Microswitch Technology for Enabling Self-Determined Responding in Children with Profound and Multiple Disabilities: A Systematic Review.

We reviewed 18 studies reporting on the use of microswitch technology to enable self-determined responding in children with profound and multiple disabilities. Identified studies that met pre-determined inclusion criteria were summarized in terms of (a) participants, (b) experimental design, (c) microswitches and procedures used, and (d) main results. The 18 studies formed three groups based on whether the microswitch technology was primarily intended to enable the child to (a) access preferred stimuli (7 studies), (b) choose between stimuli (6 studies), or (c) recruit attention/initiate social interaction (5 studies). The results of these studies were consistently positive and support the use of microswitch technology in educational programs for children with profound and multiple disabilities as a means to impact their environment and interact with others. Implications for delivery of augmentative and alternative communication intervention to children with profound and multiple disabilities are discussed.

Tangible Symbols as an AAC Option for Individuals with Developmental Disabilities: A Systematic Review of Intervention Studies.

We reviewed nine studies evaluating the use of tangible symbols in AAC interventions for 129 individuals with developmental disabilities. Studies were summarized in terms of participants, tangible symbols used, communication functions/skills targeted for intervention, intervention procedures, evaluation designs, and main findings. Tangible symbols mainly consisted of three-dimensional whole objects or partial objects. Symbols were taught as requests for preferred objects/activities in five studies with additional communication functions (e.g., naming, choice making, protesting) also taught in three studies. One study focused on naming activities. With intervention, 54% (n = 70) of the participants, who ranged from 3 to 20 years of age, learned to use tangible symbols to communicate. However, these findings must be interpreted with caution due to pre-experimental or quasi-experimental designs in five of the nine studies. Overall, tangible symbols appear promising, but additional studies are needed to establish their relative merits as a communication mode for people with developmental disabilities.

Teaching multi-step requesting and social communication to two children with autism spectrum disorders with three AAC options.

The present study involved comparing the acquisition of multi-step requesting and social communication across three AAC options: manual signing (MS), picture exchange (PE), and speech-generating devices (SGDs). Preference for each option was also assessed. The participants were two children with autism spectrum disorders (ASD) who had previously been taught to use each option to request preferred items. Intervention was implemented in an alternating-treatments design. During baseline, participants demonstrated low levels of correct communicative responding. With intervention, both participants learned the target responses (two- and three-step requesting responses, greetings, answering questions, and social etiquette responses) to varying levels of proficiency with each communication option. One participant demonstrated a preference for using the SGD and the other preferred PE. The importance of examining preferences for using one AAC option over others is discussed.

Effects of varying lengths of synthetic speech output on augmented requesting and natural speech production in an adolescent with Klinefelter syndrome.

Students with developmental disabilities and limited or no functional speech often use speech-generating devices. While the speech-output function of such devices is considered to have potential advantages, it is unclear whether the length of synthetic speech output influences augmented communication and natural speech production. To this end, we describe a two-phase study involving an adolescent with Klinefelter syndrome. In Phase 1, the frequency of augmented requests and natural speech were compared under three speech-output conditions (no-output, short-output, and long-output). In Phase 2, augmented requests in the long-output condition were no longer reinforced to determine if this would increase natural speech production. The presence and length of speech output did not influence the frequency of augmented requesting or natural speech production in Phase 1, but extinction of augmented requesting under the long-output condition in Phase 2 was associated with a significant increase in natural speech production under that condition, relative to the two other conditions. The implications of these findings for using speech-generating devices are discussed.

A comparison of picture exchange and speech-generating devices: acquisition, preference, and effects on social interaction.

Augmentative and alternative communication (AAC) includes picture exchange (PE) and speech-generating devices (SGD), but these two systems have rarely been compared. We therefore conducted three studies comparing PE and SGD for an adolescent boy with a developmental disability. Study 1 compared acquisition of a PE- and SGD-based requesting response and monitored the effects on social interaction. For Study 2, both communication modes were made simultaneously available and the child could choose to use either PE or the SGD. For Study 3, only PE intervention continued, with the distance between the child and trainer systematically increased to prompt social interaction. The results showed equally rapid acquisition of the PE- and SGD-based requesting response, but only the distancing manipulation had any positive effect on social interaction. We conclude that PE and SGD are equally viable modes of communication, but acquisition of an initial PE- or SGD-based requesting response may not be sufficient to promote social interaction.

Social problem solving and strategy use in young children.

In the present study, the authors investigated what prosocial-assertive, passive, and coercive strategies 6-year-olds (N=257) would propose in response to stories about 2 socially challenging situations: displacing another child in a game and obtaining a toy from another child. The scenarios also varied the gender composition of the characters. Participants' verbalizations while acting out their responses using toy props fell into 13 categories of strategies. Teachers reported antisocial behavior and social competence of the participants. Girls and boys responded similarly in their general suggestions of prosocial or assertive strategies, but girls were more likely to offer prosocial strategies with other girls than with boys. Teacher-rated competence and antisocial behavior interacted in predicting coercive responses by girls but not by boys. The results demonstrate that prosocial and antisocial behaviors need to be considered in interaction to fully understand the nature of social competence.

Internet survey of treatments used by parents of children with autism.

We developed an Internet survey to identify treatments used by parents of children with autism. The survey listed 111 treatments and was distributed via colleagues and through chapters of the Autism Society of America and Autism Organizations Worldwide. A total of 552 parents submitted usable returns during the 3-month survey period. On average the parents reported using seven different treatments. The number of treatments used varied as a function of the child's age and type/severity of disability within the autism spectrum. Speech therapy was the most commonly reported intervention, followed by visual schedules, sensory integration, and applied behavior analysis. In addition, 52% of parents were currently using at least one medication to treat their child, 27% were implementing special diets, and 43% were using vitamin supplements. Because parents were using a large number of treatments, many of which lack empirical support, future research should focus on understanding the decision-making processes that underlie treatment selection by parents of children with autism.

Persistence of early emerging aberrant behavior in children with developmental disabilities.

This study examined the persistence of early emerging aberrant behavior in 13 preschool children with developmental disabilities. The severity of aberrant behavior was assessed every 6 months over a 3-year period. Teachers completed the assessments using the Aberrant Behavior Checklist [Aman, M. G., & Singh, N. N. (1986). Aberrant Behavior Checklist: Manual. East Aurora, NY: Slosson Educational Publications; (1994). Aberrant Behavior Checklist--Community. East Aurora, NY: Slosson Educational Publications]. Problem behaviors were present in all children at the beginning of the study. Nine of the 13 children entered the study with relatively high levels of aberrant behaviors that showed little change over the 3 years. These data suggest that aberrant behaviors often emerge early and can be highly persistent during the preschool years. Prevention would, therefore, seem to require home-based interventions that begin before 4 years of age.

Undergraduates' perceptions of three augmentative and alternative communication modes.

OBJECTIVE: To assess undergraduates' perceptions of three augmentative and alternative communication (AAC) modes. METHOD: We showed 104 undergraduates a video clip of a person using each of the three AAC modes and asked them to rate each option in terms of perceived (a) intelligibility, (b) ease of acquisition, (c) effectiveness/acceptability, and (d) preference. The three AAC modes shown were (a) manual signing, (b) picture exchange, and (c) speech-generating device. RESULTS: Mean ratings for perceived intelligibility and effectiveness/acceptability were significantly higher for the speech-generating device. The speech-generating device and manual signing options were rated as being more preferred over picture exchange. Picture exchange was rated significantly higher on perceived ease of acquisition. CONCLUSION: Speech-generating devices were perceived to have greater social validity than manual signing and picture exchange.

Effects of response-related music stimulation versus general music stimulation on positive participation of patients with Alzheimer's disease.

OBJECTIVE: Assessing the effects of response-related music stimulation versus general (response-unrelated) music stimulation on positive participation of 11 new patients with Alzheimer's disease. METHOD: The patients were functioning in the severe and low-moderate ranges of the disease. Positive participation included behaviors such as, singing or rhythmic movements and smiles. Both music conditions relied on the display of music/song videos on a computer screen. In the response-related (active) condition, the patients used a simple hand response and a microswitch to determine music stimulation inputs. In the general (unrelated/passive) condition, music stimulation was automatically presented throughout the sessions. RESULTS: Data showed that six of the 11 patients had higher levels of positive participation in the response-related stimulation condition. The remaining five patients did not have differences between the two conditions. CONCLUSION: Based on this evidence and previous findings, one might consider the use of the active condition beneficial for daily programs.

Tutorial: teaching communicative rejecting to children with severe disabilities.

Children with severe disabilities typically require systematic instruction to develop their communication abilities. Intervention can begin by teaching functional communication skills related to requesting and rejecting. Although a considerable amount of research has focused on teaching requesting, there is an emerging literature on teaching rejecting. The aim of this tutorial is to review the emerging literature on teaching communicative rejecting to children with severe disabilities. This review considers (a) the definition of communicative rejecting, (b) reasons for teaching communicative rejecting, (c) types of communicative rejecting, and (d) empirically validated strategies for teaching communicative rejecting to children with severe disabilities. The authors include a case study to illustrate the major steps in teaching communicative rejecting to children with severe disabilities.

New camera-based microswitch technology to monitor small head and mouth responses of children with multiple disabilities.

OBJECTIVE: Assessing a new camera-based microswitch technology, which did not require the use of color marks on the participants' face. METHOD: Two children with extensive multiple disabilities participated. The responses selected for them consisted of small, lateral head movements and mouth closing or opening. The intervention was carried out according to a multiple probe design across responses. The technology involved a computer with a CPU using a 2-GHz clock, a USB video camera with a 16-mm lens, a USB cable connecting the camera and the computer, and a special software program written in ISO C++ language. RESULTS: The new technology was satisfactorily used with both children. Large increases in their responding were observed during the intervention periods (i.e. when the responses were followed by preferred stimulation). CONCLUSION: The new technology may be an important resource for persons with multiple disabilities and minimal motor behavior.

Automatic feedback to promote safe walking and speech loudness control in persons with multiple disabilities: two single-case studies.

OBJECTIVE: Assessing automatic feedback technologies to promote safe travel and speech loudness control in two men with multiple disabilities, respectively. METHOD: The men were involved in two single-case studies. In Study I, the technology involved a microprocessor, two photocells, and a verbal feedback device. The man received verbal alerting/feedback when the photocells spotted an obstacle in front of him. In Study II, the technology involved a sound-detecting unit connected to a throat and an airborne microphone, and to a vibration device. Vibration occurred when the man's speech loudness exceeded a preset level. RESULTS: The man included in Study I succeeded in using the automatic feedback in substitution of caregivers' alerting/feedback for safe travel. The man of Study II used the automatic feedback to successfully reduce his speech loudness. CONCLUSION: Automatic feedback can be highly effective in helping persons with multiple disabilities improve their travel and speech performance.

Microswitch-aided programs with contingent stimulation versus general stimulation programs for post-coma persons with multiple disabilities.

OBJECTIVE: Assessing the impact of microswitch-aided programs with contingent stimulation on response engagement (Study I) and post-session alertness (Study II) of post-coma participants with multiple disabilities. METHOD: Study I included three participants whose scores on the Coma Recovery Scale-Revised (CRS-R) were 11 or 13. Study II included three participants whose CRS-R scores were 19, 13, and 14. In both studies, the participants received sessions with contingent stimulation (i.e., sessions in which activation of a microswitch with an eyelid or hand response produced 15 s of preferred stimulation) and sessions with general, non-contingent stimulation (i.e., stimulation lasted throughout the sessions). RESULTS: Study I showed an increase in response engagement/frequencies only during the contingent stimulation sessions. Study II showed that the participants' level of vigilance after those sessions was higher than after non-contingent stimulation sessions. CONCLUSION: Microswitch-aided programs with contingent stimulation would be more beneficial than programs with general/non-contingent stimulation.

Developmental profile of speech-language and communicative functions in an individual with the preserved speech variant of Rett syndrome.

OBJECTIVE: We assessed various aspects of speech-language and communicative functions of an individual with the preserved speech variant of Rett syndrome (RTT) to describe her developmental profile over a period of 11 years. METHODS: For this study, we incorporated the following data resources and methods to assess speech-language and communicative functions during pre-, peri- and post-regressional development: retrospective video analyses, medical history data, parental checklists and diaries, standardized tests on vocabulary and grammar, spontaneous speech samples and picture stories to elicit narrative competences. RESULTS: Despite achieving speech-language milestones, atypical behaviours were present at all times. We observed a unique developmental speech-language trajectory (including the RTT typical regression) affecting all linguistic and socio-communicative sub-domains in the receptive as well as the expressive modality. CONCLUSION: Future research should take into consideration a potentially considerable discordance between formal and functional language use by interpreting communicative acts on a more cautionary note.

Three children with autism spectrum disorder learn to perform a three-step communication sequence using an iPad®-based speech-generating device.

BACKGROUND: Many children with autism spectrum disorder (ASD) have limited or absent speech and might therefore benefit from learning to use a speech-generating device (SGD). The purpose of this study was to evaluate a procedure aimed at teaching three children with ASD to use an iPad(®)-based SGD to make a general request for access to toys, then make a specific request for one of two toys, and then communicate a thank-you response after receiving the requested toy. METHOD: A multiple-baseline across participants design was used to determine whether systematic instruction involving least-to-most-prompting, time delay, error correction, and reinforcement was effective in teaching the three children to engage in this requesting and social communication sequence. Generalization and follow-up probes were conducted for two of the three participants. RESULTS: With intervention, all three children showed improvement in performing the communication sequence. This improvement was maintained with an unfamiliar communication partner and during the follow-up sessions. CONCLUSION: With systematic instruction, children with ASD and severe communication impairment can learn to use an iPad-based SGD to complete multi-step communication sequences that involve requesting and social communication functions.

An evaluation of speech production in two boys with neurodevelopmental disorders who received communication intervention with a speech-generating device.

BACKGROUND: Children with neurodevelopmental disorders often present with little or no speech. Augmentative and alternative communication (AAC) aims to promote functional communication using non-speech modes, but it might also influence natural speech production. METHOD: To investigate this possibility, we provided AAC intervention to two boys with neurodevelopmental disorders and severe communication impairment. Intervention focused on teaching the boys to use a tablet computer-based speech-generating device (SGD) to request preferred stimuli. During SGD intervention, both boys began to utter relevant single words. In an effort to induce more speech, and investigate the relation between SGD availability and natural speech production, the SGD was removed during some requesting opportunities. RESULTS: With intervention, both participants learned to use the SGD to request preferred stimuli. After learning to use the SGD, both participants began to respond more frequently with natural speech when the SGD was removed. CONCLUSION: The results suggest that a rehabilitation program involving initial SGD intervention, followed by subsequent withdrawal of the SGD, might increase the frequency of natural speech production in some children with neurodevelopmental disorders. This effect could be an example of response generalization.

A man with amyotrophic lateral sclerosis uses a mouth pressure microswitch to operate a text messaging system with a word prediction function.

OBJECTIVE: To assess whether a man with amyotrophic lateral sclerosis could benefit from using (a) a mouth pressure microswitch instead of an optic microswitch activated via head movement and (b) a special word prediction function within a text messaging system. METHOD: Initially, both microswitches were used for operating the text messaging system, and their effectiveness and the man's preference were assessed. Subsequently, only the mouth microswitch was used and the messaging system was provided with a word prediction function. RESULTS: The man was more efficient/rapid in using the text messaging (i.e., in writing) with the mouth microswitch and preferred such a microswitch. Similarly, he was more rapid in writing when the word prediction function was added (as opposed to the initial phase of the study when such function was not available) and preferred to use it. CONCLUSION: Technology updates are critical in helping persons with motor degeneration.

Two men with multiple disabilities carry out an assembly work activity with the support of a technology system.

OBJECTIVE: To assess whether two persons with multiple disabilities could learn a work activity (i.e., assembling trolley wheels) with the support of a technology system. METHOD: After an initial baseline, the study compared the effects of intervention sessions relying on the technology system (which called the participants to the different workstations and provided feedback and final stimulation) with the effects of intervention sessions carried out without technology. The two types of intervention sessions were conducted according to an alternating treatments design. Eventually, only intervention sessions relying on the technology system were used. RESULTS: Both participants managed to assemble wheels independently during intervention sessions relying on the technology system while they failed during sessions without the system. Their performance was strengthened during the final part of the study, in which only sessions with the system occurred. CONCLUSION: Technology may be critical in helping persons with multiple disabilities manage multi-step work activities.

Two women with multiple disabilities communicate with distant partners via a special text messaging system.

This study extended the research on a special text messaging system, which allows persons with multiple disabilities to (a) write and send messages to distant partners and (b) have messages from those partners read out to them. The study involved two women with multiple disabilities (including blindness or minimal residual vision). The system comprised a net-book computer, a mobile communication modem, and an input microswitch, and relied on special keyboards (not used before) to allow the women to write their messages. One of the keyboards included (a) two rows of 10 and 11 keys, respectively, reporting the 21 basic letters of the Italian alphabet arranged in alphabetical order and marked with Braille labels and (b) a space bar and an enlarged back/erase key. The other keyboard had Braille cues on the initial, central, and final keys of the letter rows. Moreover, most function keys were covered (cut out from the usable space). Both women learned to use the messaging system with the special keyboards successfully (i.e., to write their messages, to send them out, and to listen to incoming messages). These findings are analyzed in relation to preliminary data with the system and the need to adapt the writing technology to the participants' characteristics.