and Alternative Communication Technology Decoding Feature on Single-Word Reading by Individuals With Down Syndrome and Limited Functional Speech.

PURPOSE: Literacy skills are foundational to participation in adolescent and adult life, and decoding skills (i.e., sounding out to read words) are critical to literacy learning. Literacy also increases communication options for individuals with developmental disabilities who use augmentative and alternative communication (AAC). Yet, current AAC technologies are limited in their support of literacy development (especially decoding skills) for the individuals with developmental disabilities who require them. The purpose of this study was to conduct a preliminary evaluation of a new AAC feature designed to support decoding skills. METHOD: Three individuals who had limited functional speech and limited literacy skills, specifically two adolescents and one young adult with Down syndrome, participated in the study. The study used a single-subject, multiple-probe, across-participants design. RESULTS: All three participants demonstrated increases in reading performance, including decoding of novel words. High variability in performance was observed, however, and no participant reached reading mastery. Still, analysis reveals that for all participants, interacting using the new app feature increased reading. CONCLUSIONS: These results offer preliminary evidence that an AAC technology feature that provides models of decoding (upon selection of AAC picture symbols) can support individuals with Down syndrome in building decoding skills. While not intended to replace instruction, this initial study offers initial evidence in its efficacy as a supplemental avenue for supporting literacy in individuals with developmental disabilities who use AAC.

A Scoping Review of Research Evaluating Physiological Information for Individuals With Developmental Disabilities: Augmentative and Alternative Communication Research Considerations.

PURPOSE: Today, an ever-increasing number of technological advancements are becoming mainstream. As the availability of technological innovations increases, so do opportunities for evaluating any benefits of those innovations in augmentative and alternative communication (AAC) research for individuals with developmental disabilities. One innovation that has become mainstream is the use of noninvasive wearable technology to provide physiological information (e.g., heart rate, skin conductance). Such information could be valuable in AAC research, but more information about its potential feasibility and utility is needed. METHOD: A scoping review was conducted to review and report on existing research that has evaluated (a) physiological information as a communication intervention tool for individuals with developmental disabilities and (b) the relationship between physiological information from individuals with developmental disabilities and behavioral and/or environmental information in real time. RESULTS: Results revealed that, while little communication intervention research has been completed, descriptive research demonstrates that physiological information from individuals with developmental disabilities gathered using wearable technology corresponds meaningfully to observable environmental and behavioral events. CONCLUSIONS: Future AAC research incorporating wearable technology to gather physiological information is warranted. Such research could evaluate potential benefits such as preempting challenging behavior with communication opportunities, signaling readiness for language learning, indicating AAC feature preferences, and expanding methodological approaches.

Integrating familiar listeners and speech recognition technologies into augmentative and alternative communication intervention for adults with down syndrome: Descriptive exploration.

Many individuals with Down syndrome exhibit speech impairments that necessitate augmentative and alternative communication (AAC) intervention. AAC intervention allows for access to communication through means other than, or supplemental to, speech. This descriptive study provided initial insight into the feasibility of incorporating familiar listeners (e.g., family members) and speech recognition technology into AAC intervention to increase communication success for individuals with Down syndrome. Six adults with Down syndrome participated. The participants' intelligibility to a familiar listener, unfamiliar listeners, and speech recognition technologies (i.e., Google Speech-to-Text and Windows Speech Recognition) was evaluated. Additionally, consistency in word pronunciation was evaluated to examine the feasibility of future training of speech recognition technologies. The participating adults with Down syndrome experienced limited intelligibility to all listeners and technologies but were most intelligible to familiar listeners. The adults also demonstrated consistencies across their production of words, and across one another's productions. The findings suggest the promise in using familiar listeners as a current resource and speech recognition technology as a future resource in AAC intervention for adults with Down syndrome. However, intervention research and technological development are needed to thoroughly explore these approaches.

Typical preschoolers' perceptions of augmentative and alternative communication modes of a preschooler with autism spectrum disorder.

Understanding typical preschoolers' perceptions of communication modes could help guide augmentative and alternative communication (AAC) intervention for preschoolers with autism spectrum disorder (ASD). This study explored the perceptions of 16 typically developing preschoolers toward an (a) AAC application (app) on a tablet, (b) picture exchange using a binder with printed Picture Communication SymbolsTM, and (c) prelinguistic communication used by a preschooler with ASD in a series of videos the preschoolers watched. Using a multi-method design, the study implemented both quantitative (rank ordering and preference selection) and qualitative (interview) methodologies. Quantitative results revealed the typical preschoolers had a clear overall preference for the AAC app, but variation in preference existed when selecting a communication mode to use in specific social scenarios. Qualitative data show the children more easily understood the child with ASD when he used the AAC app and associated tablets with fun, which may have accounted for positive perceptions of this AAC mode. The study is exploratory in nature and limited by its size and scope. However, it provides insights useful for clinicians' understanding not just how typical preschoolers perceive various modes of communication, but also why they may perceive some more favorably than others, in order to tailor intervention accordingly.

Comparative Effects of Picture Symbol With Paired Text and Text-Only Augmentative and Alternative Communication Representations on Communication From Children With Autism Spectrum Disorder.

Purpose Technology features that maximize communicative benefit while minimizing learning demands must be identified and prioritized to amplify the efficiency and effectiveness of augmentative and alternative communication (AAC) intervention. Picture symbols with paired text are a common representation feature in AAC systems for children with autism spectrum disorder (ASD) who are preliterate, yet little research about their comparative benefit exists. Method Four school-age children with ASD and limited speech who were preliterate participated in two single-subject studies. In one study, communication of high imageability words (e.g., nouns) on an AAC app during a book-reading activity was compared across two representation conditions: picture symbols with paired text and text only. In the second study, communication of low imageability words (e.g., verbs) was compared. Both studies had baseline, intervention, generalization, and maintenance phases. Results Prior to intervention, participants communicated across both representation conditions at low rates except two participants who were relatively successful using picture symbol with paired text representations of high imageability words. In response to intervention, all participants demonstrated increases in communication across representation conditions and maintained the increases. Participants demonstrated generalization in the text-only representation condition. Conclusions Children with ASD who were preliterate acquired communication at comparable rates regardless of whether an AAC app utilized picture symbol with paired text or text-only representation. Therefore, while larger scale research is needed, clinicians and technology developers could consider increasing the use of text in AAC representation given the inherent value associated with learning to recognize written words. Supplemental Material https://doi.org/10.23641/asha.13661357.

Effect of AAC technology with dynamic text on the single-word recognition of adults with intellectual and developmental disabilities.

Purpose: Single-word recognition can support participation in life, including engagement in leisure activities, navigation through the community, and vocational opportunities. Given the limited reading skills of many adults with intellectual and developmental disabilities (IDD) and limited speech, the current study evaluated the effects of using an augmentative and alternative communication (AAC) app, featuring dynamic text and speech output embedded in visual scene displays, on the single-word recognition performance of six adults with IDD who demonstrated limited speech.Method: A multiple baseline across participants single-subject design was used. Ten target sight words for each participant were selected on an individual basis, based on participant interest. Intervention consisted solely of interactions between investigators and individual participants using the app.Result: In the absence of any formal instruction and solely through the use of the AAC app interaction, three of the six participants demonstrated increased accuracy in single-word recognition.Conclusion: Results from the study were mixed, but suggest that AAC apps which provide the dynamic display of text in conjunction with voice output can assist some adults with IDD in achieving gains in single-word reading.

Programing AAC just-in-time for beginning communicators: the process.

Individuals who have limited or no speech as a result of intellectual and developmental disabilities and who are beginning communicators (i.e., are learning early linguistic skills such as first words and early semantic relations) require augmentative and alternative communication (AAC) to build both their expressive communication and their internal language structures. Programing AAC just-in-time is a promising clinical approach to intervention for beginning communicators because of its alignment with early language development theory. Early research efforts also provide emerging evidence to support its theoretical benefits. This paper describes a six-step process for programing AAC content just-in-time for beginning communicators. It highlights clinical challenges and considerations for each step, provides case examples of using the process with beginning communicators, and highlights potential limitations and future research directions related to the just-in-time programing of AAC for beginning communicators.

Preliminary investigation of the effects of a prelinguistic AAC intervention on social gaze behaviors from school-age children with multiple disabilities.

Some school-age children with multiple disabilities communicate predominately through the display of prelinguistic behaviors such as gestures, vocalizations, facial expressions, and eye gaze. Increasing the frequency and complexity of these behaviors may be one approach to building communication and transitioning toward linguistic communication (i.e., symbolic language). The current preliminary study used a single-subject ABB'B" design nested within a multiple baseline across participants design with randomization to evaluate a multi-phase intervention aimed at increasing social gaze behaviors. The participants were 5 school-age children with multiple disabilities. Participants appeared to demonstrate increases in both the frequency and complexity of their social gaze behavior during the intervention according to Improvement Rate Difference calculations that largely maintained four months after intervention ended. More research is needed, but the intervention shows promise as one aspect of AAC intervention for children who are prelinguistic communicators. Future research is critical to evaluating this or related interventions with a larger number of individuals and across a larger range of profiles and ages.

Comparative Effects of High-Tech Visual Scene Displays and Low-Tech Isolated Picture Symbols on Engagement From Students With Multiple Disabilities.

Purpose Augmentative and alternative communication (AAC) is an intervention approach that can promote communication and language in children with multiple disabilities who are beginning communicators. While a wide range of AAC technologies are available, little is known about the comparative effects of specific technology options. Given that engagement can be low for beginning communicators with multiple disabilities, the current study provides initial information about the comparative effects of 2 AAC technology options-high-tech visual scene displays (VSDs) and low-tech isolated picture symbols-on engagement. Method Three elementary-age beginning communicators with multiple disabilities participated. The study used a single-subject, alternating treatment design with each technology serving as a condition. Participants interacted with their school speech-language pathologists using each of the 2 technologies across 5 sessions in a block randomized order. Results According to visual analysis and nonoverlap of all pairs calculations, all 3 participants demonstrated more engagement with the high-tech VSDs than the low-tech isolated picture symbols as measured by their seconds of gaze toward each technology option. Despite the difference in engagement observed, there was no clear difference across the 2 conditions in engagement toward the communication partner or use of the AAC. Conclusions Clinicians can consider measuring engagement when evaluating AAC technology options for children with multiple disabilities and should consider evaluating high-tech VSDs as 1 technology option for them. Future research must explore the extent to which differences in engagement to particular AAC technologies result in differences in communication and language learning over time as might be expected.

Effect of mobile technology featuring visual scene displays and just-in-time programming on communication turns by preadolescent and adolescent beginning communicators.

PURPOSE: Visual scene displays (VSDs) and just-in-time programming supports are augmentative and alternative communication (AAC) technology features with theoretical benefits for beginning communicators of all ages. The goal of the current study was to evaluate the effects of a communication application (app) on mobile technology that supported the just-in-time programming of VSDs on the communication of preadolescents and adolescents who were beginning communicators. METHOD: A single-subject multiple-baseline across participant design was employed to evaluate the effect of the AAC app with VSDs programmed just-in-time by the researcher on the communication turns expressed by five preadolescents and adolescents (9-18 years old) who were beginning communicators. RESULT: All five participants demonstrated marked increases in the frequency of their communication turns after the onset intervention. CONCLUSION: Just-in-time programming support and VSDs are two features that may positively impact communication for beginning communicators in preadolescence and adolescence. Apps with these features allow partners to quickly and easily capture photos of meaningful and motivating events and provide them immediately as VSDs with relevant vocabulary to support communication in response to beginning communicators' interests.

Effect of Video Embedded with Hotspots with Dynamic Text on Single-Word Reading by Children with Multiple Disabilities.

Background: The purpose of the study was to evaluate the effects of an intervention using an AAC app programmed with video visual scene displays (VSDs) embedded with hotspots with the Transition to Literacy (T2L) feature on single-word reading. Method: Three school-aged children with multiple disabilities participated in a multiple baseline across participants design. Four names of characters in favorite movies and shows served as target words for each participant. Results: All three children demonstrated an increase in accurate identification of target words from baseline to intervention with Tau-U effect sizes for the participants of 0.69, 0.76, and 0.84, all of which were statistically significant (p<0.05). Conclusions: Clinicians can consider including the intervention evaluated in the current study as one component of literacy intervention for school-aged children with multiple disabilities. Future research should further evaluate video VSDs and the T2L feature for use with individuals with multiple disabilities.

Effect of AAC partner training using video on peers' interpretation of the behaviors of presymbolic middle-schoolers with multiple disabilities.

Children require consistent responses from partners to their presymbolic behaviors in order to increase the frequency and variety of these behaviors and eventually build symbolic language. This study served as an initial attempt to evaluate the effect of AAC training on typically-developing peers' interpretation of the behavior of three students with multiple disabilities whose communication was presymbolic and idiosyncratic in nature. The study used a pretest-posttest control group design with 12 peers in each condition (i.e., experimental and control). During the pretest, peers in both groups were inaccurate in their interpretations of the behaviors of the students with multiple disabilities. During the posttest, peers who completed the training interpreted the behaviors of the students with multiple disabilities with statistically significantly higher accuracy than participants who did not complete the training. The training may be an effective intervention approach to increase the accuracy and consistency with which communication partners interpret the idiosyncratic behaviors of children with multiple disabilities. Future research should evaluate the efficacy of using such training to increase communication partners' identification of and responsivity to idiosyncratic behaviors within the context of real-world interactions.

Effects of dynamic text in an AAC app on sight word reading for individuals with autism spectrum disorder.

The purpose of this study was to investigate the effects of Transition to Literacy (T2L) software features (i.e., dynamic text and speech output upon selection of a graphic symbol) within a grid display in an augmentative and alternative communication (AAC) app, on the sight word reading skills of individuals with autism spectrum disorders (ASD) and complex communication needs. The study implemented a single-subject multiple probe research design across one set of three participants. The same design was utilized with an additional set of two participants. As part of the intervention, the participants were exposed to an AAC app with the T2L features during a highly structured matching task. With only limited exposure to the features, the five participants all demonstrated increased accuracy of identification of 12 targeted sight words. This study provides preliminary evidence that redesigning AAC apps to include the provision of dynamic text combined with speech output, can positively impact the sight-word reading of participants during a structured task. This adaptation in AAC system design could be used to complement literacy instruction and to potentially infuse components of literacy learning into daily communication.

Systematic review of AAC intervention research for adolescents and adults with autism spectrum disorder.

Much of augmentative and alternative communication (AAC) research for individuals with autism spectrum disorder has focused on young children. Given that the lives, communication, strengths, and needs of adolescents and adults with autism spectrum disorder are quite different from those of young children, the purpose of the current study was to consolidate current AAC intervention research findings specific to these individuals. A systematic review was conducted to identify and evaluate relevant research. Results indicate that AAC intervention benefits adolescents and adults with autism spectrum disorder. However, more research is urgently needed. Future research focused on supporting communicative functions other than requesting (e.g., social closeness, information transfer) while participating in contexts important to the lives of adolescents and adults may be particularly valuable.

Typical Toddlers' Participation in "Just-in-Time" Programming of Vocabulary for Visual Scene Display Augmentative and Alternative Communication Apps on Mobile Technology: A Descriptive Study.

PURPOSE: Augmentative and alternative communication (AAC) promotes communicative participation and language development for young children with complex communication needs. However, the motor, linguistic, and cognitive demands of many AAC technologies restrict young children's operational use of and influence over these technologies. The purpose of the current study is to better understand young children's participation in programming vocabulary "just in time" on an AAC application with minimized demands. METHOD: A descriptive study was implemented to highlight the participation of 10 typically developing toddlers (M age: 16 months, range: 10-22 months) in just-in-time vocabulary programming in an AAC app with visual scene displays. RESULTS: All 10 toddlers participated in some capacity in adding new visual scene displays and vocabulary to the app just in time. Differences in participation across steps were observed, suggesting variation in the developmental demands of controls involved in vocabulary programming. CONCLUSIONS: Results from the current study provide clinical insights toward involving young children in AAC programming just in time and steps that may allow for more independent participation or require more scaffolding. Technology designed to minimize motor, cognitive, and linguistic demands may allow children to participate in programming devices at a younger age.