Using occupational therapy principles and practice to support independent message generation by individuals using AAC instead of facilitated communication.

Facilitated communication (FC) has been a heavily debated and documented topic across multiple disciplines, including sociology, education, psychology, pediatrics, speech-language pathology, and disability studies. Although many professionals from various disciplines and advocates have offered opinions, suggestions, and research on the topic, there has been minimal input from the occupational therapy (OT) profession. The lack of OT input is noteworthy as OTs are experts in enabling upper extremity performance and independence through a variety of training, adaptation and modification strategies, and use of external supports. Because of their professional code of ethics and a specific knowledge base, OTs are uniquely positioned to provide a host of ethical and evidence-based strategies that enable independent access to communication technology. The consideration of multiple access options is contrary to the typical facilitated encounter where facilitators exclusively choose to manipulate an upper extremity in order for letters to be selected on a display or keyboard. The purpose of this paper is threefold: (a) To offer insight into the standard of care by OTs including their ethical standards; (b) to identify varied accommodations that enable access using a feature-matching standard of care that eliminates the need for a facilitator; and (c) to highlight how to increase independent assistive technology/augmentative and alternative communication access, thus dissuading the need or use of facilitated access to letters.

Miniature Linguistic Systems for Individuals With Autism Spectrum Disorder: A Systematic Review and Meta-Analysis.

PURPOSE: Miniature linguistic systems (also known as matrix training) is a method of organizing learning targets to achieve generative learning or recombinative generalization. This systematic review is aimed at determining whether matrix training is effective for individuals with autism spectrum disorder (ASD) in terms of improving recombinative generalization for instruction-following, expressive language, play skills, and literacy skills. METHOD: A systematic review methodology was employed to limit bias in the various review stages. A multifaceted search was conducted. Potential primary studies were imported into Covidence, a systematic review software, and inclusion criteria were applied. Data were extracted regarding (a) participant characteristics, (b) matrix designs, (c) intervention methods, and (d) dependent variable. A quality appraisal using the What Works Clearinghouse (WWC) Single-Case Design Standards (Version 1.0, Pilot) was carried out. In addition to the visual analysis of the data, an effect size estimate, non-overlap of all pairs (NAP), was generated for each participant. Independent t tests and between-subjects analyses of variance were conducted to identify moderators of effectiveness. RESULTS: Twenty-six studies including 65 participants met criteria for inclusion. All included studies were single-case experimental designs. Eighteen studies received a rating of Meets Standards Without Reservations or Meets Standards With Reservations. The aggregated combined NAP scores for acquisition, recombinative generalization, and maintenance of a range of outcomes were in the high range. CONCLUSIONS: Findings suggested that matrix training is an effective teaching method for individuals with ASD for acquisition, recombinative generalization, and maintenance of a range of outcomes. Statistical analyses to identify moderators of effectiveness were insignificant. Based on the WWC Single-Case Design Standards matrix training meets criteria to be considered an evidence-based practice for individuals with ASD.

The effect of cue type on directive-following in children with moderate to severe autism spectrum disorder.

For this study, 11 children with moderate to severe autism spectrum disorder (ASD) were given directives containing prepositions in three cue conditions: (a) spoken alone, (b) a short video clip along with spoken cues, and (c) a sequence of three graphic symbols accompanied by spoken cues. Participants followed directives significantly more accurately with the video clip than with spoken cues only, and significantly more accurately with spoken cues only relative to the sequence of graphic symbols. Results suggest that the short video clip along with spoken cues may be an optimal mode for enhancing learners' ability to follow directives containing prepositions. In addition, results reveal three statistically significant correlations between participants' preexisting skills and directive-following accuracy: a positive correlation between spoken preposition preassessment total score and accuracy in the spoken-alone condition; a positive correlation between spoken noun preassessment total score and accuracy in the video-clip condition; and a positive correlation between ASD severity and the need for repetition in the video-clip condition. Results also suggested that, for children with more severe ASD symptoms, the video clips require repetitions so that the relationships illustrated within it can gain more semantic salience. Implications for clinical practice and future research are discussed.

Providing visual directives via a smart watch to a student with Autism Spectrum Disorder: an intervention note.

Smart watches are discreet and wearable tools that may be repurposed to improve directive-following for individuals with autism spectrum disorder (ASD). Specifically, a mentor can transmit just-in-time (JIT) visual supports (e.g., video clips, photographs, text) that depict an upcoming directive to a learner's smart watch to prompt the learner as needed from a distance. Using a single-case multiple probe design across settings, this investigation evaluated the effectiveness of providing text-based prompts on an Apple Watch 1 to a child with ASD within a school setting. A mentor transmitted 2-step written directives via text message to the participant's Apple Watch. The participant was instructed to attend to, read, and follow directives received on the watch. Results demonstrated that the intervention improved directive-following as well as increased the instructor's distance from the learner. It is proposed that JIT supports sent to a learner's smart watch may reduce the obtrusiveness of traditional prompting while also maintaining the naturalness of ongoing social or academic interactions. Clinical limitations and implications are discussed.

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 effectiveness of aided augmented input techniques for persons with developmental disabilities: a systematic review.

When working with individuals with little or no functional speech, clinicians often recommend that communication partners use the client's augmentative and alternative communication (AAC) device when speaking to the client. This is broadly known as "augmented input" and is thought to enhance the client's learning of language form and content. The purpose of this systematic review was to determine the effects of augmented input on communication outcomes in persons with developmental disabilities and persons with childhood apraxia of speech who use aided AAC. Nineteen studies met the inclusion criteria. Each included study was reviewed in terms of participant characteristics, terminology used, symbol format, augmented input characteristics, outcomes measured, effectiveness, and study quality. Results indicate that augmented input can improve single-word vocabulary skills and expression of multi-symbol utterances; however, comprehension beyond the single word level has not been explored. Additionally, it is difficult to form conclusions about the effect of augmented input on specific diagnostic populations. Directions for future research are posited.

Brief Report: Just-in-Time Visual Supports to Children with Autism via the Apple Watch:® A Pilot Feasibility Study.

Using augmented input might be an effective means for supplementing spoken language for children with autism who have difficulties following spoken directives. This study aimed to (a) explore whether JIT-delivered scene cues (photos, video clips) via the Apple Watch® enable children with autism to carry out directives they were unable to implement with speech alone, and (b) test the feasibility of the Apple Watch® (with a focus on display size). Results indicated that the hierarchical JIT supports enabled five children with autism to carry out the majority of directives. Hence, the relatively small display size of the Apple Watch does not seem to hinder children with autism to glean critical information from visual supports.

Effects of environmental sounds on the guessability of animated graphic symbols.

Graphic symbols are a necessity for pre-literate children who use aided augmentative and alternative communication (AAC) systems (including non-electronic communication boards and speech generating devices), as well as for mobile technologies using AAC applications. Recently, developers of the Autism Language Program (ALP) Animated Graphics Set have added environmental sounds to animated symbols representing verbs in an attempt to enhance their iconicity. The purpose of this study was to examine the effects of environmental sounds (added to animated graphic symbols representing verbs) in terms of naming. Participants included 46 children with typical development between the ages of 3;0 to 3;11 (years;months). The participants were randomly allocated to a condition of symbols with environmental sounds or a condition without environmental sounds. Results indicated that environmental sounds significantly enhanced the naming accuracy of animated symbols for verbs. Implications in terms of symbol selection, symbol refinement, and future symbol development will be discussed.

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.

Autism spectrum disorders in the era of mobile technologies: impact on caregivers.

OBJECTIVE: This paper explores possible connections among existing literature on parental stress, augmentative and alternative communication (AAC), and use of mobile technology for persons with autism spectrum disorder (ASD). METHODS: A narrative review of the literature. RESULTS: Parental support contributes to positive outcomes for children who use AAC. Parents identify communication as a high priority, but describe the process as challenging. AAC is often used with children with ASD, a population in which parental stress is especially high. Though there is research evidence that mobile technology is a promising tool for individuals with ASD, potentially misleading media anecdotes exist, and the effects on parental expectations and stress remain unstudied questions. CONCLUSION: Increased understanding of the connections in these research areas should help clarify the potential impact of mobile technologies on parental stress level, help to define appropriate future research directions, and contribute to development of appropriate caregiver training.

Exploring the feasibility of the visual language in autism program for children in an early intervention group setting: views of parents, educators, and health professionals.

OBJECTIVE: To explore the views of key stakeholders on using visual supports for children with developmental disabilities in early intervention group settings. Specifically, this study aimed to determine stakeholders' views on the barriers to and facilitators for the use of visual supports in these settings to inform the feasibility of implementing an immersive Visual Language in Autism program. METHODS: This study involved three focus groups of parents, educators, and health professionals at one Australian early intervention group setting. RESULTS: Lack of time, limited services, negative attitudes in society, and inconsistent use were cited as common barriers to using visual supports. Facilitators included having access to information and evidence on visual supports, increased awareness of visual supports, and the use of mobile technologies. CONCLUSION: The Visual Language in Autism program is feasible in early intervention group settings, if barriers to and facilitators for its use are addressed to enable an immersive visual language experience.

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.

Applying technology to visually support language and communication in individuals with autism spectrum disorders.

The burgeoning role of technology in society has provided opportunities for the development of new means of communication for individuals with Autism Spectrum Disorders (ASD). This paper offers an organizational framework for describing traditional and emerging augmentative and alternative communication (AAC) technology, and highlights how tools within this framework can support a visual approach to everyday communication and improve language instruction. The growing adoption of handheld media devices along with applications acquired via a consumer-oriented delivery model suggests a potential paradigm shift in AAC for people with ASD.

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.

Using AAC technology to access the world.

This paper describes the monumental shift in the nature of augmentative and alternative communication (AAC) access that has occurred over the past three decades. In its earliest days AAC technology was directed at enabling interpersonal face-to-face interactions mainly for persons with physical impairment. Contemporary AAC access attempts to mirror the access needs of a broader population. Accordingly AAC access to today's mainstream technologies expands the focus from interpersonal communication to access of information and services over the expanding World Wide Web. With this expanded view comes a new range of challenges and opportunities. At the same time AAC has expanded its reach to include more people with a wider range of complex communication needs.

AAC technology transfer: an AAC-RERC report.

Transferring innovative technologies from the university to the manufacturing sector can often be an elusive and problematic process. The Rehabilitation and Engineering Research Center on Communication Enhancement (AAC-RERC) has worked with the manufacturing community for the last 10 years. The purpose of this article is to discuss barriers to technology transfer, to outline some technology transfer strategies, and to illustrate these strategies with AAC-RERC related activities.

Electronic screen media for persons with autism spectrum disorders: results of a survey.

Social and anecdotal reports suggest a predilection for visual media among individuals on the autism spectrum, yet no formal investigation has explored the extent of that use. Using a distributed questionnaire design, parents and caregivers report on time allotted toward media, including observable behaviors and communicative responses. More time was spent engaged with electronic screen media (ESM) than any other leisure activity. Television and movie viewing was more popular than computer usage. Across media platforms, animated programs were more highly preferred. Prevalent verbal and physical imitation was reported to occur during and following exposure to ESM. Clinical implications to strategically incorporate ESM into learning approaches for children with autism spectrum disorders (ASD) are provided.