Environmental factors contributing to using spelling in communication: Perceptions of literate aided communicators.

The aim of this interpretive qualitative study was to explore how environmental factors influence the transition from relying solely on graphic symbols to using spelling in face-to-face communicative interactions, from the perspective of literate adults with speech and motor impairments who use augmentative and alternative communication (AAC). Fourteen adults either chose to submit a written story with weekly email follow-up, took part in interviews conducted via Zoom1, or chose to communicate solely by email. Researchers analyzed data using Charmaz's (2014) constructivist grounded theory approach. The analysis yielded three themes explaining environmental factors relevant to the transition from using graphic symbols to spelling in communication: (a) access to AAC systems and services; (b) knowledgeable and supportive communication partners who have high expectations; and (c) opportunities to learn reading, writing, and spelling. Supportive factors included providing sufficient time for spelling in communicative interactions, structured learning opportunities for practice and independence, opportunities to learn through socially meaningful interactions and having print-rich and language-rich activity settings. Slow speed in navigating graphic symbols and lack of ability to express an exact message were motivational reasons for participants to use spelling in communicative interactions. The interaction among environmental factors and person-related characteristics warrants further investigation.

Communication partner strategies in negotiation for meaning in interactions involving aided communication.

Co-constructing meaning is a common feature of all conversations but may have a more specific role in interactions where one of the participants uses aided communication. The present study applies qualitative descriptive analysis supported by quantitative measures in exploring meaning-negotiation strategies of speaking communication partners in task-related aided conversations. The study focuses on identifying and exploring strategies that the communication partners utilise when attempting to interpret the meaning and resolve potential ambiguities of aided utterances in the context of event descriptions. The participants of the study were three aided communicators (age 8 to 11 years), who used graphic communication systems as their main means of communication, and familiar adult communication partners. The results demonstrate that the communication partners employed several strategies in attempting to comprehend, interpret and co-construct the meaning of aided utterances at various phases of interaction. The primary strategy involved clarifying the lexical properties of the aided constructions, reflecting the multidimensional and polysemous nature of graphic communication systems. Structural and referential complexities affected how the elements produced were understood as part of the ongoing context. The study highlights the participants´ shared responsibility in developing and utilising effective meaning-negotiation and repair strategies to support successful communication.

Aided communication, mind understanding and co-construction of meaning.

Mind understanding allows for the adaptation of expressive language to a listener and is a core element when communicating new information to a communication partner. There is limited knowledge about the relationship between aided language and mind understanding. This study investigates this relationship using a communication task. The participants were 71 aided communicators using graphic symbols or spelling for expression (38/33 girls/boys) and a reference group of 40 speaking children (21/19 girls/boys), aged 5;0-15;11 years. The task was to describe, but not name, drawings to a communication partner. The partner could not see the drawing and had to infer what was depicted from the child's explanation. Dyads with aided communicators solved fewer items than reference dyads (64% vs 93%). The aided spellers presented more precise details than the symbol users (46% vs 38%). In the aided group, number of correct items correlated with verbal comprehension and age.

Expressive and receptive performance with graphic symbol sentences by individuals who use aided communication.

This study explored performance on expressive and receptive graphic symbol tasks and spoken comprehension by individuals who use augmentative and alternative communication (AAC) as well as the relationship of performance with participants' skills and characteristics. Participants were 19 children and youth (aged 5- to 18-years-old) who used aided communication. Four experimental tasks were administered, with either speech or symbols as input (stimuli) and symbols or choice from an array of pictures as output (response). Symbols were not accompanied by written or spoken labels in the tasks. Measures of receptive vocabulary, receptive syntax, memory, and visual cognitive skills as well as information regarding participant characteristics were collected. There were strong relationships among all experimental tasks. Cluster analysis revealed different response patterns that may suggest a progression in expressive and receptive performance with graphic symbol sentences. Individual differences in receptive language, particularly receptive syntax, were related to task performance. The findings suggest that different ways of experiencing symbols, in addition to spoken comprehension of the sentences and receptive spoken language more generally, may contribute to expressive graphic symbol sentences. Performance on receptive symbol tasks may uncover a level of facility with the graphic-symbol modality not observed through expressive symbol use in communicative situations.

Sibling involvement in interventions for children with a disability: a systematic review.

PURPOSE: To conduct a systematic review of the involvement of siblings of individuals with a disability in therapeutic interventions to explore (a) sibling roles, (b) reported outcomes related to participant skills, interactions, or relationships, and (c) participant experiences. METHODS: A search of popular databases and grey literature was completed identifying studies published in English from 1999-2020. In total, 14,815 citations were extracted. Following a review of titles and abstracts, 31 studies met the inclusion criteria and were assessed for study quality. RESULTS: The most common role assigned to siblings was that of a trained playmate (n = 11), followed by an untrained playmate (n = 5). Overall, the interventions reported positive outcomes, although sample sizes were small and variability in outcomes was high. None of the studies included adult participants and most (n = 28, 90.32%) included participants who had a diagnosis of Autism Spectrum Disorder (ASD). Over half of the studies reported participant experiences of the intervention, with most reporting positive experiences. CONCLUSIONS: Notwithstanding the reported positive outcomes of the interventions in this review, further research is needed to better understand the specific impact of involving siblings in interventions, as is research with adult participants and participants with diagnoses other than ASD.Implications for RehabilitationSiblings can fulfil a range of roles, (e.g., trained playmate, instructor, model), when participating in interventions for an individual with a disability. frequently with positive outcomes.While overall involving siblings in interventions seems to lead to positive outcomes, the specific effect of involving a sibling (rather than a peer or parent) in an intervention is not clear.Most of the available research has focused on children with a diagnosis of autism spectrum disorder and so the findings may not apply across all disability groups.It is important to acknowledge sibling opinions about taking part in such interventions to ensure all participants' needs are being met.

Expressive and receptive use of speech and graphic symbols by typically developing children: What skills contribute to performance on structured sentence-level tasks?

PURPOSE: To explore expressive and receptive use of speech and graphic symbols and relationships with linguistic and cognitive skills in children with typical development. METHOD: Participants were 82 children with typical development (4 to 9 years). Measures of memory, visual analysis skills, and receptive language were used, along with five experimental tasks with speech or symbols as input (stimulus) or output (response), using single clause and compound clause stimuli. Cluster analysis grouped participants with similar performances patterns, who were then compared on linguistic and cognitive skill measures. RESULT: The lowest performing group sometimes accurately interpreted graphic symbol utterances that were visible during responding. The mid-performing group was stronger on expressive than receptive symbol utterances when the model did not remain visible. The highest group was comparable on expressive and receptive symbol tasks, but nonetheless stronger with spoken utterances. Relationships of linguistic and cognitive skills with task performance differed across the clusters. CONCLUSION: The findings help clarify the input-output modality asymmetry in graphic symbol communication. Spoken language proficiency does not directly transfer to sentence-level expressive and receptive graphic symbol use. Exploring potentially challenging sentence-level phenomena is important. Research is warranted to explore developmental progressions and potential clinical applications more systematically.

The BCH message banking process™, voice banking, and double-dipping™.

Significant advances have been made in interventions to maintain communication and personhood for individuals with neurodegenerative conditions. One innovation is Message Banking, a clinical approach first developed at Boston Children's Hospital (BCH). This paper outlines the Message Banking process as implemented at BCH, which includes the option of "Double Dipping," where banked messages are mined to develop personalized synthesized voices. More than a decade of experience has led to the evolution of six core principles underpinning the BCH process, resulting in a structured introduction of the associated concepts and practices with people with amyotrophic lateral sclerosis (ALS) and their families. These principles highlight the importance of assigning ownership and control of the process to individuals with ALS and their families, ensuring that as a tool it is empowering and offers hope. Changes have been driven by feedback from individuals who have participated in the BCH process over many years. The success of the process has recently been extended through partnerships that allow the recorded messages to be used to develop individual personalized synthetic voices to complement banked messages. While the process of banking messages is technically relatively simple, the full value of the process should be underpinned by the values and principles outlined in this tutorial.

Communication difficulties in adults with Intellectual Disability: Results from a national cross-sectional study.

BACKGROUND: People with an intellectual disability (ID) are vulnerable to communication impairments, with consequences for employment, education, and social participation. AIMS: To identify the communication skills of a population of adults (40+ years) with ID and explore relationships between individual and environmental factors and communication skills. METHODS AND PROCEDURES: Data from a sample of 601 adults with ID was selected from the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA) addressing communication characteristics, demographics, co-morbidities, challenging behaviours, and social participation. A multiple regression model and a decision-making tree were built to identify factors related to communication abilities. OUTCOMES AND RESULTS: Overall, 57.9 % of participants experienced communication difficulties, with 23.5 % reporting severe difficulties. Only 75.1 % of participants communicated verbally; more than half found communicating with professionals and non-familiar partners difficult. Level of ID, low social participation, challenging behaviours, and diagnosis of Down syndrome were significantly associated with communication difficulties. CONCLUSIONS AND IMPLICATIONS: Communication difficulties are prevalent in adults with ID and are influenced by complex factors. Interventions to enhance interaction and quality of life of individuals with ID should consider communication opportunities, needs, and barriers.

Professionals' decision-making in recommending communication aids in the UK: competing considerations.

Existing research suggests the provision of communication aids for children with complex communication needs can have significant positive impacts on health and quality-of-life. The process of clinical decision-making related to the recommendation of high-tech communication aids is not well documented or evaluated, and research evidence related to the provision of these aids remains limited. This study aimed to understand the factors that specialized AAC professionals in the UK consider when recommending high-tech communication aids. Purposive sampling was used to recruit teams to six focus groups, each of which centred on a team's recent recommendation process (i.e. a discussion following a real-time assessment session, where the team attempted to arrive at an agreed recommendation for a specific child). Thematic network analysis was used to interpret data from the focus group discussions. Participants identified a wide range of child characteristics, access features, and communication aid attributes in weighing up decisions for individual children. Findings suggest that specialized AAC professionals in the UK prioritize access features over language considerations in their communication aid recommendations. An explanatory model was developed to illustrate the interaction effect that several competing considerations may have on decision-making. Implications for clinical practice and future research are discussed.

Decision-making in communication aid recommendations in the UK: cultural and contextual influencers.

High-tech communication aids are one form of augmentative and alternative communication (AAC) intervention offered to children following an assessment process to identify the most appropriate system based on their needs. Professional recommendations are likely to include consideration of child characteristics and communication aid attributes. Recommendations may be influenced by contextual factors related to the cultural work practices and service context of professionals involved, as well as by contextual factors from the child's life including their family environment and wider settings. The aim of this study was to explore the influence of cultural and contextual factors on the real-time decision-making processes of specialized AAC professionals in the UK. A total of six teams were recruited to the study. Each team carried out an assessment appointment related to a communication aid recommendation for a child and family. Following the appointment, each team participated in a focus group examining their decision-making processes during the preceding assessment. Inductive coding was used to analyse the transcribed data, and three organizing themes emerged relating to the global theme of Cultural and Contextual Influencers on communication aid decision-making. An explanatory model was developed to illustrate the funnelling effect that contextual factors may have on decision-making, which can substantially alter the nature and timing of a communication aid recommendation. Implications for clinical practice and future research are discussed.

Innovations for Supporting Communication: Opportunities and Challenges for People with Complex Communication Needs.

Individuals with complex communication needs have benefited greatly from technological innovations over the past two decades, as well as from social movements that have shifted focus from disability to functioning and participation in society. Three strands of technological innovation are reviewed in this paper: (1) innovations in the tools that have become available, specifically tablet technologies; (2) innovations in access methods (eye gaze technologies and brain-computer interfaces); and (3) innovations in output, specifically speech technologies. The opportunities these innovations offer are explored, as are some of the challenges that they imply, not only for individuals with complex communication needs, but also for families, professionals, and researchers.

Constructing narratives to describe video events using aided communication.

Narratives are a pervasive form of discourse and a rich source for exploring a range of language and cognitive skills. The limited research base to date suggests that narratives generated using aided communication may be structurally simple, and that features of cohesion and reference may be lacking. This study reports on the analysis of narratives generated in interactions involving aided communication in response to short, silent, video vignettes depicting events with unintended or unexpected consequences. Two measures were applied to the data: the Narrative Scoring Scheme and the Narrative Analysis Profile. A total of 15 participants who used aided communication interacted with three different communication partners (peers, parents, professionals) relaying narratives about three video events. Their narratives were evaluated with reference to narratives of 15 peers with typical development in response to the same short videos and to the narratives that were interpreted by their communication partners. Overall, the narratives generated using aided communication were shorter and less complete than those of the speaking peers, but they incorporated many similar elements. Topic maintenance and inclusion of scene-setting elements were consistent strengths. Communication partners offered rich interpretations of aided narratives. Relative to the aided narratives, these interpreted narratives were typically structurally more complete and cohesive and many incorporated more elaborated semantic content. The data reinforce the robust value of narratives in interaction and their potential for showcasing language and communication achievements in aided communication.

Vocabulary comprehension and strategies in name construction among children using aided communication.

Vocabulary learning reflects the language experiences of the child, both in typical and atypical development, although the vocabulary development of children who use aided communication may differ from children who use natural speech. This study compared the performance of children using aided communication with that of peers using natural speech on two measures of vocabulary knowledge: comprehension of graphic symbols and labeling of common objects. There were 92 participants not considered intellectually disabled in the aided group. The reference group consisted of 60 participants without known disorders. The comprehension task consisted of 63 items presented individually in each participant's graphic system, together with four colored line drawings. Participants were required to indicate which drawing corresponded to the symbol. In the expressive labelling task, 20 common objects presented in drawings had to be named. Both groups indicated the correct drawing for most of the items in the comprehension tasks, with a small advantage for the reference group. The reference group named most objects quickly and accurately, demonstrating that the objects were common and easily named. The aided language group named the majority correctly and in addition used a variety of naming strategies; they required more time than the reference group. The results give insights into lexical processing in aided communication and may have implications for aided language intervention.

Communicating the unknown: descriptions of pictured scenes and events presented on video by children and adolescents using aided communication and their peers using natural speech.

The facility to describe scenes and events is important in everyday communication, but little is known about the description skills and strategies of young people using aided communication. This article explores how 81 children and adolescents using aided communication and 56 peers using natural speech, aged 5-15 years, described pictured scenes and events presented on video to a partner who had no prior knowledge of the content. The group who used aided communication took longer and included fewer elements in their descriptions than the reference group; however, the groups did not differ in their use of irrelevant or incorrect elements, suggesting that both groups stayed on topic. Measures related to aided message efficiency correlated significantly with measures of spoken language comprehension. There were no significant differences between groups for their descriptions of pictured scenes and video events. Analyses showed both unpredicted group similarities and predictable differences, suggesting key components for future research consideration.

You and me: The structural basis for the interaction of people with severe and profound intellectual disability and others.

Interaction between two people may be construed as a continuous process of perception and action within the dyad. A theoretical framework is proposed in this article that explains the concepts and processes which comprise the interaction process. The article explores the transactional nature of interaction, through analysis of narrative data from two dyads, each comprising a person with severe or profound intellectual and multiple disability and a service worker. The novel application of grounded theory to analyse video data of non-verbal communication data in order to develop the theoretical framework is reviewed. Previously, attuning has been identified as the key process that drives interaction. This article explores the other concepts of the theory proposed, namely, setting, being, stimulus, action, attention and engagement. The article concludes by contrasting this theory of the interaction process with other related concepts and suggests how application of the proposed framework may enhance practice.

Attuning: A Communication Process between People with Severe and Profound Intellectual Disability and Their Interaction Partners.

BACKGROUND: People with severe and profound intellectual disability typically demonstrate a limited ability to communicate effectively. Most of their communications are non-verbal, often idiosyncratic and ambiguous. This article aims to identify the process that regulates communications of this group of people with others and to describe the methodological approach that was used to achieve this. MATERIALS AND METHODS: In this qualitative study, two dyads consisting of a person with severe or profound intellectual and multiple disability and a teacher or carer were filmed as they engaged in school-based activities. Two 1-hour videotapes were transcribed and analysed using grounded theory. RESULTS: Attuning was identified within the theory proposed here as a central process that calibrates and regulates communication. CONCLUSION: Attuning is conceptualized as a bidirectional, dyadic communication process. Understanding this process may support more effective communication between people with severe or profound intellectual and multiple disability and their interaction partners.