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.

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.

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.

Systematic Review of Verbal Operants in Speech Generating Device Research from Skinner's Analysis of Verbal Behavior.

Skinner's (1957) book Verbal Behavior is a critical tool in designing effective communication programs for individuals with limited speech. The purpose of this systematic review was to analyze the speech generating device (SGD) research literature from Skinner's taxonomy of primary verbal operants. An extraction procedure yielded 56 studies published between 1995 and 2018, with a total of 221 participants, most of whom had autism spectrum disorder (ASD) or an intellectual and developmental disability (IDD). The large majority of SGD studies (42) targeted multiply controlled mands, whereas only a handful of studies targeted verbal operants that were not mands. Few studies employed procedures for fading contrived sources of stimulus control to promote spontaneous responding, and few studies targeted more sophisticated, topography-based responses (e.g., typing, speech). Results of the review highlight the need for better dissemination of Skinner's Verbal Behavior, the need for research to evaluate effects of SGD in teaching a greater variety of spontaneous verbal operants, and the need to focus on application of SGD with populations beyond individuals with ASD and IDD.

A Systematic Review of Tablet Computers and Portable Media Players as Speech Generating Devices for Individuals with Autism Spectrum Disorder.

Powerful, portable, off-the-shelf handheld devices, such as tablet based computers (i.e., iPad(®); Galaxy(®)) or portable multimedia players (i.e., iPod(®)), can be adapted to function as speech generating devices for individuals with autism spectrum disorders or related developmental disabilities. This paper reviews the research in this new and rapidly growing area and delineates an agenda for future investigations. In general, participants using these devices acquired verbal repertoires quickly. Studies comparing these devices to picture exchange or manual sign language found that acquisition was often quicker when using a tablet computer and that the vast majority of participants preferred using the device to picture exchange or manual sign language. Future research in interface design, user experience, and extended verbal repertoires is recommended.