Advances in augmentative and alternative communication research for individuals with Autism spectrum disorder: moving research and practice forward.

Augmentative and alternative communication (AAC) approaches offer expressive and receptive supports for the segment of the population of individuals with autism spectrum disorder (ASD) who have little or no functional speech. The National Center for Autism Evidence and Practice (NCAEP) declared augmentative and alternative communication (AAC) interventions for individuals with autism an "evidence-based practice." Following a brief analysis of the breakdown of studies included in NCAEP by dependent variable, we introduce each of the four papers published as part of this special issue on Advances in Augmentative and Alternative Communication Research for Individuals with Autism Spectrum Disorder. In addition to elucidating the contributions and advances of each paper to the research base, including the NCAEP report, we provide a critical commentary as applicable in the hopes of stimulating and guiding further research.

Effects of Interventions Involving Speech Output Technologies on Communication Outcomes for Individuals With Developmental Disabilities: A Scoping Review.

PURPOSE: This scoping review aimed to map the literature on the effects of interventions involving speech output technologies on communication outcomes for individuals with developmental disabilities other than autism spectrum disorder. METHOD: A scoping review methodology was used to limit bias in searching, selecting, coding, and synthesizing relevant intervention studies. This involved a multifaceted search for studies conducted between 1991 and March 2021 using various electronic databases, ancestry searches, and forward citation searches from selected articles. Studies had to meet stringent inclusion criteria. Each study was summarized in terms of authors, purpose, participants, design, speech output, outcomes, effectiveness, and quality appraisal. RESULTS: Twenty-five single-case experimental design studies (88 participants) and one group design studies (62 participants) qualified for inclusion. Most of the participants had multiple diagnoses followed by a diagnosis of cerebral palsy and Down syndrome. Most studies focused on requesting behaviors and to a much lesser extent on syntactic structure and word identification. A dearth of high-quality studies was identified. CONCLUSIONS: Overall, there is a paucity of high-quality research investigating the effects of speech output technologies for children with developmental disabilities. Additionally, several directions for future research are posited. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20468928.

Attitudes Toward and Perceived Communicative Competence of Individuals with Aphasia Using Speech-Generating Devices.

The purpose of this study was to investigate the effects of interface display and respondent group on listener attitudes toward and perceived communicative competence of persons with aphasia. The Attitudes Toward Nonspeaking Persons scale and the Communicative Competence Scale was used to measure listener attitudes and communicative competence, respectively. A 2 × 3 mixed factorial design was used. Interface display videos served as the within-subjects variable (i.e., grid and scene displays), and the respondent group served as the between-subjects variable. A total of 113 respondents (i.e., undergraduate lower-division students, undergraduate upper-division students, and family caregivers of individuals with aphasia) watched an individual with aphasia using a grid display in one video and a scene display in another video. The respondents completed the two scales. Significant main effects (p < .05) were found for interface display and respondent group. The use of scene displays had a more favorable impact on competence ratings than the use of grid displays. Family caregiver ratings were significantly (p < .05) more favorable than ratings from other groups. The Communicative Competence Scale was found to be a reliable measure of perceived communicative competence. Scene displays have the potential to enhance the perceived communicative competence of this population.

Effect of clear speech intervention program on speech intelligibility in persons with idiopathic Parkinson's disease: A pilot study.

Purpose: This preliminary study was designed to assess the feasibility of Clear Speech Intervention Program (CSIP) on improving speech intelligibility of persons with idiopathic Parkinson's disease (PD). Clear Speech is a behavioural approach which focuses on improving speech intelligibility of persons with PD within a relatively short frame of time.Method: A single group pretest-posttest design was used to assess the effectiveness of CSIP. Fifteen adults diagnosed with PD participated in 8 sessions of CSIP with each session lasting 45-50 minutes over a period of 4 weeks in South Korea. All the data were collected in a quiet room with an ambient noise level of equal to or less than 40 dB SPL. Data on acoustical/aerodynamic, auditory-perceptual, and self-perceptual measures were obtained pre- and post-intervention. The Phonatory Aerodynamic System (PAS) was used to analyse acoustical/aerodynamic data.Result: The acoustical/aerodynamic assessment revealed statistically significant (p < 0.01) improvements in habitual pitch, pitch range, speaking rate, and number of respirations. In the auditory-perceptual assessment, statistically significant (p < 0.01) improvements were observed in overall speech intelligibility, tone, intonation, intensity, and articulation. Medium to large effect sizes were observed for significant results. The Pearson correlation analysis showed significant (p < 0.01) and strong correlation between articulation and speech intelligibility.Conclusion: The preliminary data has provided promising results and warrants future large-scale studies with suitable controls. Additionally, future research must focus on investigating long term effects of the intervention.

Effects of a Systematic Augmentative and Alternative Communication Intervention Using a Speech-Generating Device on Multistep Requesting and Generic Small Talk for Children With Severe Autism Spectrum Disorder.

Purpose The purpose of this study was to determine the effects of augmentative and alternative communication (AAC) intervention using a speech-generating device (SGD) on acquisition, maintenance, and generalization of multistep requesting and generic small talk in three children with severe autism spectrum disorder (ASD) between the ages of 7 and 13 years. Method A multiple-baseline design across participants combined with a posttreatment multiple-generalization-probe design was used to assess acquisition, generalization, and maintenance of target communicative behaviors with the experimenter and the participants' familiar communication partners (FCPs). Intervention was composed of systematic instruction in the use of an SGD using least-to-most prompting, constant time delay, error correction, and reinforcement. Results Visual analysis established a strong functional relationship between the independent variable and the two dependent variables (i.e., requesting preferred activities, engaging in generic small talk) for all three participants. Effect size indicator analyses corroborated these findings, indicating strong effects for performing multistep requesting and medium effects for engaging in generic small talk. All participants were able to generalize the acquired communicative behaviors to request new and untrained snacks and activities and engage in generic small talk with FCPs who were not part of the training. Maintenance of acquired communicative behaviors was demonstrated 3 weeks post completion of intervention. Conclusion This study provides preliminary evidence that AAC intervention using an SGD and incorporating least-to-most prompting, constant time delay, error correction, and reinforcement is effective in terms of multistep requesting and generic small talk behaviors in children with severe ASD. Supplemental Material https://doi.org/10.23641/asha.16663630.

The effect of augmented input on the auditory comprehension of narratives for people with aphasia: a pilot investigation.

Augmented input is the strategy of supplementing expressive language with visuographic images, print, gestures, or objects in the environment. The goal of augmented input is to facilitate comprehension of spoken language. The purpose of this study was to evaluate the relative effectiveness of two different augmented input conditions in facilitating auditory comprehension of narrative passages in adults with aphasia. One condition involved the communication partner (clinician) of the adult with aphasia actively pointing (AI-PP) out key content words using visuographic supports. The second condition involved no active pointing (AI-NPP) by the communication partner (i.e., attention was not drawn to the visuographic supports). All 12 participants with aphasia listened to two narratives; one in each condition. Auditory comprehension was measured by assessing participants' accuracy in responding to 15 multiple-choice cloze-type statements related to the narratives. Of the 12 participants, seven gave more accurate responses to comprehension items in the AI-PP condition, four gave more accurate responses in the AI-NPP condition, and one scored the same in both conditions. These differences were not statistically significant (p > 0.05). Communication-partner-referenced augmented input using combined high-context and PCS symbol visuographic supports improved response accuracy for some participants. Continued research is necessary to determine partner involvement with and frequency of augmented input that improve auditory comprehension.

Does Animation Facilitate Understanding of Graphic Symbols Representing Verbs in Children With Autism Spectrum Disorder?

Purpose The effects of animation on identification of graphic symbols for verbs were studied using the Autism Language Program Graphic Symbols Set in children diagnosed with mild-to-severe autism spectrum disorder between the ages of 3 and 7 years. Method The participants were randomly assigned to an animated symbol condition or a static symbol condition. Static symbols were spliced from the animated symbols to ensure that the symbols differed only in terms of the absence or presence of movement. The participants were asked to identify a target symbol among foils given the spoken label. Results There were no significant differences between the groups with respect to chronological age, autism severity, and receptive target verb knowledge. An independent t test revealed that animated symbols were more readily identified than static symbols. Conclusions Animation enhances the identification of verbs in children with autism spectrum disorder. Clinicians are encouraged to take advantage of animation when introducing graphic symbols representing verbs. Limitations and implications for future research are discussed.

The Effects of Systematic Instruction in Teaching Multistep Social-Communication Skills to Children with Autism Spectrum Disorder Using an iPad.

Objective: Tablets have successfully been used with individuals with autism spectrum disorder (ASD) and other developmental disabilities to request preferred items, label objects, share information, and engage in social interactions. However, there are limited data on the efficacy of utilizing such devices to teach multistep social-communication skills. Method: We used nonconcurrent multiple baseline design across behaviors to examine the effectiveness of systematic instruction on teaching multistep social-communication skills using an iPad® loaded with Proloquo2Go™. Three children between the ages of 7 and 10 years diagnosed with ASD and other developmental disabilities participated in the study. Results: To varying degrees, the participants were successful in using the iPad® to perform a multistep sequence in requesting, saying "thank you," and answering personal questions. Procedural modifications were made during the intervention phase for two participants so that they were able to acquire social-communication skills using AAC. Conclusions: The findings indicate that systematic instruction is effective in developing advanced social-communication skills.

Nurses' perspectives about communication with patients in an intensive care setting using a communication board: A pilot study.

BACKGROUND: Communication in the intensive care setting (ICS) is critical for both the patient and the medical staff to provide efficient care and thus alleviate possible patient adverse effects. Persons with complex communication needs are particularly vulnerable in ICSs and therefore require additional communication support. AIM: This study focused on the perspectives of nurses about communication with patients with communication needs in ICSs using paper-based communication boards, namely the translated Vidatak EZ Board, before and after a training session. SETTING: A 1650-bed public hospital with a 26-bed ICS in a semi-urban, low socio-economic area in South Africa served as the research setting. METHODS: A quasi-experimental pre-test post-test group design with withdrawal and a control group was used. Data were gathered using a custom-designed questionnaire completed by ICS nurse participants recruited from a public hospital. RESULTS: Responses of some nurses did not change in post-test 1, but their responses did change in post-test 2. Some of the nurses' perspectives changed, as expected from the pre-test to post-test 1. Nurses recommended specific adaptations to the communication board. CONCLUSIONS: Most nurses agreed that communication is crucial in ICSs and that a communication board can be implemented; however, limited success was observed implementing the board following a short training. The inter-professional collaboration between nurses and speech-language therapists to provide optimal health care to patients in ICS is emphasised.

Nurses' perspectives about communication with patients in an intensive care setting using a communication board: a pilot study

Background: Communication in the intensive care setting (ICS) is critical for both the patient and the medical staff to provide efficient care and thus alleviate possible patient adverse effects. Persons with complex communication needs are particularly vulnerable in ICSs and therefore require additional communication support. Aim: This study focused on the perspectives of nurses about communication with patients with communication needs in ICSs using paper-based communication boards, namely the translated Vidatak EZ Board, before and after a training session. Setting: A 1650-bed public hospital with a 26-bed ICS in a semi-urban, low socio-economic area in South Africa served as the research setting. Methods: A quasi-experimental pre-test post-test group design with withdrawal and a control group was used. Data were gathered using a custom-designed questionnaire completed by ICS nurse participants recruited from a public hospital. Results: Responses of some nurses did not change in post-test 1, but their responses did change in post-test 2. Some of the nurses' perspectives changed, as expected from the pre-test to post-test 1. Nurses recommended specific adaptations to the communication board. Conclusions: Most nurses agreed that communication is crucial in ICSs and that a communication board can be implemented; however, limited success was observed implementing the board following a short training. The inter-professional collaboration between nurses and speech-language therapists to provide optimal health care to patients in ICS is emphasised

Message banking: Perceptions of persons with motor neuron disease, significant others and clinicians.

PURPOSE: Message banking is an intervention strategy that has the potential to facilitate effective communication for people with motor neuron disease when their condition deteriorates to the extent that they cannot communicate using natural speech. The aim of the current study was to determine and compare the perceptions on message banking of three stakeholder groups, namely, persons with motor neuron disease, their significant others and speech-language pathologists. METHOD: A comparative group survey design was used. Participants listened to a short presentation about message banking, after which they individually completed a questionnaire. RESULT: Although most participants reported that they had never heard of message banking, all were interested in it. The survey results revealed statistically significant differences between the various groups of stakeholders regarding the relevance of message banking and types of messages to bank. CONCLUSION: The study concluded that there is limited awareness about message banking amongst all participant groups.

Teaching children with autism spectrum disorder and other developmental disabilities to perform multistep requesting using an iPad.

Many children with autism spectrum disorders (ASD) and/or developmental disabilities are unable to meet their daily communication needs with speech alone. These individuals are considered potential candidates for speech-generating devices (SGDs) and mobile technologies with AAC-specific applications. The purpose of this study was to determine the effectiveness of systematic instruction on teaching multistep requesting skills using an iPad loaded with Proloquo2Go to children with ASD and other developmental disabilities. The participants in this study were four children between the ages of 8 and 10 years diagnosed with ASD and/or other developmental disabilities. The results indicated that for these participants, the intervention was effective in increasing multistep requesting using the iPad. All participants were successful to varying degrees in navigating across pages and combining symbols to request preferred items. Additionally, the participants demonstrated generalization of newly acquired skills by requesting different preferred items and activities during the generalization probes. Results are discussed and implications for research and practice are presented.

Speech Output Technologies in Interventions for Individuals with Autism Spectrum Disorders: A Scoping Review.

The purpose of this scoping review was to (a) map the research evidence on the effectiveness of augmentative and alternative communication (AAC) interventions using speech output technologies (e.g., speech-generating devices, mobile technologies with AAC-specific applications, talking word processors) for individuals with autism spectrum disorders, (b) identify gaps in the existing literature, and (c) posit directions for future research. Outcomes related to speech, language, and communication were considered. A total of 48 studies (47 single case experimental designs and 1 randomized control trial) involving 187 individuals were included. Results were reviewed in terms of three study groupings: (a) studies that evaluated the effectiveness of treatment packages involving speech output, (b) studies comparing one treatment package with speech output to other AAC modalities, and (c) studies comparing the presence with the absence of speech output. The state of the evidence base is discussed and several directions for future research are posited.

An examination of the effectiveness of video modelling intervention using a speech-generating device in preschool children at risk for autism.

OBJECTIVE: To investigate whether preschool children at risk for autism would learn to request a preferred object using a speech-generating device (SGD) following a video modelling (VM) intervention and generalize requesting behaviours to preferred objects across stimuli and communication partners. METHOD: A single-subject multiple baseline design across participants (n = 3) was used to assess the effects of VM intervention on requesting behaviour. Intervention consisted of having each participant view a VM of two adults demonstrating the requesting of a preferred object using the SGD. Additionally, a least-to-most-prompting technique was employed to facilitate the production of a correct response. RESULTS: All three participants demonstrated the ability to request preferred objects following the intervention and were able to generalize the newly acquired requesting behaviour across stimuli and people. CONCLUSIONS: Study findings indicate that a VM treatment package is effective in facilitating communication in children with little or no functional speech.

Effects of animation on naming and identification across two graphic symbol sets representing verbs and prepositions.

PURPOSE: The effects of animation on naming and identification of graphic symbols for verbs and prepositions were studied in 2 graphic symbol sets in preschoolers. METHOD: Using a 2 × 2 × 2 × 3 completely randomized block design, preschoolers across three age groups were randomly assigned to combinations of symbol set (Autism Language Program [ALP] Animated Graphics or Picture Communication Symbols [PCS]), symbol format (animated or static), and word class (verbs or prepositions). Children were asked to name symbols and to identify a target symbol from an array given the spoken label. RESULTS: Animated symbols were more readily named than static symbols, although this was more pronounced for verbs than for prepositions. ALP symbols were named more accurately than PCS in particular with prepositions. Animation did not facilitate identification. ALP symbols for prepositions were identified better than PCS, but there was no difference for verbs. Finally, older children guessed and identified symbols more effectively than younger children. CONCLUSIONS: Animation improves the naming of graphic symbols for verbs. For prepositions, ALP symbols are named more accurately and are more readily identifiable than PCS. Naming and identifying symbols are learned skills that develop over time. Limitations and future research directions are discussed.

Effect of Number of Graphic Symbols, Levels, and Listening Conditions on Symbol Identification and Latency in Persons with Aphasia.

This study investigated the ability of persons with aphasia to complete a series of experimental tasks involving single symbol and subject-verb-object sentence identification on a speech-generating device (SGD) in the presence/absence of competing stimuli. In all, 10 persons with Broca's aphasia and 10 persons in the control group were compared on accuracy and response latency of symbol identification across three listening conditions. Persons with aphasia identified fewer symbols accurately and had longer response latencies than persons in the control group. Number of symbols on the screen and location level had a significant effect on accuracy and latency for both groups. Persons with aphasia perceived tasks to be more difficult than persons in the control group. Results indicate that effective use of SGDs by persons with aphasia may depend on several message organization factors including location and number of symbols per screen.

Satisfaction with health care among people with hearing impairment: a survey of Medicare beneficiaries.

PURPOSE: The purpose of this study was to investigate the determinants of access to and satisfaction with health care from Medicare participants with hearing impairment. METHOD: Raw data for the study was obtained from the 2004 Medicare Current Beneficiary Survey (MCBS). Satisfaction with care was assessed using 10 of the MCBS questions probing satisfaction in a number of areas related to health care. The data were analyzed using logistic regression. This analysis was conducted in three steps. The first step involved identifying potentially important predisposing and enabling variables that influenced satisfaction with care using univariate analysis. The second step involved fitting the variables retained from the first step into a multiple logistic regression equation to determine a preliminary main effects model. The final analysis included determining the odds ratio for each independent variable retained from the earlier analysis. RESULTS: Individuals with hearing impairment demonstrated some level of dissatisfaction with quality of health care. Each of the MCBS satisfaction questions were significantly (p < 0.05) associated with at least one of the communication variables. CONCLUSIONS: Understanding the effects of hearing impairment on satisfaction with health care is critical to the delivery of effective and efficient services to individuals with such disabilities. IMPLICATIONS FOR REHABILITATION: Presence of communication impairment, specifically hearing impairment, affects satisfaction with health care. Medical school training regarding methods to improve diagnosis and treatment of patients with communicative impairments could lead to improved patient-provider interactions and ultimately increased satisfaction with the provider and care given. Health care providers need to allow for extended appointments for patients with communication impairments. Time accommodations could prevent misunderstandings about diagnosis and treatment methods which otherwise might have detrimental results.

Implementing directives that involve prepositions with children with autism: a comparison of spoken cues with two types of augmented input.

Some children with autism face considerable challenges with comprehension, including difficulties following spoken directives involving prepositional relations. The use of augmented input through visual modalities might be an effective means for supplementing spoken language. The purpose of this preliminary study was to compare spoken input with two augmented input modalities (i.e., speech + visual cues) in terms of children's ability to follow directives involving prepositions. The augmented input modalities consisted of static scene cues (i.e., photographic or pictorial visual scenes that portray relevant concepts and their relationships) and dynamic scene cues (i.e., full-motion video clips that depict the actions underlying relevant concepts and their relationships). A within-subjects design involving nine children with autism or pervasive developmental disorders-not otherwise specified was used to examine the effectiveness of the three input conditions. Results indicated that both static scene cues and dynamic scene cues were more effective than spoken cues, but there were no differences between static scene cues and dynamic scene cues. Results are discussed in terms of appropriate instructional inputs for children with autism. Limitations are noted and directions for future research are posited.

Animation of graphic symbols representing verbs and prepositions: effects on transparency, name agreement, and identification.

PURPOSE: The effects of animation on transparency, name agreement, and identification of graphic symbols for verbs and prepositions were evaluated in preschoolers of 3 age groups. Methods A mixed-group design was used; in each age group, half of the children were randomly allocated to 1 of 2 orders of symbol formats. The 52 children were asked to guess the meaning of symbols and to identify a target symbol among foils given the spoken label. RESULTS: Animated symbols were more transparent than static symbols, although this was more pronounced for verbs. Animated verbs were named more accurately than static verbs, but there was no difference between animated and static prepositions. Verbs were identified more accurately compared with prepositions, but there was no difference between symbol formats. Older children guessed, named, and identified symbols more effectively than younger children. CONCLUSION: Animation enhances transparency and name agreement, especially for verbs, which reduces the instructional burden that comes with nontransparent symbols. Animation does not enhance identification accuracy. Verbs are easier to identify than prepositions. A developmental effect was observed for each measure. Limitations and implications for future research are discussed.

Identifying performing and under performing graphic symbols for verbs and prepositions in animated and static formats: a research note.

The purpose of this study was to identify graphic symbols for verbs and prepositions that were performing and underperforming in static and animated formats in a recent experiment on the effects of animation on transparency, name agreement, and identification of graphic symbols. Variable-specific criteria were developed in order to define when a symbol is considered to be performing in terms of its transparency, name agreement, and identification accuracy. Additionally, across-variable heuristic criteria were developed that allowed classification of symbols into four categories: (a) performing exceptionally, (b) performing effectively, (c) performing adequately, and (d) performing inadequately. These criteria were applied to 24 symbols for verbs and 8 symbols for prepositions in both animated and static formats. Results indicated that the vast majority of the symbols performed adequately or better while a few did not. Potential reasons as to why some of the symbols may have underperformed are discussed. Where appropriate, implications for modifying existing symbols and future research are drawn. Although the fact that the heuristic criteria were developed post-hoc is discussed as a limitation, the benefits of the proposed categories bode well for future applications.