Summaries

Here you will find plain language summaries that we have written to help you understand various reports and articles, but they contain a link to the full bibliography if you want further detail.

A comparison of two approaches for representing AAC vocabulary for young children (short summary)

The authors developed developmentally appropriate symbols (DAS) based on children’s interpretations of 10 abstract early language concepts; all gone, big, come, eat, more, open, up, want, what and who.

They compared the abilities of typically developing, preschool children to identify the DAS symbols to the same concepts represented by Picture Communication Symbols (PCS) which are based on adult understanding of the concepts. They also investigated whether the children preferred one type of symbol over the other and why.

In the symbols identification task the children were 82% accurate with the DAS set and 58% with PCS. All items in the DAS group scored more highly except ‘who’ which was identified correctly by equal numbers of children in both groups.

The DAS symbols had consistently higher correct selections across all three word categories used; action words, descriptors and questions.

In choosing preferences for symbols sets there was no significant difference between the two, though higher numbers selected DAS.


Things you may want to look into:

Interpretation and Construction of Meaning of Bliss-words in Children

Teaching Conceptually Referenced Core Vocabulary for Initial Augmentative and Alternative Communication

The Iconicity of Picture Communication Symbols for Children with English Additional Language and Mild Intellectual Disability

Iconicity in the Development of Picture skills: Typical Development and Implications for Individuals with Severe Intellectual Disabilities

Added to site September 2016


 

A comparison of two approaches for representing AAC vocabulary for young children (summary)

Background

A significant percentage of children with special educational needs have complex communication needs and might benefit from the use of some form of augmentative and alternative communication (AAC) system.

It is important that these children are given early access to language and communication to enable them to express early communicative functions. Develop language concepts and build social relationships. This requires access to a wide range of vocabulary.

Vocabulary items range from very concrete to highly abstract, the latter being much more difficult to ‘experience’, for example concepts such as ‘more’ or ‘big’.

Young AAC users need access to a range of concrete and abstract linguistic concepts.

When using symbols for communication the user has to recognise the link between the picture or symbols and the concept it represents, and be able to use it in different situations to communicate different intentions. Concrete vocabulary is generally easy to represent in pictoral or symbol form, abstract concepts are more difficult and less ‘transparent’ with little obvious connection to the thing they represent.

Research has found that the transparency of graphic symbols effects the ability of typically developing young children to identify and learn symbols. Representations of concrete concepts e.g. object labels (nouns) are easier to learn than more abstract words such as verbs and adjectives.

Many AAC systems represent abstract concepts with symbols based on adult understanding of the word they represent, this understanding is not necessarily the same for children. This has been investigated by Janice Light and colleagues who asked typically developing children to draw 10 abstract early concepts and explain their drawings. There were great differences between these and other, commercially available symbol systems such as Picture Communication Symbols (PCS).

This study aimed to look into the ability of young children to identify symbols developed and designed using children’s understanding of the concepts represented, known as Developmentally Appropriate Symbols (DAS), compared with the commercially available PCS which are based on adult understanding of the concepts. Children’s preferences of the different symbol types were also investigated.

 

What did they do?

Forty typically developing pre-school children were randomly divided into two groups and the authors looked into the accuracy with which they identified symbols following a short period of training and which symbol set the children reported to prefer.

10 early concepts were used; all gone, big, come, eat, more, open, up, want, what and who. All were represented in PCS and DAS symbol sets.

Each child took part in one sessions during which they were shown one set of 10 symbols, either all DAS or all PCS, given the label for the symbols and an explanation of the relation between the idea/concept and the symbol.

The children were asked to look at all 10 symbols on a single sheet and identify each one when the name was given by the researcher.

Immediately after completion of the 10 identification trials the children were shown both sheets of 10 symbols together and asked which pictures they liked best and what they liked about the preferred set.

 

What did they find?

In the symbols identification task the children were 82% accurate with the DAS set and 58% with PCS. All items in the DAS group scored more highly except ‘who’ which was identified correctly by equal numbers of children in both groups.

The DAS symbols had consistently higher correct selections across all three word categories used; action words, descriptors and questions.

In choosing preferences for symbols sets there was no significant difference between the two, though higher numbers selected DAS.

 

Conclusions:

It is suggested that it might be beneficial to use symbols developed taking children’s conceptual knowledge into account when introducing symbols based AAC to very young children, but these are acknowledged to be complex and difficult to create.

The concepts that were most difficult to represent in DAS were those that are used in a wide variety of contexts and so are challenging to represent in a single relevant picture.

The authors suggest that it is not easy to collect information on symbols preferences from very young children, possibly due to their understanding of the questions being asked; ’ Which pictures do you like better?’ and ‘Why?’. Understanding of these question forms tends to develop later than understanding of ‘What?’ and ‘Who?’ questions. Some children did not express a preference and more were unable to give a reason for their choice.

 

Cautions:

This study investigated typically developing children only, further research should include children with developmental disabilities.

The study also considered only a small number of concepts, possibly increasing the rate of learning and reducing errors. This did not realistically represent the amount of early vocabulary young children need and generally acquire.

The training given in the study was not typical of that used in introducing AAC. The way in which children need to use symbols to represent language in an AAC system is much more complex than simply identifying symbols in response to spoken labels.


Things you may want to look into:

Interpretation and Construction of Meaning of Bliss-words in Children

Teaching Conceptually Referenced Core Vocabulary for Initial Augmentative and Alternative Communication

The Iconicity of Picture Communication Symbols for Children with English Additional Language and Mild Intellectual Disability

Iconicity in the Development of Picture skills: Typical Development and Implications for Individuals with Severe Intellectual Disabilities

Added to site September 2016


 

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication (short summary)

A systematic review of literature related to research regarding communication between nurses and patients with complex communication needs (CCN) was carried out. Papers were published in English in peer-reviewed journals between 1990 and 2007 and addressed one or more of 4 identified areas: importance of communication, barriers to effective communication, supports needed for effective communication and recommendations for improving the effectiveness of communication between nurses and patients with CCN.

The papers were based on the perspectives of the nurse, patient or patients' families and carers.

Recommendations for improving nurse-patient communication for people with CCN relate largely to increased training for nurses and improved availability of communication support tools for use with these patients.


Things you may want to look into:

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology 

Nurses' perceptions of communication training in the ICU

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Communication boards in critical care: patients' views

Added to site October 2014


A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication (summary)

Background

Nurses work in a wide variety of healthcare settings and with a wide range of patients, many of whom might have severely impaired communication skills, either temporarily or permanently, and who might benefit from communication support.

Effective nurse-patient communication is very important in efficient care provision but nurses typically receive very little education or training in the use of supportive communication strategies.

What did the authors do?

A systematic review of literature related to research regarding communication between nurses and patients with complex communication needs (CCN) was carried out. Papers were published in English in peer-reviewed journals between 1990 and 2007 and addressed one or more of 4 identified areas: importance of communication, barriers to effective communication, supports needed for effective communication and recommendations for improving the effectiveness of communication between nurses and patients with CCN.

The papers were based on the perspectives of the nurse, patient or patients' families and carers.

What did they find?

Importance of nurse-patient communication

The possible impact of poor nurse-patient communication on quality of care was frequently highlighted. Some patients believed that communication with nurses was rarely successful, even when written information was given prior to hospital admission and many felt that even basic needs were unmet. Caregivers were afraid that the patient was at risk due to poor communication with nurses.

Barriers to effective nurse-patient communication

The majority of the papers indicated that interactions were limited to physical and medical needs, were minimal and often ineffective.The perception was that the difficulty was due to the nurses' lack of AAC knowledge and training or an unwillingness to provide assistive communication tools.

The increased time taken to communicate with people with CCN was another barrier. Other issues included; lack of access to AAC equipment, patients' inability to gain the nurses attention, patients' level of cognitive and/or language impairment, changes in nursing staff and pressure of family members in the care setting.

Supports for effective nurse-patient communication

Several supports identified as increasing communication effectiveness were related to the nurses; training received and experience of working with people with disabilities, willingness to take time and persist with interactions until the message was understood, willingness to ask family members or other professionals for assistance and willingness to share information during shift changes.

Factors related to the patient and environment were also identified and discussed.

Recommendations for improving communication

The main recommendations related to the need for training in CCN and AAC for nurses, including giving them information about augmented communication input for patients have difficulty in understanding spoken language and identifying the need for patients to be referred for further AAC assessment.


Things you may want to look into:

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology 

Nurses' perceptions of communication training in the ICU

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Communication boards in critical care: patients' views

Added to site October 2014


AAC adults acquired neurological conditions (summary)


This article is about people who have grown up with typical speech and language skills. They have lost those skills for a number of reasons, as detailed below. 


Why was the review carried out?

It aimed to provide an update on the use of AAC technologies associated with a range of acquired medical conditions that impact on speech and communication. This review was based on USA statistics, research studies and service provisions, although it refers to studies completed in other parts of the world.

What did they look at?

They looked at the typical use of AAC systems in people with medical diagnoses of: ALS (a form of motor neuron disease, a condition that gets worse over time); TBI (a range of brain traumas); Brain Stem Trauma (an aspect of the brain that is involved in control of reflexive (e.g. breathing) and voluntary movement). This may be called ‘Locked-in-Syndrome’ in many individuals. This often means that people are anarthric – cannot say anything, rather than dysarthric – produce slurred and distorted speech; and Dementia (a progressive loss of thinking and language skills). They also looked at speech and language diagnoses: Aphasia (a speech and language difficulty usually following a stroke); and PPA (a form of aphasia that gets worse and may eventually be related to dementia).

What did they find out?

ALS: This has several characteristics that can make communication more challenging. These include: slurring of speech with eventual loss of the movement control to produce speech, breathing co-ordination difficulties and low volume of speech. They found that as things progress there is evidence that ventilation support and nutrition support can have a positive impact on quality of life experiences including both life expectancy and the length of time that AAC might be used. Research suggests a good uptake of AAC (95%) when recommended; and in those who rejected it there were often additional difficulties, e.g. dementia. One study suggests that 100% of those with ALS used AAC to within weeks or days of their death. It is reported that AAC supports offered to the individual with ALS and their family members gave a greater sense of social closeness and understanding.

TBI: The communication impact of TBI is many and varied. Those introduced to AAC early found it helpful but equally as many held out for the return of natural and effective speech. Changes in medical interventions are resulting in changes to the residual difficulties encountered, e.g. cognitive changes, memory changes, speech and communication changes. Currently there is limited information available on the usefulness of AAC in survivors of TBI.

Brain stem trauma:  Many individuals rely on AAC from an early stage due to chronic and on-going speech production limitations. Reports on AAC needs go back over two decades and suggests that there is a reliance on access to AAC systems that require minimal motor movement control.

Dementia: this is anticipated to be a growing population in the UK (as well as the USA, i.e. the focus of this article). It will impact on communication, socialisation and independent living capacity. 

Aphasia: This is evident in an approximate 1:3 part of the population from 65 years onward; irrespective of male or female ratios. This results in changes in the ability to understand and express communication. It affects thinking, language accessing skills and the ability to put words and sentences together. Individuals with severe aphasia do not tend to regain communication function that allows them to get by without AAC compensatory strategies that effectively support them to get their message across.

PPA: Once diagnosed (usually after 60 years), planning ahead is critical as the reduction in communication capacity must be expected. Individuals show signs of communication disturbance in the absence of wider cognitive disturbance over a two year period. Eventually cognitive issues are recognised, e.g. memory loss, social and emotional contentment.

What are the implications for assessment?

ALS: the timing of referral for AAC assessment is critical in terms of predicting the point at which speech is becoming too difficult and individuals are in a position to understand the usefulness of an AAC system. One recommendation is to look for changes in speech (production and clarity) rate. When someone’s speech rate drops to between 100-125 words per minute, this is an optimal time for referral.

TBI: In a recent review, 68% of people assessed were recommended AAC techniques and technology; of these 94% accepted the recommendations with 81% still making good use of AAC techniques three years later. Of those who relied on high tech options 87% used letter by letter systems, whilst 13% used symbolised communication systems (usually because they had their brain injury prior to learning literacy). Low technology options were offered to 32% of this sub group, of that there was 100% acceptance of the system to support communication and conversation.

Brain stem trauma: It is important to maintain openness to considering a range of accessing options and a more limited output (communication system) options to meet the range of needs observed in people with this particular challenge. It seems a range of communication options work for a range of people with the same medical diagnosis.

Dementia: nothing provided within this review that informs assessment processes.

Aphasia: a traditional explanation of aphasia assessment and how that relates to AAC is not available in this article.

PPA: nothing was provided within this article to inform assessment.

What are the implications for intervention?

ALS: people who supported communication (mentors, family members) found it easier to succeed if given 1-1 training support from services and contact with commercial suppliers, especially if they did not have a technical background or interest.

TBI: The statistics quoted in the assessment section (above) suggest a relevance of a range of AAC technologies. Those who gave up on their AAC system fell into one of two main groups: (i) they had recovered sufficient natural speech and language, (ii) they had lost their mentor-communication volunteer to support their (and their families’) use of the system.

Brain stem trauma: there is limited evidence to support services and therapy options in this group. There is need for extensive research in this area.

Dementia: this is best described in terms of low tech communication, i.e.  a chart or book supports communication. Concrete examples of communication situations are most helpful. A range of context specific examples are provided.

Aphasia: There is limited research information available. Those familiar with aphasia are more supportive of AAC techniques; whilst family members are keen to regain the natural speech and language abilities of the individual prior to their stroke. The capacity to regain skills is poorly documented, as is the usefulness of AAC systems. Low-tech solutions (books, communication charts) appear to have had greater success but there remains a concern about the capacity of such systems to provide real and current conversational information. There are a number of technological applications being developed to support re-gaining language and communication skills in aphasia. These need further documentation and publication. Visual scene display, a research product development, seems worthy of more extensive consideration as it provides a context for communication success, e.g. a birthday party visual scene display.

PPA: AAC interventions are limited. The article suggests the consideration of low tech materials including: remnant boards that aid reminiscence and recognition, symbols boards, photo graphic communication books. Currently there is limited understanding of how they may support people with PPA.

What are the implications for further research and development?

ALS: Access options – whilst there have been great developments in access options over the last decade; there is an on-going need to develop methods that are more robust in terms of calibration according to postural change and lighting conditions. Speech synthesis – given the age range of people with ALS using AAC, there is a need to investigate the intelligibility of current speech synthesis in a range of real life contexts, e.g. how intelligible synthetic speech is to elderly people in long term care settings. Access to other technologies – this varied and currently seems age related but there is a suggestion that looking at the access to social media as a way of maintaining social contact whilst using AAC is not well understood. Mentor instruction – this is often related to who is available rather than based on technological confidence. It is suggested that regular training support is needed but that there is limited understanding of how this works in a real life context.

TBI: Many letter-by-letter systems offer an encoding system that enables the storing of phrases and sentences under a letter sequence. This prediction method lacks detailed research and many people who accessed and used this system suggested that they rarely sued it as it was ‘just too difficult. This suggests an on-going need to understand what supports encoding language generation method. Secondarily, people with TBI often aim to transition to semi-independent living circumstances. It seems there is limited understanding of the impact of a key ‘communication buddy’ during these phases of transition.

Brain stem trauma: there is need to explore motor learning theory (repetitive learning) in this group to see if people can re-learn motor sequencing routes that enable access to and use of AAC systems. Eye tracking research remains poorly understood. More work is needed in terms of: (i) proper lighting of the system to aid communication, (ii) precise positioning of the technology to support access, (iii) limited residual head movements (which support access to the communication system), (iv) the capacity to individualise the calibration of the system that can cope with changing g calibration needs of the user, i,e. changing muscle tone for example.

Dementia: there are studies underway exploring the integration of reminiscence and linguistic capacity skills. These have yet to be shared across research stakeholders.

Aphasia: there is much to be understood including: the relevance of commercial computer software, digital photography and Internet tools and how these relate to personalised and contextualised low-technology solutions. Natural sounding speech technologies were a concern that relates to previously expressed issues within other clinical groups in this paper. Equally, we have limited knowledge of how and in what way mentors can support communication in the person with aphasia and specifically how that relates to AAC. Lastly, understanding the perspectives of non-AAC specialists’ perspectives on what can be achieved needs further explorations, including GPs, specialist rehab teams, e.g. the consultant geriatrician.

PPA: the type, effectiveness and timing of AAC interventions are non existence in the literature, as well as facilitator support evaluations. We probably need N=1 case study reports over a period of years to inform the evidence base.

 


Further things you may want to look at:

complex communication needs (CCN)

brain stem trauma

PPA

Added to site December 2012


AAC adults severe aphasia (summary)


This article reviews literature specific to the use of AAC with adults who have severe aphasia.


How did they do it?

The authors reviewed studies involving AAC interventions for adults with severe aphasia.

What did they find?

Published data support the use of aided and unaided AAC with adults with severe aphasia in controlled treatment contexts. Reported gains in communication typically have not generalised to everyday settings.

What did they conclude?

The application of AAC with persons with severe aphasia must address factors potentially limiting treatment success outside of training environments.

Questions of further interest

What did they look at?

What are the implications for intervention and use in real life situations?

What are the implications for further research and development?


Things you may want to look into:

complex communication needs (CCN)

ALS

TBI

brain stem trauma

dementia

PPA

Added to site December 2012


AAC and severe ID (short summary)

Five teenagers with severe intellectual disability and communication impairment had taken part in traditional speech and language therapy for five years with little effect. After the introduction of communication boards by multidisciplinary teams, the teenagers improved their communication, daily living skills and socialization.


Things you may want to look into:

AAC

PMLD

complex communication needs (CCN)

Added to site August 2013


AAC and severe ID (summary)

What was the purpose of the study? The authors of this study reported their experience of introducing AAC to five adolescents with severe intellectual disability and communication impairment.

Why was the paper written? The authors wrote this paper because past research suggests that providing AAC to people with intellectual disability can increase their communication opportunities and ability to participate in society.

What did the authors do? The authors worked with five teenagers with severe intellectual disability and communication impairment. The teenagers had taken part in traditional speech and language therapy for at least five years but had not made any notable progress. AAC was introduced by the multidisciplinary team of each teenager in biweekly one-hour sessions over three years. The teenagers received instruction on how to use communication boards.

The researchers tested each teenager using the Vineland Adaptive Behaviour Scale before and after AAC was introduced. The test measured communication, daily living skills and socialization, and the teenagers' performance showed that they scored lowest in the area of communication compared to daily living and socialization skills before they were introduced to AAC.

What did they find? The teenagers with severe intellectual disability showed improvement in communication, daily living skills and socialization aft er they learned about AAC.

Conclusion: This study showed that the introduction of AAC can improve communication even if traditional speech and language therapy has been ineffective in the past.


Things you may want to look into:

AAC

PMLD

complex communication needs (CCN)

Added to site August 2013


AAC and social interaction (short summary)

This study compared the use of a picture exchange system and a speech-generating device for a fifteen-year-old boy with autism and Down syndrome. The authors were interested in finding out whether teaching an AAC system could improve social interaction. Trevor, the boy in this study, successfully learned how to use both types of AAC systems to request his favourite snacks in response to prompts from a communication partner. Trevor did not clearly prefer one type of AAC over the other, and he remained socially withdrawn during these interactions. Increasing the physical distance between Trevor and his partner was successful in decreasing the time Trevor spent in social withdrawal, though it is likely that this reflected Trevor's response to the new circumstances of the task rather than in increased interest in social interaction.


Things you may want to look into:

ASD FAQs

VOCA

PECS

Added to site January 2014


AAC and social interaction (summary)

Background Many children with developmental disabilities who use AAC have deficits in social skills, or the ability to comfortably interact with others. While previous research in the field of paediatric AAC has shown that children often prefer one type of AAC over another, little research has been done on the potential effect of AAC interventions on social interactions of children with developmental disabilities.

What was the aim of the study? This study investigated the effects of AAC interventions of the social interactions of one child.

What did the authors do? The authors worked with Trevor, a fifteen-year-old boy with diagnoses of autism and Down syndrome who was in a class of six children with developmental disabilities.

The study took place in three parts. First, Trevor was taught to use both a picture exchange system and a speech-generating device in order to request his favourite snacks. Second, the researchers determined whether Trevor preferred using one method over the other. Third, the researchers investigated whether social interaction could be increased by varying the distance between Trevor and his communication partner.

What did they find? Trevor successfully learned to use both the picture exchange system and the speech-generating device in order to request a snack in the classroom. However, for most of the time he was acquiring these skills, Trevor was socially withdrawn. He turned away from his communication partner and remained with his head between his knees and his arms wrapped around his shins. This may have been because Trevor did not find social interaction satisfying, and the scenario used to teach Trevor to use AAC did not require much social interaction.

Trevor showed only a slight preference for one AAC system over the other. This contrasts with other research that reported children with developmental disabilities clearly preferred certain types of AAC given a choice of two or more options. Rather, Trevor selected the AAC device that was nearest to him and that required the least overall movement from his withdrawn position. Trevor showed only a slightly more frequent use of picture exchange, so this system was used in the final part of the study. It also was easier to implement in the classroom setting, and Trevor's teacher was more familiar with it than speech-generating devices.

The final part of the study was successful in increasing Trevor's social interaction. Trevor's communication partner stood 60, 90 and 120 centimetres away from the table at which Trevor sat with the picture exchange system, and Trevor usually left his seat and approached his partner with the picture symbol in order to request a snack. This method left little time for Trevor to be socially withdrawn, and after he returned to the table with his snack, Trevor usually remained oriented toward his partner.

Cautions: The picture exchange system used in this study was not the one extensively developed by Frost and Bondy and often reported elsewhere in the literature. The authors of this study used a more general form of picture exchange that was suitable for the aims of the study, which was to compare two types of AAC systems rather than to teach only one form.

Importantly, Trevor did not make his requests in this study spontaneously. When he requested a snack, it was always in response to a prompt from his communication partner asking him to 'let me know if you want a snack'. Thus, though Trevor was successful in learning how to make requests, it is likely this skill was limited to the specific setting of responding to prompts.

Additionally, the authors point out that Trevor spent less time socially withdrawn in the last part of the study, but this is most likely a by-product of the requesting requirements. Trevor learned how to behave in order to obtain a snack, but it was not clear that he showed any more interest in social interaction than in other parts of the study.

Conclusions: Picture exchange systems and speech-generating devices can both be used successfully to aid the communication of children with developmental disabilities. However, the use of such AAC systems alone is not sufficient to produce an increase in social interaction. This will be important to parents and therapists designing interventions for and working with children like Trevor.


Things you may want to look into:

ASD FAQs

VOCA

PECS

Added to site January 2014


AAC and young children with disabilities - review (short summary)

This review included studies that investigated the use of AAC for children aged three years and younger. Twelve studies were included in the review, and seven were determined to have conclusive results, or constitute high-quality evidence. AAC was successful in improving the communication of the majority of children in the studies. This review found evidence to support the use of AAC for young children, and the authors stressed the importance of trying a variety of AAC methods, including aided and unaided AAC systems, with young children.


Things you may want to look into:

VOCA

FAQ: AAC + ASD

assessing AAC preferences developmental disabilities - review

Added to site August 2013


AAC and young children with disabilities - review (summary)

What was the aim of the study? This study reviewed the literature on AAC for infants and toddlers with developmental disabilities under the age of three years.

Why was the paper written? The learning experiences of children's first three years of life can influence later brain development, but these experiences may be lessened if caregivers cannot recognize children's communicative behaviours. Early access to AAC can benefit children's early intentional communication, but most literature on AAC relates to older age groups.

What did the authors do? The authors searched electronic databases, journals and reference lists for studies that addressed AAC in children with developmental disabilities aged three years and younger. For each study they included in their review, the authors determined how conclusive the evidence was about its finding. In other words, the authors evaluated the quality of the evidence in each study they reviewed. They included 12 studies in their review and determined that seven of them had conclusive, or high-quality, reliable results.

The 12 studies included in this review involved 190 children aged 8 to 36 months. The studies tested both aided and unaided forms of AAC, targeted a variety of skills and included designs that measured outcomes of individual children and groups.

What did they find? This review found evidence to support the use of AAC with children aged 36 months and younger. In particular:

None of the studies advocated an age requirement for the introduction of AAC, but younger children tended to be introduced to unaided rather than aided AAC systems. The seven conclusive studies of the highest quality showed that AAC of many different types is effective for young children.

Cautions: Evidence from five of the 12 studies was inconclusive.

Conclusions: It is important that clinicians and caregivers are willing to try a range of different AAC systems with young children. If a child's communication is difficult to interpret, there is no reason to withhold an aided communication system such as a VOCA or pictures due to young age.


Things you may want to look into:

VOCA

FAQ: AAC + ASD

assessing AAC preferences developmental disabilities - review

Added to site August 2013


AAC personnel framework - adult acquired complex communication needs (summary)


This research examined the framework of support for people who rely on AAC because of acquired medical conditions.

What did they look at?

The research looked at the roles of AAC finders, general practice clinicians, AAC intervention specialists, AAC facilitators, and AAC experts. The requirements of the roles are described in detail for people with amyotrophic lateral sclerosis (ALS), brainstem impairment, and severe chronic aphasia.

Questions of further interest 

Why was the framework developed?

Which staff groups were targeted in the framework?

What training needs were identified?

What does this mean for service delivery?

What are the implications for research and development?


December 2012

Acceptance of Augmentative and Alternative Communication Technology by Persons with Amyotrophic Lateral Sclerosis (short summary)

This study aimed to investigate whether there is a pattern to acceptance of high-tech augmentative and alternative communication (AAC) devices and to investigate the reasons for either acceptance or discontinuance of the use of AAC technology among people who have amyotrophic lateral sclerosis (ALS).

The researchers found a very high rate of acceptance of AAC technology among the 50 participants. 90% showed immediate acceptance, 6% delayed acceptance and 4% rejection. None of the participants in this study discontinued their use of AAC until very close to the end of their lives.

This study found a higher rate of AAC acceptance than previous studies, possibly reflecting changes in technology and increasing acceptance of AAC within wider society. The authors suggest that factors influencing acceptance of AAC amongst PALS include; early intervention, provision of information about the effects of ALS on speech and language, ongoing contact with specialist professionals, monitoring of changes to ensure timely intervention and keeping PALS aware of AAC services and possible interventions. Further research is needed into these areas and also into the type of cognitive impairment that can be associated with ALS and the influence of this on the use of AAC.


Things you may want to look into:

Real-Life Challenges in Using Augmentative and Alternative Communication by Persons With Amyotrophic Lateral Sclerosis

Supporting communication for patients with neurodegenerative disease

Use of augmentative-alternative communications in patients with amyotrophic lateral sclerosis

Don't give up: Employment experiences of individuals with amyotrophic lateral sclerosis who use augmentative and alternative communication

Motor Neurone Disease Association

Added to site May 2016


Acceptance of Augmentative and Alternative Communication Technology by Persons with Amyotrophic Lateral Sclerosis (summary)

Background

Around 80% of people with amyotrophic lateral sclerosis (ALS) experience significant impairment to their communication and require augmentative and alternative communication (AAC) to support their daily communication needs. Literature suggests that around 25% of these people do not accept AAC interventions. For those who do accept AAC there is little known about their patterns of acceptance, e.g. the influence of high versus low technology, the point in the progression of ALS at which AAC is introduced etc. Some researchers have found that high-tech systems tend to be used by people who have ALS (PALS) to express detailed needs, for written communication and to tell their stories, whilst low-tech is used for conversational communication and to rapidly indicate wants and needs.

The reasons some PALS do not accept AAC technology are not well understood, but might include; the rate of progression of their disease, the time taken to get a diagnosis of ALS, expectations and attitudes of their communication partners, experience with and attitude to technology and access to intervention and support.

PALS attitudes to AAC can be considered as being on a continuum, from immediate acceptance of the technology to acceptance with reluctance or delay and then to outright rejection. If AAC is initially accepted its’ use might be discontinued at a later point due to a change in need, ability or simply no longer wanting to use it.

What did they do?

This study aimed to see if there is a pattern to acceptance of high-tech AAC and to investigate the reasons for either acceptance or discontinuance of the use of AAC technology among PALS. It looks only at high-tech systems.

Fifty PALS participated in the study. They were all patients who regularly attended one of 2 clinics for reviews of their speech and swallowing. The information was gathered over a 4 year period.

Participants were seen for AAC assessment when their speech was beginning to deteriorate and their intelligibility was 90% or lower on assessment. During the AAC evaluations participants were shown a selection of different types of AAC device, given opportunities to use them and to have a brief trial of preferred systems. Following the AAC evaluation interventions were recommended for each person.

The PALS responses to the evaluations were divided into four categories; immediate acceptance, delayed acceptance, rejection and discontinuance.

Participants and their families were interviewed about their decisions, and from this data the researchers explored themes for AAC technology acceptance.

What did they find?

There was a very high rate of acceptance of AAC technology. 90% of participants showed immediate acceptance, 6% delayed acceptance and 4% rejection.

Reasons given for immediate acceptance included the wish to communicate with other people and to ‘write/tell one’s story’, a desire to be involved in in their community and to continue in employment or volunteer in a work related field.

The people who showed delayed acceptance had between 6 months and 2 years delay and were unable to speak for at least six months prior to getting a device. Reasons found for delayed acceptance included family member resistance, lack of support from medical specialist and participants not viewing themselves as being disabled or needing AAC. The support and encouragement of family members was very helpful in these PALS accepting AAC.

The main reason identified for complete rejection of AAC technology by two participants was cognitive limitations, both had a form of dementia and rejected any form of AAC, high and low-tech.

None of the participants in this study discontinued their use of AAC until very close to the end of their lives.

Conclusions

This study found a higher rate of AAC acceptance than previous studies, possibly reflecting changes in technology and increasing acceptance of AAC within wider society. The authors suggest that factors influencing acceptance of AAC amongst PALS include; early intervention, provision of information about the effects of ALS on speech and language, ongoing contact with specialist professionals, monitoring of changes to ensure timely intervention and keeping PALS aware of AAC services and possible interventions. Further research is needed into these areas and also into the type of cognitive impairment that can be associated with ALS and the influence of this on the use of AAC.

Cautions

The participants in the study were very familiar with the clinician who made the AAC recommendations, this might have influenced their acceptance of suggestions, as might the clinician’s level of experience and expertise.


Things you may want to look into:

Real-Life Challenges in Using Augmentative and Alternative Communication by Persons With Amyotrophic Lateral Sclerosis

Supporting communication for patients with neurodegenerative disease

Use of augmentative-alternative communications in patients with amyotrophic lateral sclerosis

Don't give up: Employment experiences of individuals with amyotrophic lateral sclerosis who use augmentative and alternative communication

Motor Neurone Disease Association

Added to site May 2016


Acquisition, Preference and Follow-up Comparison Across Three AAC Modalities Taught to Two Children with Autism Spectrum Disorder (short summary)

In this study, related to McLay et al 2015, the authors investigated whether two boys with autism spectrum disorder (ASD) could be taught to request continuation of toy play using ‘more’ using three different augmentative and alternative communication systems; signing, picture exchange and a speech generating device (SGD), whether this learning would be maintained over time and whether they would show a preference for any of the AAC systems over the others.

They found that signing was the least successful AAC modality and that the SGD was preferred by both participants. The authors suggest that this might be due to the reinforcement given by the voice output system but indicate that further investigations into this are needed.


Things you may want to look into:

Comparing Acquisition, Generalization, Maintenance, and Preference Across Three AAC Options in Four Children with Autism Spectrum Disorder

Acquisition, Preference, and Follow-up Data on the Use of Three AAC Options by Four Boys with Developmental Disability/Delay

Speech-Generating Devices Used at Home by Children With Autism Spectrum Disorders

Facilitating requesting skills using high-tech augmentative and alternative communication devices with individuals with autism spectrum disorders: A systematic review

A Review and Analysis of the Picture Exchange Communication System (PECS) for Individuals with Autism Spectrum Disorders Using a Paradigm of Communication Competence

A Comparison of PECS and iPad to Teach Requesting to Pre-schoolers with Autistic Spectrum Disorders

Interaction of Participant Characteristics and Type of AAC With Individuals With ASD: A Meta-AnalysisEvaluating Picture Exchange and the iPad™ as a Speech Generating Device to Teach Communication to Young Children with Autism

Added to site September 2016


Acquisition, Preference and Follow-up Comparison Across Three AAC Modalities Taught to Two Children with Autism Spectrum Disorder (summary)

Background

Many people diagnosed with autism spectrum disorder (ASD) fail to develop enough speech to meet their everyday communication needs. Augmentative and alternative communication (AAC) has been used successfully with some of this population. Possible AAC strategies for children with ASD include the use of manual signing, picture exchange and speech generating devices (SGDs). This leads to the question of which of these systems should be taught to any individual.

It has been suggested that it might be beneficial to trial all of these options in the early stages of intervention. It would also be useful to look at children’s performance using the different strategies following intervention, in generalisation and maintenance phases.

This study is related to a similar one (McLay et al, 2015), focussing on the teaching of ‘more’ to children with ASD.

 

What did they do?

The study aimed to partially replicate the 2015 paper using a slightly different sequence of intervention phases.

The research questions were; would an intervention be effective in teaching two children with ASD to request continuation of toy play using 3 different AAC modalities? Would this learning be maintained over time? Would the child show a preference for one or more of the 3 systems? And would that preference remain stable over time?

Two boys aged 5 and 10 took part in the study. Both had an ASD diagnosis and severe receptive and expressive language difficulties. They had no previous experience of signing, picture exchange or SGDs, but were able to use an iPad to play games.

The boys were taught to request ‘more’ play with highly motivating toys using each of the three AAC methods. Prior to intervention beginning a baseline level of their use of this request was established. During intervention they were taught to use the 3 AAC systems in separate sessions with prompting of their responses.

The intervention was followed by long-term follow up 5 to 7 months after the last intervention session, at this time no prompts were given.

After each baseline, intervention and follow up session preferences for any of the 3 AAC systems was checked.

 

 What did they find?

The older boy used the SGD twice during baseline sessions but did not use either of the other AAC options. With intervention he was able to use the SGD and picture exchange to the level of 80% correct and unprompted responses, but did not meet this level using signing.

On follow up he made only one request and used picture exchange.

When being assessed for a preferred AAC modality he selected the SGD on 55% of trials, made no selection on 40%, used picture exchange 3% and signed 2%, in a total of 50 trials.

The younger boy used the SGD during baseline assessment but did not use the other systems. During intervention he reached the 80% level only with picture exchange but also used both of the other systems. On follow up the SGD was used correctly 100% of the time in two sessions and picture exchange 80% of the time in one session. When preferences were investigated he chose the SGD 61% of the time, picture exchange 18% and sign 5%. He made no choice on 16% of trials in a total of 62 probes.

 

Conclusions:

The findings were consistent with the earlier McLay et al study. Signing was the least successful/ preferred AAC modality. The participants generally showed a preference for SGDs over picture exchange or signing.

The long gap between the final intervention session and follow up, with no maintenance activities led to a decrease in performance compared to the intervention phase.

The authors suggest that whilst the children’s performance with the SGD was not more successful than picture exchange they might have preferred it due to the voice output which possibly acted as a reinforcer.

 

Cautions:

This was a very small study, although similar to another carried out by the same lead author. The request being taught, ‘more’, is a very early communication skill which the participants might have been able to express through other prelinguistic behaviour reducing the need to use AAC systems.


Things you may want to look into:

Comparing Acquisition, Generalization, Maintenance, and Preference Across Three AAC Options in Four Children with Autism Spectrum Disorder

Acquisition, Preference, and Follow-up Data on the Use of Three AAC Options by Four Boys with Developmental Disability/Delay

Speech-Generating Devices Used at Home by Children With Autism Spectrum Disorders

Facilitating requesting skills using high-tech augmentative and alternative communication devices with individuals with autism spectrum disorders: A systematic review

A Review and Analysis of the Picture Exchange Communication System (PECS) for Individuals with Autism Spectrum Disorders Using a Paradigm of Communication Competence

A Comparison of PECS and iPad to Teach Requesting to Pre-schoolers with Autistic Spectrum Disorders

Interaction of Participant Characteristics and Type of AAC With Individuals With ASD: A Meta-AnalysisEvaluating Picture Exchange and the iPad™ as a Speech Generating Device to Teach Communication to Young Children with Autism

 

Added to site September 2016


Adults with complex communication needs who volunteer (summary)

 


This summary looks at personal experiences of adults volunteering, with their complex communication needs creating a barrier.


Aim of the study: to find out about the personal experiences of volunteering for people who use AAC.

Why was this an important topic? Other studies have found that adults who use AAC want to volunteer but are not well represented across the volunteering workforce. Previous research has identified barriers to volunteering for people with disabilities but not specifically communication disabilities. Barriers include: being underestimated, staff training and knowledge, being given meaningful roles, access, literacy levels and negative attitudes.

How did they look at volunteering experiences for those with communication needs?

Some background: The study was based in Australia. The authors interviewed 24 adults (12 women and 12 men) who had experience of a formal volunteering role in their adulthood. Those interviewed ranged in ages between 20 and 70. During the interview process 14 were actively involved in volunteering and 10 were not looking for further voluntary opportunities. 18 people used an AAC system as their main method of communication, whilst 6 preferred to use their AAC system to support their own speech.

Voluntary roles experienced included: committee work, broadcasting, presenting on disability issues, mentoring and roles in hospitals, religious organisations and performing arts groups.

What happened in this study? The people were interviewed two times. Firstly, to discuss their own experiences. Secondly, to share some other interviewees’ experiences and get reactions and comments on these issues. Comments and experiences were coded into themes. This is a type of analysis that allows lots of descriptive comments from interviews to be summarised into the key points, commonly called themes.

What did they find? The themes were summarised into three main categories (i) control, (ii) that is life, and (iii) making a difference.

The most important element was a sense of control over what they participated in and how they participated. This was positively and negatively affected by elements summarised under (ii) that is life and (iii) making a difference. For example, not having control over which staff supported them during volunteering had both positive and negative effects. Or access issues like unreliable taxis making it impossible to be able to do their hospital radio broadcast. These two examples were often described as ‘that is life’ by the interviewees. Making a difference was often about seeing the positive impact they could have on someone, e.g. mentoring activities enabled a parent to see that their child could potentially use a powered chair.

The paper provides lots of examples under these three categories. Throughout the paper one thing that recurs is the impact of a network of family and friends supporting the volunteer, for example, having someone to provide emotional support if something stressful has happened whilst volunteering.

Benefits: All felt that there were more positive than negative aspects to volunteering and these included: making a difference, making friends, increasing in confidence and self-esteem, and improving communication skills. Feelings of success seemed to be a very personal judgment.  Many saw volunteering as a way to get more involved in and to be part of their community.

Challenges: All felt that their communication needs had made it very difficult to get volunteering opportunities and to keep control of what they did and when.

Conclusions: Having complex communication needs seems to add an additional barrier. The study recommends that such volunteers need support with their communication, even although they may not be receiving formal support through speech and language therapy. This has implications for service provision and delivery. They also recommended that similar interviews are completed with staff who co-ordinate volunteering activities and users of voluntary services to understand their perspectives and experiences.


Things you may want to look into: volunteering opportunities

Authors: 

Trembath, Balandin, Togher, Stancliffe

Published: 

Disability & Rehabilitation Journal, 2010

© aacknowledge.org.uk Sept 2012


An Investigation of Aided Language Stimulation: Does it Increase AAC Use with Adults with Developmental Disabilities and Complex Communication Needs? (short summary)

The authors investigated whether the use of Aided Language Stimulation (ALS) i.e. communication partners modelling the use of AAC using a system the same or very similar to that used by the AAC user, could be beneficial in teaching adults with developmental difficulties and complex communication needs to use AAC. They aimed to consider the effect of ALS on functional use of AAC.

A group of adult AAC users were given a number of intervention sessions in which the researchers modelled the use of AAC following set scripts in structured situations and supported the people who used AAC to use their systems to participate. Speaking peers of the participants were also involved as role models.

Over the intervention period all of the people who used AAC were found to have increased both the number of communicative turns they took and their use of AAC. However this was not always maintained after the intervention period.

Overall the authors conclude that ALS can 'help adults with developmental disabilities and complex communication needs to learn, maintain and enhance their ability to communicate functionally in their natural settings, and, therefore, to participate more fully in life.'


Things you may want to look into:

The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech

Complex communication needs (CCN)

The Effect of Aided AAC Modeling on the Expression of Multi-Symbol Messages by Preschoolers who use AAC

Added to site May 2015


An Investigation of Aided Language Stimulation: Does it Increase AAC Use with Adults with Developmental Disabilities and Complex Communication Needs? (summary)

Background

Adults with complex communication needs (CCN) are often unable to communicate functionally using spoken language. Their communicative attempts are often difficult for others to understand and their communicative behaviours might be seen as 'challenging'.

There is evidence that in order to increase positive communications augmentative and alternative communication (AAC) might be beneficial but teaching adults with developmental disabilities to use this effectively can be difficult.

Best practice says that AAC for adults should focus on developing functional communication in natural environments. Aided Language Stimulation (ALS) incorporates these elements. This means that communication partners model the use of AAC, usually using the AAC users own system or similar, and then support the user to respond.

There is limited research into this method of teaching AAC, particularly with adults. This study aimed to address this and looked at the effect of ALS on the functional use of AAC by adults with developmental disabilities and CCN.

What did the authors do?

They followed a five phase process to design interactive communications for adults:

Initially 16 adults took part in the study, all had developmental disabilities 8 had CCN and 8 who were able to communicate functionally using spoken language and so provide good role models.

All participants had the same pictures available to them regardless of AAC system used; voice output communication aid, symbols boards or individual symbols. The researchers had an enlarged copy of each overlay to enable them to model aided AAC.

Following identification of the most appropriate AAC technique for each participant they were introduced to two scripts, one, an introductory routine for a group and one used to choose which music to play and to talk about it.

During intervention sessions all participants had access to AAC so that peer modelling by the speaking participants could be encouraged. The group leader researchers followed the script and modelled the use of AAC, pointing to one or two pictures on the large overlays as they spoke and encouraged participation.

There were two episodes of intervention over a number of weeks, followed by a third in which the use of scripts and modelling stopped, participants' use of AAC was monitored to determine whether it had been maintained.

What did they find?

The researchers looked at the number of communicative turns taken and the use of aided AAC. Most turns took the form of a single word.

The pattern of results varied between participants and sometimes between sessions, but all demonstrated some increase in the number of communicative turns and use of aided AAC during the intervention sessions, suggesting that the use of ALS was effective. However this was not always maintained after the intervention period.
Data was not gathered for the speaking participants, but observation indicated some positive changes in their communicative behaviours.

Cautions:

The authors believe that the lack of detailed descriptions of the participants makes generalisation of the results difficult, as does the fact that generalisation of AAC use was only measured subjectively at an informal concert.

There was no formal training for staff at the centre attended by the participants to enable them to provide similar interventions consistently and no facility to monitor follow up at the centre was in place.

Conclusions:

Overall the authors conclude that ALS can 'help adults with developmental disabilities and complex communication needs to learn, maintain and enhance their ability to communicate functionally in their natural settings, and, therefore, to participate more fully in life.'


Things you may want to look into:

The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech

Complex communication needs (CCN)

The Effect of Aided AAC Modeling on the Expression of Multi-Symbol Messages by Preschoolers who use AAC

Added to site May 2015


Assessing AAC preferences developmental disabilities-review (short summary)

This review aimed to determine whether participants with developmental disabilities preferred certain types of AAC. The review included seven studies with twelve participants. Eight of these participants preferred speech generating devices, and four preferred picture exchange systems, though this result must be interpreted with caution due to the very small size of the studies. Incorporating individual preferences into an AAC intervention could improve the control that individuals with developmental disabilities have over their decisions and lives.


Things you may want to look into:

voice output communication aid (VOCA)

aided communication

Added to site August 2013


Assessing AAC preferences developmental disabilities-review (summary)

What was the aim of the study? The authors reviewed studies that determined the type of AAC that individuals with developmental disabilities preferred.

Why was the paper written? Individuals with developmental disabilities may often benefit from AAC, which puts clinicians, families and users in the position of selecting which type of AAC may best serve individual circumstances. Accounting for the user's perspective is an important step in promoting self-determination and could possibly affect the outcomes of the AAC intervention.

What did the authors do? The authors searched electronic databases, reference lists and journals to locate studies that were appropriate for this review. The authors limited the studies they included in their review to those that included participants with developmental disabilities, determined whether participants expressed a preference for one type of AAC over another and detailed the procedure that researchers used to decide on a participants' preferences.

What did they find? Seven studies met the criteria for inclusion in this review. These studies pertained to twelve individuals with developmental disabilities, aged 2-22 years. The types of AAC included in these studies were speech generating devices, picture exchange systems and manual signing. Most studies taught participants to make requests using AAC.

Six studies, with ten participants, compared preferences only between speech generative devices and picture exchange systems. Half of the participants preferred speech generating devices over picture exchange systems. Three of the ten participants preferred picture exchange systems.

When considering all seven studies included in the review, eight of the twelve participants expressed a preference speech generating devices over picture exchange systems. Four of the twelve participants preferred picture exchange systems. Therefore, participants in this review did express preferences for certain types of AAC over others.

Cautions: These results are based on a very limited number of studies and participants, and most studies compare only two types of AAC. Only one study included manual signing as an AAC intervention. Additionally, these studies only evaluated participants' use of AAC to make requests and did not take a comprehensive view of participants' skills and deficits.

Conclusions: Most individuals included in this review expressed a preference for one type of AAC over another. The preferences of individuals with developmental disabilities who use AAC could be used to inform the decision to use AAC and give these individuals more control over their own lives.


Things you may want to look into:

voice output device (VOCA)

aided communication

unaided communication

Added to site August 2013


Augmentative and alternative communication for children with autism spectrum disorder: An evidence-based evaluation of the Language Acquisition through Motor Planning (LAMP) programme (short summary)

The Language Acquisition through Motor Planning (LAMP) approach to teaching language using a voice output communication aid (VOCA) was used over a five week period with eight children, aged between 4 and 12, who had ASD. Parents and teachers were also trained to use the LAMP approach. The study aimed to test whether augmentative and alternative communication (AAC) systems can improve the functional communication of children with ASD in their daily lives.

The researchers used the LAMP approach in addressing 4 aims:

The study found that all eight participating children improved their use of functional core words and, at the post-programme assessment all were communicating independently and were not restricted only to words that had been taught.

In addition to improvements in expressive communication other positive outcomes were reported. These included increases in joint attention, interest, motivation and engagement with other people, plus an overall willingness to communicate. Increases in play and social communication were also reported as were improvements in behaviour and reductions in frustration.

At the two year post intervention follow up five of the families were still using the device in a variety of settings, two of the families had found they could not use it in everyday life. The main concerns were about lack of technical support and lack of confidence in problem solving. Those who had continued with LAMP use reported that their children actively requested their device.

The ongoing support of a LAMP trained speech pathologist was found to have positive outcomes.

 


Things you may want to look into:

Speech-Generating Devices Used at Home by Children With Autism Spectrum Disorders

Facilitating requesting skills using high-tech augmentative and alternative communication devices with individuals with autism spectrum disorders: A systematic review

Comparing Acquisition, Generalization, Maintenance, and Preference Across Three AAC Options in Four Children with Autism Spectrum Disorder

AAC Interventions for Individuals with Autism Spectrum Disorders: State of the Science and Future Research Directions

 

Added to site July 2016


 

Augmentative and alternative communication for children with autism spectrum disorder: An evidence-based evaluation of the Language Acquisition through Motor Planning (LAMP) programme (summary)

Background

 It is estimated that up to 50% of people with autism spectrum disorder (ASD) do not use functional speech and there is evidence to suggest that augmentative and alternative communication (AAC) can improve the quality of life for non-verbal children with ASD by supporting them to increase their communication. There are many different forms of AAC available including high-tech systems that can be used to generate speech and allow for spontaneous expression.

Motivation and independence are essential factors in developing a child’s communication ability. Structured teaching is an educational theory that includes environmental considerations being included into education making the learning setting understandable and suitable for individual student’s needs. Structured teaching is central to the curriculum and teaching approach used at Autism Spectrum Australia (Aspect), the centre at which this study was carried out. It incorporates approaches used in the Treatment and Education of Autistic and related Communication-handicapped Children (TEACCH) and in the naturalistic behaviour-based pivotal response training intervention which aims to increase a student’s motivation to respond to educational activities that are central to the development of complex language, play and social interaction skills.

The Language Acquisition through Motor Planning (LAMP) approach provides strategies for teaching communication using a voice output communication aid (VOCA) in which words are stored in a consistent position within the device and is based on five teaching elements necessary to teach effective communication. The LAMP approach provides opportunities to learn word meanings through natural consequences, in the same way as speaking children learn. The programme also focusses on ‘core’ words that are used frequently, with a variety of meanings, in everyday situations; words such as stop, go, more, eat, drink etc.

 

What did they do?

The aim of the study was to test whether AAC can improve the functional communication of children with ASD in their daily lives. The researchers used the LAMP approach in addressing the 4 aims:

The authors evaluated the developmental progression of communication in the participants.

Eight families with children aged between 4 and 12 who had ASD completed participation in the study and 7 of these completed the 2 year follow up.

All of the children were receiving speech and language therapy prior to the study and were using some level of picture exchange to communicate, but not consistently, spontaneously and independently.

Teachers and therapists involved with the children were given LAMP training. Children were given both structured and non-structured sessions using the LAMP approach. Both core and fringe words were taught using different levels of prompting.

Data was collected, pre and post intervention, using Aspect’s expressive and receptive communication checklists. These considered functions and methods of communication, whether this was pre-intentional, intentional or symbolic, and understanding and level of support needed to enable the child to respond. Data was also gathered through the built in LAMP data logging option and a parent and teacher questionnaire.

The two year follow up was carried out in a telephone interview.

The research was carried out in the children’s homes and school over a fourteen week period, with 5 weeks of direct intervention. Child assessments were carried out immediately before and after the intervention period and 2 weeks after it ended. Parents and teachers were surveyed pre and post intervention.

 

What did they find?

The biggest improvements were in the children’s expressive outcomes. All of the children had reached the level of using symbolic communication at the end of intervention. Those who were at a symbolic level prior to intervention improved and established a consistent method of communicating after 5 weeks. The participants also increased the range of communicative functions they used and the amount of spontaneous communication. All of the children demonstrated increases in the number of vocabulary items used and the length of utterance.

All but one of the parents and teachers showed an increase in their confidence to teach other people how to use the LAMP approach.

At the two year follow up five of the families were still using the device in a variety of settings, two of the families had found they could not use it in everyday life. The main concerns were about lack of technical support and lack of confidence in problem solving. Those who had continued with LAMP use reported that their children actively requested their device.

The ongoing support of a LAMP trained speech pathologist was found to have positive outcomes. All families reported some difficulties, mainly technical, in using the device.

 

Conclusions:

The use of the LAMP programme on a VOCA was found to improve communication in young children with ASD when a family-centred, individualised plan is used. It was also found that, with ongoing support, the system will continue to be used long-term.

The study found that all eight participating children improved their use of functional core words and, at the post-programme assessment all were communicating independently and were not restricted only to words that had been taught.

In addition to improvements in expressive communication other positive outcomes were reported. These included increases in joint attention, interest, motivation and engagement with other people, plus an overall willingness to communicate. Increases in play and social communication were also reported as were improvements in behaviour and reductions in frustration.

 

Cautions:

This study was carried out in a single school setting and with a small number of families. The findings might not be transferable to the wider population of children with ASD.

 


Things you may want to look into:

Speech-Generating Devices Used at Home by Children With Autism Spectrum Disorders

Facilitating requesting skills using high-tech augmentative and alternative communication devices with individuals with autism spectrum disorders: A systematic review

Comparing Acquisition, Generalization, Maintenance, and Preference Across Three AAC Options in Four Children with Autism Spectrum Disorder

AAC Interventions for Individuals with Autism Spectrum Disorders: State of the Science and Future Research Directions

 

Added to site July 2016


 

Augmentative and alternative communication in daily clinical practice: strategies and tools for management of severe communication disorders (short summary)

This paper looks at the use of AAC with people who have had a stroke. Possible reasons for abandonment or unwillingness to use AAC systems are considered. The authors describe various elements of communicative competence that need to be taken into account when working with stroke patients and their families and carers and emphasise that the needs of people with severe communication impairments are diverse, as are considerations to be taken in identifying possible support systems. They conclude that early provision of appropriate resources to aid the regaining of communicative competence might lead to greater acceptance of AAC systems and the development of functional communication using a combination of natural speech and language and AAC strategies should be the aim of interventions.


Things you may want to look into:

The effect of remnant and pictographic books on the communicative interaction of individuals with global Aphasia 

Promoting acceptance of augmentative and alternative communication by adults with acquired communication disorders

Bill's experiences after a stroke

Terry using a communication aid after a stroke

Augmentative and Alternative Communication (AAC) for adults with severe aphasia: Where we stand and how we can go further

Weblinks - aphasia / stroke

Factsheet - What is a stroke?

Factsheet - What is Aphasia?

Factsheet - Dysarthria and Dysphasia

Added to site October 2014


Augmentative and alternative communication in daily clinical practice: strategies and tools for management of severe communication disorders (summary)

Background

People who have had strokes often use natural speech in combination with various AAC strategies to improve the effectiveness of their communication. These strategies might change over time as communication needs change.

Interventions to help build stroke patients' communicative competence need to consider a wide variety of factors including the individual, their environments and their communication partners. They should not necessarily be seeking a 'cure', rather to implement strategies to compensate for difficulties.

The perception and attitudes of patients, communication partners and professionals can influence access to and acceptance of AAC methods.

When these issues are addressed early and consistently in patient care then it is more likely that AAC will be viewed positively.

What did the authors do?

The paper describes various aspects of communication competence from an AAC perspective, and looks at specific AAC strategies and technologies to encourage professionals to view AAC as a way of maximising natural speech and language skills.

Areas of communicative competence are considered, including the use of communication to; convey wants and needs, give information, support social closeness and social etiquette and self-communication.

It is suggested that speech and language therapists (SLTs) consider using a variety of strategies to facilitate communication.

People who use AAC need to be able to show competency using their system both expressively and to support their understanding, they, and their care givers, need to be able to demonstrate the technical skills needed to operate their system and keep it up to date. They need to be able to follow the social rules of interaction and overcome the limitations of AAC systems.

Early, direct training in each of these areas, and how to modify strategies as skills change, is identified as a means of improving communicative competence.

The paper looks at the use of AAC strategies for people with acquired motor speech disorders and/or aphasia, suggesting possible strategies to be considered.

There is a brief consideration of possible reasons for people with aphasia abandoning AAC strategies and the suggestion is made that using an approach to intervention that emphasises competence and inclusion rather than deficits, and involves other people within the AAC users social circle, might increase the rate of acceptance of AAC systems.

Conclusions:

The use of AAC strategies and systems can be beneficial to adults with acquired disorders, and help improve quality of life. However overcoming negative attitudes and perceptions and selecting the most appropriate systems presents many challenges.

The development of more 'mainstream' communication support systems, such as mobile communication apps, might increase acceptance of devices, but introduces their own difficulties in terms of funding and technical support.

The authors conclude that the needs of people with severe communication impairments are diverse, as are considerations to be taken in identifying possible support systems. Early provision of appropriate resources to aid the regaining of communicative competence might lead to greater acceptance of AAC systems and the development of functional communication using a combination of natural speech and language and AAC strategies should be the aim of interventions.


Things you may want to look into:

The effect of remnant and pictographic books on the communicative interaction of individuals with global Aphasia 

Promoting acceptance of augmentative and alternative communication by adults with acquired communication disorders

Bill's experiences after a stroke

Terry using a communication aid after a stroke

Augmentative and Alternative Communication (AAC) for adults with severe aphasia: Where we stand and how we can go further

Weblinks - aphasia / stroke

Factsheet - What is a stroke?

Factsheet - What is Aphasia?

Factsheet - Dysarthria and Dysphasia

Added to site October 2014


Augmentative and alternative communication supports for adults with autism spectrum disorders (short summary)

This study aimed to explore the views and experiences of six adults with ASD, their support workers and family members, regarding the outcomes of providing them with low-tech communication aids.

The benefits of AAC for people with ASD were most frequently reported as in supporting their understanding. Visual AAC supports were felt to reduce levels of anxiety and so decrease incidences of challenging behaviour. One worker indicated that AAC led to benefits such as improved confidence and increased independence and helped unfamiliar people to communicate more successfully with the person with ASD.

Although several positive benefits of low-tech AAC support were identified some difficulties were noted by support workers. These were related mainly to issues of 'time' and individual workers views and attitudes to AAC.

The importance of ongoing professional support, training and education in the use of AAC systems and the need for ongoing advocacy for adults with ASD who use AAC is also recognised.


Things you may want to look into:

Demonstration of a method for assessing semantic organization and category membership in individuals with autism spectrum disorders and receptive vocabulary limitations

Strategies in Construction and Interpretation of Graphic-Symbol Sequences by Individuals who use AAC Systems

Can the facilitated communication method support autistic people, according to facilitators' opinions?

Adults with Autism


Added to site August 2015

Augmentative and alternative communication supports for adults with autism spectrum disorders (summary)

Background

Autism spectrum disorder (ASD) refers to a group of lifelong developmental disabilities. Most research into the condition has focussed on the needs of children. What research there is into adults with ASD shows the need for ongoing services and support for them and their families and carers across the whole range of ASD. This is especially the case for those people who have complex communication needs (CCN) associated with low IQ and who might benefit from augmentative and alternative communication (AAC) to maximise their independence and participation at home and in the community. There is little research into outcomes of AAC provision for this population.

In 2005 in Australia a government-funded low-technology AAC scheme, the Non-Electronic Communication Aid Scheme (NECAS), was developed. This aimed to 'enhance communication, participation and independence for people with communication difficulties'. 206 of the people provided with services through NECAS had a diagnosis of ASD. This study aimed to explore the views and experiences of people with ASD, their support workers and family members, regarding the outcomes of providing them with communication aids.

What did they do?

The researchers used semi-structured interviews and qualitative analysis to explore people's views and experiences.

The study included six people with ASD, who had accessed NECAS at least six months previously, seven support workers, who knew individuals well, and two family members. The original aim was for the people with ASD to report their own experiences with input from others who were important in their lives. However, as the support workers and family members were found to be the main responders in all of the interviews it was their views and experiences that became the main focus of the analysis.

Each participant was interviewed with their support worker or family member. A semi-structured question guide was used to be sure that a range of issues were discussed in all interviews. The interviews were transcribed and analysed into themes.

What did they find?

Two main themes came out of the analysis of the information gathered. The first was termed 'Proven Potential'. This covered the benefits AAC provided for the participants and their communication partners. The second theme was 'Inconsistent Action', the fact that although support for the use of AAC was common its uptake and support in everyday life was inconsistent for a number of reasons.

The benefits of AAC for people with ASD were most frequently reported as being supporting their understanding e.g. using visual timetables to increase awareness of what was going to happen or supporting routines. Visual AAC supports were felt to reduce levels of anxiety and so decrease incidences of challenging behaviour too. One support worker indicated that AAC led to benefits such as improved confidence and increased independence through the provision of cards to use in shops and bars. This also helped unfamiliar people to communicate more successfully with the person with ASD.

Other benefits for communication partners were in communication passports or 'chat books' helping people to understand and recognise communicative behaviour and respond to this appropriately and consistently.

Although several positive benefits of low-tech AAC support were identified there were difficulties noted by support workers. These were divided into 'Finding the Time' and 'Knowing What to Do', with additional issues related to individual's views and attitudes to AAC.

The 'time' element related to both preparation of AAC resources and the time needed to actually make the referral to NECAS. The lack of knowledge tended to relate to care staff turnover and lack of training, experience and support to use the system.

Within care settings not all staff used available AAC resources consistently, which could lead to increased anxiety levels for people with ASD. Some care workers were not willing to support all AAC strategies; they reported that some were not practical to use in the community and might have a negative effect on the way the user was viewed by others. Most carers wanted AAC systems to be simple in order to make them easier for staff to use.

Conclusions:

An important finding was the emphasis placed on the use of AAC to support understanding and reduce anxiety, rather than to support expressive communication. This might be related to the use of visual supports for communication being easier for carers to learn to use than more complex expressive communication systems, particularly in view of the high turnover of staff and the implications of this for staff training needs.

The focus on comprehension might also be related to the social communication difficulties characteristic of ASD, meaning that participants generally avoided social/expressive interactions.

The importance of ongoing professional support, training and education in the use of AAC systems and the need for ongoing advocacy for adults with ASD who use AAC is also recognised.

Cautions:

The sample size was small the qualitative analysis of the data means that the finding of this study cannot be generalised to the wider population.

It is possible that people volunteered to be part of the study because of positive experiences of AAC use, therefore the findings might not be truly representative of people with ASD as a whole.

The researchers did not carry out their own assessments and relied on pre-existing diagnoses, which also restricts the potential to generalise their findings.


Things you may want to look into:

Demonstration of a method for assessing semantic organization and category membership in individuals with autism spectrum disorders and receptive vocabulary limitations

Strategies in Construction and Interpretation of Graphic-Symbol Sequences by Individuals who use AAC Systems

Can the facilitated communication method support autistic people, according to facilitators' opinions?

Adults with Autism


Added to site August 2015

Barriers to Participation in Kindergarten Literacy Instruction for a Student with Augmentative and Alternative Communication Needs (short summary)

The author studied a single seven year old child with severe speech and mild cognitive impairment and challenging behaviours, who attended a mainstream kindergarten setting on a part-time basis. Barriers to the development of his early literacy skills were identified and divided into access and opportunity barriers. Access barriers refer to those related to the AAC users own needs, skills and abilities, opportunity barriers are imposed by others policy, practice, attitude, knowledge and skill.

She concluded that the identification of these barriers and ways to overcome them is vital in the inclusion of children who use AAC into mainstream classrooms. This could include training for team members, planning and preparation time, classroom support workers, peer training and support.

The author suggests that there is no evidence that students who use AAC acquire literacy skills differently from typically developing children, but need to be provided with high quality teaching, adapted materials and an effective AAC system.


Things you may want to look into:

AAC and developmental difficulties

Supporting the Communication, Language, and Literacy Development of Children with Complex Communication Needs

Teacher literacy expectations for kindergarten children with cerebral palsy in special education

Evidence-based literacy instruction for individuals who require augmentative and alternative communication: a case study of a student with multiple disabilities

Added to site July 2014


Barriers to Participation in Kindergarten Literacy Instruction for a Student with Augmentative and Alternative Communication Needs (summary)

Background
Many individuals who use augmentative and alternative communication (AAC) have been found to have difficulties in developing reading and writing skills. This can lead to difficulty in effectively participating in mainstream education activities.

What was the aim of the study?
The author looked at whether it is possible for a mainstream reading programme, Building Blocks, used in the United States, to meet the needs of a young child using AAC in a mainstream setting. She aimed to identify the literacy activities used in the programme, to describe opportunities for the child to participate within the activities and to record how the AAC user joined in within the classroom routines.

She also considered barriers to the development of the child's early literacy skills in terms of: a) access barriers – related to the AAC users own needs, skills and abilities and b) opportunity barriers – imposed by others policy, practice, attitude, knowledge and skill.

What did the authors do?
A seven year old boy with mild cognitive and severe speech impairment and challenging behaviour was observed in a mainstream classroom over eight months. The child had a split placement attending both a mainstream setting and a special educational needs classroom.

At the beginning of the study the child used a range of communication behaviours many of which were non-symbolic, including facial expression, body movements, pointing and vocalisations. He was beginning to use some symbolic communication which included a small number of signs which were mainly used for requesting when prompted, and some communication boards using Picture Communication Symbols (PCS) to label objects and answer activity-specific questions.

The author collected information about the child's participation in Building Blocks activities over 25 sessions, 14 in the mainstream setting and in the special needs classroom. Unstructured interviews were also carried out with teachers in both settings and a classroom support worker in mainstream, along with a semi-structured interview with the mainstream teacher at the end of the study.

What did they find?
Over the period of the study the child made very limited progress in the development of new literacy skills within the Building Blocks programme. This was found to be due to a combination of access and opportunity barriers.

The three main access barriers were identified as: lack of functional speech, challenging behaviours, fine motor impairment. As these areas were not addressed they led to many opportunity barriers. A lack of joint working between school staff resulted in minimal planning and preparation for the child's integration, there was no identification of roles and responsibilities of key school staff, the mainstream teacher had no training or support to integrate an AAC user in the classroom. Additionally the child was not provided with the support he needed to participate successfully in the mainstream class; he did not have an appropriate AAC system or effective training and his peer group were not prepared or trained about how best to communicate with and AAC user.

The child's non-symbolic communication attempts were not recognised or acknowledged by either his teacher or classmates. He was better able to participate when supported by a trained AAC support worker but this was not regularly available to him.

As a result of these issues the child was not encouraged to follow the same classroom routines as his peers even when he would be able to do so and his challenging behaviour was not addressed in mainstream. This led to a decrease in social integration and learning opportunities.

He often had no appropriate means of responding to open-ended questions and multiple choices were not offered. His communication boards were noun based and did not include social vocabulary, verbs, adjectives, prepositions or places.

Therapy sessions meant that the child was often withdrawn from school sessions, the author suggests that it would be helpful if these could be integrated into the classroom reducing time missed from education and offering learning opportunities for the class teacher.

Cautions:
The single participant study in only one setting means that the findings cannot necessarily be generalised to other children or places. Further research might be beneficial

Conclusions:
It is suggested that in order to successfully include pupils who use AAC mainstream teachers need specific training about their communication needs and time for planning and evaluating progress. They also benefit from classroom assistance from trained workers or classroom assistants.

The author suggests that there is no evidence that students who use AAC acquire literacy skills differently from typically developing children, but need to be provided with high quality teaching, adapted materials and an effective AAC system.


Things you may want to look into:

AAC and developmental difficulties

Supporting the Communication, Language, and Literacy Development of Children with Complex Communication Needs

Teacher literacy expectations for kindergarten children with cerebral palsy in special education

Evidence-based literacy instruction for individuals who require augmentative and alternative communication: a case study of a student with multiple disabilities

Added to site July 2014


Bridging the gap from values to actions: a family systems framework for family-centered AAC services (short summary)

The importance of family-centred interventions that recognise and acknowledge the differences between families and the roles all family members have to play in the success of input for people with additional needs have been increasingly recognised as important in the delivery of augmentative and alternative communication (AAC) services.

Professionals often intend to offer family-centred AAC services but face various and numerous challenges in delivering them.

As a gap exists between the recognition of the need for family-centred practice and actual AAC service delivery professionals need support to establish collaborative family-professional relationships.

This paper had three aims:

The paper focusses on a small number of the elements of family systems and ecological systems theory that are most relevant to AAC service delivery. Alongside the theoretical framework some clinical tools are suggested to support professionals implementing family-centred interventions.

The authors produced a theoretical framework showing how family systems theory applies to children who have complex communication needs (CCN

The paper looks at and defines various components (subsystems) and processes that can influence families, discusses the implications of these for children who use AAC and offers suggestions for professionals to support the delivery of family-centred services.

The framework suggests tools/assessments that can lead to improvements in the implementation of family-centred services based on established principles. This should lead to better professional support for children who rely on AAC and their families.


Things you may want to look into:

‘‘It’s got to be more than that’’. Parents and speech-language pathologists discuss training content for families with a new speech generating device

Alternative service delivery models for families with a new speech generating device: Perspectives of parents and therapists

Added to site April 17


Bridging the gap from values to actions: a family systems framework for family-centered AAC services (summary)

Background

The importance of family-centred interventions that recognise and acknowledge the differences between families and the roles all family members have to play in the success of input for people with additional needs have been increasingly recognised as important in the delivery of augmentative and alternative communication (AAC) services.

Family structures are increasingly diverse and studies have found that AAC intervention practices often lack family-centredness often being more professionally centred.

Professionals often intend to offer family-centred AAC services but face various and numerous challenges in delivering them. Challenges include lack of knowledge, skills and tools to deliver family-centred services effectively, particularly not understanding that this is more than simply having contact with families, but involves recognising the ‘centrality of the family’ and supporting and strengthening family ‘capacity to enhance the child’s communication’.

As a gap exists between the recognition of the need for family-centred practice and actual AAC service delivery professionals need support to establish collaborative family-professional relationships.

This paper had three aims:

The paper focusses on a small number of the elements of family systems and ecological systems theory that are most relevant to AAC service delivery. Alongside the theoretical framework some clinical tools are suggested to support professionals implementing family-centred interventions. It also stresses that the unique characteristics of each family must be considered.

 

What did they do?

The authors produced a theoretical framework showing how family systems theory applies to children who have complex communication needs (CCN); viewing the family as an interconnected system, interlinked and interdependent. Different family members; parents, siblings, grandparents etc. form ‘subsystems’ that vary depending on who are the important people in the child’s life,

The family must be viewed as a whole rather than individual members (wholism). The framework assumes that the family system is all affected by the environment and events in it and adjusts to maintain balance (homeostasis).

In addition families exist and interact and change in other contexts such as local communities, schools etc. People in these different ‘systems’ around the child can be significant influences on the child and family, for example a child’s ‘microsystem’ might include carers, siblings, extended family plus neighbours, friends etc.

The paper looks at and defines various components (subsystems) and processes that can influence families, discusses the implications of these for children who use AAC and offers suggestions for professionals to support the delivery of family-centred services.

 

Conclusions:

Family involvement in AAC service delivery can be challenging, but not involving the family can have negative effects. The authors suggest that their theoretical framework can be used to improve understanding of a child’s family systems and so the environment in which they develop and communicate.

The framework suggested tools/assessments that can lead to improvements in the implementation of family-centred services based on established principles. This should lead to better professional support for children who rely on AAC and their families.


Things you may want to look into:

‘‘It’s got to be more than that’’. Parents and speech-language pathologists discuss training content for families with a new speech generating device

Alternative service delivery models for families with a new speech generating device: Perspectives of parents and therapists

Added to site April 17


 

Case study family intervention, eye gaze-multimodal (short summary)

This paper describes the impact of a family-centred intervention that used video to enhance communication in a young girl with cerebral palsy.


This single case study describes how the video-based intervention worked in the context of multimodal communication, which included high-tech augmentative and alternative communication (AAC) device use. This paper includes the family’s perspective of the video intervention and they describe the impact of it on their family." title="<--break-->" border="0">

Methods This single case study was based on the premise that the video interaction guidance intervention would increase attentiveness between participants during communication. It tests a hypothesis that eye gaze is a fundamental prerequisite for all communicative initiatives, regardless of modality in the child. Multimodality is described as the range of communicative behaviours used by the child and these are coded as AAC communication, vocalizations (intelligible and unintelligible), sign communication, nodding and pointing. Change was analysed over time with multiple testing both pre and post intervention. Data were analysed within INTERACT, a computer software to analyse behaviourally observed data. Behaviours were analysed for frequency and duration, contingency and co-occurrence.

Results Results indicated increased duration of mother’s and girl’s eye gaze, increased frequency and duration in AAC communication by the girl and significant change in frequency [c2 (5, n = 1) = 13.25, P < 0.05] and duration [c2 (5, n = 1) = 12.57, P < 0.05] of the girl’s multimodal communicative behaviours. Contingency and co-occurrence analysis indicated that mother’s eye gaze followed by AAC communication was the most prominent change between the pre- and post-intervention assessments.

Conclusions There was a trend for increased eye gaze in both mum and girl and AAC communication in the girl following the video intervention. The family’s perspective concurs with the results.


Things you may want to look into: eye gaze, multimodal communication, video interaction guidance

December 2012


Case study family intervention, eye gaze-multimodal (summary)


A UK study looking at the relationship between communication partners and a child's communication strategies.


What was the aim of the study?

To see if therapy focussed on improving eye gaze between mother and child had an additional effect on the child’s range of communication strategies.

What did they do?

Background: This study was completed in England. It involved an 11 year old girl with cerebral palsy, her parents and a best friend. The study outlines all the case background data recommended by Pennington et al (2003) to enable replication of this work. The girl had experience of traditional therapy, focussing on speech production and AAC use. This was described by the parents as always looking at and working on things that she couldn’t do very well.

The study: In summary the girl was videoed four times at home, in a naturalistic way, communicating with her best friend, her mother or her father. These videoed sessions lasted approximately 20 minutes. They were called the starting point, i.e. an evaluation of what typical communication was like before the therapy aspect of the study started. It included the recording of a range of communication strategies, e.g. AAC communication, use of speech (intelligible and unintelligible), pointing, nodding and gesture. The intervention component involved a therapy technique called Video Interaction Guidance (VIG). This meant that all the videos were looked at for micro moments of successful interaction. This selection of moments was independently completed by the intervention guider and the parents.

The first ‘intervention session’ was sharing those moments with each other and discussing why they were regarded as successful. The mother completed a similar sharing intervention session with the girl and her best friend. The total amount of video time included in these sharing interventions was 5 minutes.

After this intervention phase 4 more video sessions were completed. The effects were independently evaluated from the parents’, girl’s and researcher’s perspectives. There was agreement across these perspectives.

What did they find out?

1. Focussing on what the girl had done well rather than what she was struggling with was a new slant for the parents to get used to in a ‘therapy session’. It changed their perceptions of how skilful their daughter was in using a range of communication strategies (referred to as multi modal communication).

2. Independent measurement of before and after videos demonstrated that there had been changes in eye gaze duration (showing perseverance) between girl and communication partners.

3. There were notable changes in the communication strategies used which included (i) an increase in use of AAC system, (ii) an increase in the use of pointing and nodding, (iii) a decrease in the number of unintelligible utterances. The authors comment on the evaluation of intelligibility/unintelligibility and acknowledge that this is by nature a subjective measure but intelligibility was measured in this study in terms of both partners agreed message transfer.

Conclusions: although each person with cerebral palsy is an individual with varying skills, strengths and needs; the authors believe that this intervention approach of not focussing on the tools, e.g. the AAC system, but rather the relationship between communication partners promoted a subtle increase in desirable communication strategies. Further research in this area would be beneficial.


Things you may want to look into: Video Interaction Guidance (VIG), communication partners, communication strategies, intelligible and unintelligible speech, multi modal communication

December 2012


Cited references: Pennington, L., Goldbart, J. & Marshall, J. (2003), Speech and language therapy to improve the communication skills of children with cerebral palsy. Cochrane Database of Systematic Reviews, Issue 2, Art. No.: CD003466.

http://www.cckm.ca/CPSLPR/pdf/Pennington2003.pdf


 

 

 

 

 

Children Who Use Communication Aids Instructing Peer and Adult Partners During Play-Based Activity (short summary)

This study investigates the way in which children with severe motor impairments who use AAC are able to use language to give instructions to familiar communication partners in barrier activities involving construction play. It investigates their use of referential communication i.e. their ability to name or describe items so that the listener can identify them. The tasks used in the study included dressing a doll, making a bead necklace, building a tower of blocks and making a pattern of dominoes.

They found that in general the task was completed more slowly and more misunderstandings occurred between children who use AAC and their communication partners than was the case for a typically developing comparison group. However most of the communication aid users were able to complete the tasks successfully and misunderstandings could be corrected.

It was found that the older children and those with higher levels of communication functioning and non-verbal reasoning were more successful in solving the tasks.

The authors conclude that children with motor impairments can successfully instruct others to carry out tasks and in doing so alter the balance of a communication partnership and that children who use communication aids can direct the actions of others in construction play, though not always as successfully as typically developing peers. They suggest that interventions focussing on offering opportunities for autonomous communication in structured activities might promote the development of aided language and autonomy in children with severe physical impairments and little or no speech.

 


Things you may want to look into:

Systematic Review of the Effects of Interventions to Promote Peer Interactions for Children who use Aided AAC

Differences in maternal responsive and directive behavior during free play with and without aided AAC

Participation and Enjoyment in Play with a Robot between Children with Cerebral Palsy who use AAC and their Peers

 Added to site August 2016


 

Children Who Use Communication Aids Instructing Peer and Adult Partners During Play-Based Activity (summary)

Background

Play is important to children’s social, emotional and cognitive development, helping to develop an understanding of the world, problem solving skills etc. It is not known how limited access to play might affect children with significant motor impairment who use communication aids as they acquire language.

Construction play, in which something is made or built, accounts for a large percentage of play activity in typically developing pre-school children, however as it involves manipulation of physical objects children with severe motor impairments might not be able to engage with it independently even with the use of technology.

In children with motor impairments language is often their strongest skill, but aided vocabulary tends to be more restricted and slower to produce than natural speech. However aided communication can offer a means of actively participating in play and other activities by giving instructions to others to act for them. There is limited information about the extent to which children and young people who use communication aids do this, interactions are generally thought to be dominated by the speaking communication partner.

To be able to direct another person to carry out actions that are not already known requires the use of ‘referential communication’ i.e. naming or describing items so that the listener can identify them. This skill develops over time in typically developing children as they begin to understand the minimum amount of information they need to give.

Barrier games have been suggested as a way to develop this skill in people who use augmentative and alternative communication (AAC), this study used this type of activity to investigate how children who use AAC provide real instructions about unknown items to listeners.

 

What did they do?

The study involved at a group of 18 children aged between 5 and 15 who had severe motor difficulties and used AAC. It looked into a number of factors influencing  the extent to which children who use communication aids succeed in leading a goal-oriented interaction including whether they give instructions that are similar to or different from those of typically developing children who use natural speech. A comparison group of 17 children were also included.

The children interacted with up to three familiar communication partners, parents, professionals and peers. They were assessed on four tasks, each presented twice; dressing a doll, making a bead necklace, building a tower of blocks and making a pattern of dominoes. The tasks included 29 objects and 67 attributes needed to describe their size, shape, colour, location, orientation and sequence. The interactions were analysed into five categories; success, time required, misunderstandings, child contributions and partner contributions.

The activities were all presented as barrier tasks in which the child had to instruct the communication partner to create an identical model to the one they could see.

 

What did they find?

The children in the comparison group generally gave more information when describing the elements and as a result there was little spoken interaction between them and their communication partners during the tasks as the partners focussed on constructing the model and listening to the instructions. The aided communication group’s partners had lots of waiting time as the children constructed messages.

The AAC user group made significantly more errors and took longer to complete the tasks than the comparison group. This group also had more misunderstandings; mainly communication partners not understanding the children. Around two-thirds of these were resolved, often through questioning by the communication partner. The AAC user group also showed lower than expected specificity/precision in their descriptions.

The communication partners of the children who used AAC provided more help than those in the comparison group, requesting specific information whereas the typically developing children tended to be asked more open-ended questions.

It was found that the older children and those with higher levels of communication functioning and non-verbal reasoning were more successful in solving the tasks. There was no association between the length of time taken and the success rate.

 

Conclusions:

The authors conclude that children with motor impairments can successfully instruct others to carry out tasks and in doing so alter the balance of a communication partnership.

On average it took the children who used AAC five times longer to solve tasks than their speaking peers and access to the communication device through scanning was much slower than direct selection, but did not interfere with the ability to successfully complete the activity.

It is suggested that limited access to a communication aid and restricted vocabulary availability are likely to impact on participation and communication, and that the vocabulary to express subtle differences between e.g. a square and a cube might not be available to AAC users.

The authors conclude that children who use communication aids can direct the actions of others in construction play, though not always as successfully as typically developing peers. They suggest that interventions focussing on offering opportunities for autonomous communication in structured activities might promote the development of aided language and autonomy in children with severe physical impairments and little or no speech.

 

Cautions:

This was a small sample of children with no cognitively matched control group. It did not consider what children might have done with a communication system specially designed to meet the needs of the task nor with unfamiliar communication partners.

There is also a need for more detailed analysis of a wider range of activities.

 


Things you may want to look into:

Systematic Review of the Effects of Interventions to Promote Peer Interactions for Children who use Aided AAC

Differences in maternal responsive and directive behavior during free play with and without aided AAC

Participation and Enjoyment in Play with a Robot between Children with Cerebral Palsy who use AAC and their Peers

 

Added to site August 2016


 

Children’s joint attention in AAC (short summary)

This study investigated infants' attention in situations that involved an infant, adult, storybook and potential aided AAC system. Differences in infants' attention depended on the physical location of the AAC system, infants' age, activity levels and cognitive skills and adults' interactive styles. Though the infants in this study did not have any developmental disabilities, results suggest that these factors may be important in children's interactions with AAC systems generally.


Things you may want to look into:

high tech AAC

assessing AAC preferences for developmental disabilities

Added to site August 2013


Children’s joint attention in AAC (summary)

Background One aspect of infant development that is important to social engagement and communication is joint attention. This refers to the relationship among a child, the caregiver and another object. For example, joint attention is evident if an infant and her sister are looking at a book together. This situation is made more complex if the child has access to an aided communication system, which becomes another component in the interaction between an infant and the people and objects in the surrounding environment.

What was the aim of the study? The authors wanted to look at whether certain characteristics of an infant had an effect on joint attention episodes in an interaction that included an aided AAC system. They were interested in the age, language abilities and temperament of the child, and the interactive style of the caregiver.

Why was the paper written? Very little is known about the roles of these factors in interactions that include AAC. The presence of an AAC system could impact infants' attention and focus.

What did the authors do? The authors investigated joint attention in 16 infants aged 9-14 months. They set up interactions that included a tablet computer as a potential AAC device. An infant was seated on the caregiver's lap. The pair faced an experimenter who read a story. The experimenter used both a picture book and a tablet computer which played sounds related to the story.

The authors then investigated the relationships between the age, language abilities and temperament of the infant, the interactive style of the caregiver and episodes of joint attention.

What did they find? When the tablet computer was held near the experimenter's body, older children were more likely to engage in joint attention than younger children. Children with high activity levels, however, were less likely to engage in joint attention than children with lower activity levels.

When the tablet computer was placed farther away from the experimenter, children who, in other situations, were able to focus longest on objects engaged in joint attention more than other children.

Additionally, children engaged in joint attention more often when their caregiver followed the children's focus of attention.

Cautions: The infants in this study were typically developing, so important differences between infants with developmental delays may exist.

Conclusions: The placement of an AAC device – a tablet computer in this study – may present different types of challenges to children with different skills, as not all children will engage with their environment in the same way. Several factors contribute to when and how long infants engage in joint attention. Importantly, children may benefit from adults' following their lead in interactions, rather than adults directing the attention of children to a specific focus.


Things you may want to look into:

high tech AAC

assessing AAC preferences for developmental disabilities

Added to site August 2013


Communication Opportunities for Elementary School Students who use Augmentative and Alternative Communication (short summary)

Children with complex communication needs (CCN) often continue to experience educational and social barriers even after they have received appropriate augmentative and alternative communication (AAC) systems.

It is known that in interactions involving people who use AAC the naturally speaking partner tends to be dominant and take the lead, usually by asking a lot of direct questions. Children who use AAC often have limited opportunities to initiate new topics of conversation instructions and the majority of interactions are with adults not peers.

This study aimed to look at the natural communication environments of children who use AAC. The authors aimed to describe naturally occurring communication opportunities offered to AAC users attending elementary schools in the USA.

The study had three areas of interest: to look at a sample of students who used AAC and attended a range of inclusive schools, to look at the consequences of AAC users communicative behaviours and to understand how communication partners could best respond to communication attempts and to look at the social participation of students who used AAC.

Overall the authors aimed to describe naturally occurring communication opportunities offered to AAC users attending elementary schools in the USA.

They found that 90% of communication events were opportunities to respond, only 10% were spontaneous initiations by the child. The vast majority of interactions were with adults not peers and took place in special needs classrooms.

The authors conclude that students who use AAC need support to become active communicators and that this is not always appropriately available and that children who use AAC need support to develop initiation skills and to ensure their devices are available to them at all times.


Things you may want to look into:

Teachers’ perceptions of implementation of aided AAC to support expressive communication in South African special schools: a pilot investigation

The Communication Supports Inventory-Children & Youth (CSI-CY), a new instrument based on the ICF-CY

‘The right path of equality’: supporting high school students with autism who type to communicate

Social Interactions of Students with Disabilities Who Use Augmentative and Alternative Communication in Inclusive Classrooms

Support for AAC Use in Preschool, and Growth in Language Skills, for Young Children with Developmental Disabilities

 

Added to site January 17


 

Communication Opportunities for Elementary School Students who use Augmentative and Alternative Communication (short summary)

Children with complex communication needs (CCN) often continue to experience educational and social barriers even after they have received appropriate augmentative and alternative communication (AAC) systems.

It is known that in interactions involving people who use AAC the naturally speaking partner tends to be dominant and take the lead, usually by asking a lot of direct questions. Children who use AAC often have limited opportunities to initiate new topics of conversation instructions and the majority of interactions are with adults not peers.

This study aimed to look at the natural communication environments of children who use AAC. The authors aimed to describe naturally occurring communication opportunities offered to AAC users attending elementary schools in the USA.

The study had three areas of interest: to look at a sample of students who used AAC and attended a range of inclusive schools, to look at the consequences of AAC users communicative behaviours and to understand how communication partners could best respond to communication attempts and to look at the social participation of students who used AAC.

Overall the authors aimed to describe naturally occurring communication opportunities offered to AAC users attending elementary schools in the USA.

They found that 90% of communication events were opportunities to respond, only 10% were spontaneous initiations by the child. The vast majority of interactions were with adults not peers and took place in special needs classrooms.

The authors conclude that students who use AAC need support to become active communicators and that this is not always appropriately available and that children who use AAC need support to develop initiation skills and to ensure their devices are available to them at all times.

 


Things you may want to look into:

 

Teachers’ perceptions of implementation of aided AAC to support expressive communication in South African special schools: a pilot investigation

The Communication Supports Inventory-Children & Youth (CSI-CY), a new instrument based on the ICF-CY

‘The right path of equality’: supporting high school students with autism who type to communicate

Social Interactions of Students with Disabilities Who Use Augmentative and Alternative Communication in Inclusive Classrooms

Support for AAC Use in Preschool, and Growth in Language Skills, for Young Children with Developmental Disabilities

 

Added to site January 17


 

Communication Opportunities for Elementary School Students who use Augmentative and Alternative Communication (short summary)

Children with complex communication needs (CCN) often continue to experience educational and social barriers even after they have received appropriate augmentative and alternative communication (AAC) systems.

It is known that in interactions involving people who use AAC the naturally speaking partner tends to be dominant and take the lead, usually by asking a lot of direct questions. Children who use AAC often have limited opportunities to initiate new topics of conversation instructions and the majority of interactions are with adults not peers.

This study aimed to look at the natural communication environments of children who use AAC. The authors aimed to describe naturally occurring communication opportunities offered to AAC users attending elementary schools in the USA.

The study had three areas of interest: to look at a sample of students who used AAC and attended a range of inclusive schools, to look at the consequences of AAC users communicative behaviours and to understand how communication partners could best respond to communication attempts and to look at the social participation of students who used AAC.

Overall the authors aimed to describe naturally occurring communication opportunities offered to AAC users attending elementary schools in the USA.

They found that 90% of communication events were opportunities to respond, only 10% were spontaneous initiations by the child. The vast majority of interactions were with adults not peers and took place in special needs classrooms.

The authors conclude that students who use AAC need support to become active communicators and that this is not always appropriately available and that children who use AAC need support to develop initiation skills and to ensure their devices are available to them at all times.

 


Things you may want to look into:

 

Teachers’ perceptions of implementation of aided AAC to support expressive communication in South African special schools: a pilot investigation

The Communication Supports Inventory-Children & Youth (CSI-CY), a new instrument based on the ICF-CY

‘The right path of equality’: supporting high school students with autism who type to communicate

Social Interactions of Students with Disabilities Who Use Augmentative and Alternative Communication in Inclusive Classrooms

Support for AAC Use in Preschool, and Growth in Language Skills, for Young Children with Developmental Disabilities

 

Added to site January 17


 

Communication Opportunities for Elementary School Students who use Augmentative and Alternative Communication (summary)

Background

Children with complex communication needs (CCN) often continue to experience educational and social barriers even after they have received appropriate augmentative and alternative communication (AAC) systems. This means that opportunities to communicate functionally need to be created and supported in the children’s natural environments including schools.

It is known that in interactions involving people who use AAC the naturally speaking partner tends to be dominant and take the lead, usually by asking a lot of direct questions. This means the number and type of communication functions used by the AAC user are limited and mainly responsive. Children who use AAC often have limited opportunities to initiate new topics of conversation and many of the interactions begun by other people are related to meeting physical or medical needs or giving instructions and the majority of interactions are with adults not peers. It has also been found that often children who use AAC in schools do not have their system available at all times.

This study aimed to look at the natural communication environments of children who use AAC.

 

What did they do?

The study had three areas of interest: to look at a sample of students who used AAC and attended a range of inclusive schools, to look at the consequences of AAC users communicative behaviours and to understand how communication partners could best respond to communication attempts and to look at the social participation of students who used AAC.

Overall the authors aimed to describe naturally occurring communication opportunities offered to AAC users attending elementary schools in the USA.

Twenty three students participated in the study. They had a range of disabilities and communication needs. AAC systems used included single message devices, picture cues and sentence strips, signing and speech generating devices (SGDs).

Six different schools were involved.

Each participant was observed across the school day, in a variety of lessons, break times and moving between sessions. Specific therapy sessions were not observed.

The observers recorded communication events as either ‘opportunity to respond’, ‘opportunity to initiate’ or ‘spontaneous student initiation’.

Opportunities to initiate were identified when the communication partner deliberately ‘sabotaged’ an event and allowed at least five seconds for the child to communicate about this without prompting, e.g. necessary items were held back, only small amounts of food given, items were placed out of reach etc.

Each pupil was observed for an average of 306 minutes with a range of 3 to 7 observations over multiple days.

 

What did they find?

A total of 2179 communication events were recorded at an average of 19 per student per hour. 90% of these were opportunities to respond and only 10% were spontaneous initiations by the child. Staff were not seen to try to set up any opportunities for the children to initiate communication. When possible opportunities to initiate were provided the five second wait to allow the child time to communicate was not observed and therefore the event was not recorded.

Over 70% of communication events took place in special needs classrooms, 20% were in mainstream classes and 9% in non-academic environments.

Most interactions (97%) were between children using AAC and adults, with an average of less than one communication event per hour involving peers. 35% of participants did not interact with peers at all during the observation period.

In 55% of opportunities to respond no response was made even with prompts. For systems that were not SGDs there was no response 64% of the time.

The main modes of communication used by the participants when responses were made were; an aided AAC system (65%), natural speech (21%), sign or gesture (9%) and hand over hand prompts on an SGD or vocal imitation (5%).

Students who used SGDs had access to their system for 63% of communication events, those who used other aided systems had them available only 27% of the time.

 

Conclusions:

The authors conclude that students who use AAC need support to become active communicators and that this is not always appropriately available, leading to the need for training for communication partners and peers.

Children who use AAC also need support to develop initiation skills and to ensure their devices are available to them at all times.

 

Cautions:

The methods used to record data limited some of the information that could be gathered. There was not a great deal of information regarding context which would have been useful.

The length of observations varied between the students making it difficult to compare findings between participants.

The observations for each student took place over a relatively short, two week, period, this could be extended and possibly reduce the effects of the students being conscious of being observed.

The findings cannot be generalised beyond the areas in which it was undertaken.

Additional data about communication partners would be useful, including information about training they have received and their perceptions of what is effective in promoting communication for AAC users.


Things you may want to look into:

Teachers’ perceptions of implementation of aided AAC to support expressive communication in South African special schools: a pilot investigation

The Communication Supports Inventory-Children & Youth (CSI-CY), a new instrument based on the ICF-CY

‘The right path of equality’: supporting high school students with autism who type to communicate

Social Interactions of Students with Disabilities Who Use Augmentative and Alternative Communication in Inclusive Classrooms

Support for AAC Use in Preschool, and Growth in Language Skills, for Young Children with Developmental Disabilities

Added to site January 17


 

Communication boards in critical care: patients’ views (short summary)

The authors interviewed patients who had been ventilated in a critical care ward to find out their perceptions of their levels of frustration when they were unable to communicate effectively, how they thought this might be alleviated by the use of a communication board and what they thought would be useful for the board to contain.

It was found that the majority of the interviewees thought that a communication board would be beneficial, particularly if they had been given opportunities to see the board prior to surgery to enable them to become familiar with the content and how it could be used.


Things you may want to look into:

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology

Nurses' perceptions of communication training in the ICU

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Use of augmentative and alternative communication strategies by family members in the intensive care unit

Added to site October 2014


Communication boards in critical care: patients’ views (summary)

Background

Communication difficulties have been reported as a very significant problem for patients on mechanical ventilation in hospital, leading to increased levels of stress and anxiety related to difficulty in getting needs met or having communication attempts misunderstood. Some of the methods used by healthcare workers to overcome these problems have been found to be tiring and emotionally draining. The use of communication boards has been suggested as a possible solution to this but there has been little research into what content would be most beneficial on the boards.

This study aimed to look at patients' perceptions of: their levels of frustration when trying to communicate when ventilated, their level of frustration if a communication board had been used and appropriate form and content for a communication board to be used in this situation.

What did the authors do?

29 patients who had been ventilated for a minimum of 18 hours were interviewed using a series of questions related to the research aims. The interviews were analysed into themes.

What did they find?

Over 60% of the patients reported high levels of frustration due to their inability to communicate effectively when being ventilated. A large majority believed that having a communication board would have reduced their level of frustration and been helpful.

The patients were also asked to look at a pre-prepared communication board and to consider how it would have worked, or not, for them. They had both positive and negative comments and suggestions to improve, or change, the board.

It was particularly felt that seeing the board prior to their surgery, in order to be familiar with it before it was needed, would have been beneficial.

Cautions:

Further research is needed to evaluate the use of pre-printed communication boards and other AAC supports with patients in critical care. It would be beneficial to look at the experiences of families and nurses in using communication boards.

Conclusions:

The use of communication boards might be effective in supporting communication and decreasing frustration for patients on ventilators, increasing the efficiency and speed of communication, enabling needs to be met and helping staff to recognise patients individuality.


Things you may want to look into:

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology

Nurses' perceptions of communication training in the ICU

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Use of augmentative and alternative communication strategies by family members in the intensive care unit

Added to site October 2014


Communication in the ICU (short summary)

Researchers ran a programme for nurses who worked in the ICU about communicating with patients who cannot speak. The nurses learned about AAC strategies, and many of them reported positive effects of using these strategies in hospital. The nurses favoured basic strategies that did not take up too much time.


Things you may want to look into:

Information on acquired disorders

Family members' AAC communication strategies in the ICU

Added to site August 2013


Communication in the ICU (summary)

What was the aim of the study? This study described the thoughts of nurses who worked in the ICU about a programme in which they took part to increase their knowledge about how to communicate with patients who cannot speak.

Why was the paper written? The researchers ran a programme to teach ICU nurses about communication skills and AAC strategies that they could use with patients who do not speak. The researchers wanted to find out what the nurses thought about the programme and whether they used any of the information that they had learned.

What did the authors do? The authors ran focus groups with ICU nurses. Twenty-six nurses participated in the training programme, and six of these nurses gave their feedback in small group settings.

What did they find? Nurses reported many positive things about their learning experience, but there were some negative aspects as well. Some nurses thought communication was very important for patients on the ICU, but other nurses thought it had low priority. Nurses thought that patients often tried to communicate about their immediate needs, but messages about more personal topics were often ignored.

Nurses found many benefits to learning about communication. Nurses thought that they were less frustrated and stressed and more patient when communicating in the ICU. They also thought that there were benefits for patients, such as making a quicker recovery. Nurses were not able to use everything they learned in their jobs because of time constraints. Some AAC strategies were not appropriate for the ICU, because many patients have cognitive impairments or motor difficulties that mean they cannot use certain communication aids.

Nurses found that part of the programme was helpful in reminding them about natural strategies such as making eye contact, speaking slowly and using voice inflection. They thought these strategies were very effective and used them frequently. Some nurses found the programme so beneficial that they began to incorporate information about patient communication into medical reports and promoted communication strategies in their workplace.

Cautions: This study took place in two hospital units in the USA, and there were only a small number of nurses who took part in the programme.

Conclusions: Nurses provided positive feedback about the programme and the AAC strategies that they learned. Overall, they increased their skills and confidence in communicating to patients who cannot speak.


Things you may want to look into:

Information on acquired disorders

Family members' AAC communication strategies in the ICU

Added to site August 2013


Communicative participation changes in pre-school children receiving augmentative and alternative communication intervention (short summary)

This study looked into the effects of augmentative and alternative communication (AAC) intervention on the real-life participation in communication activities of eight pre-school children.

The AAC systems used varied and included signs, Picture Exchange Communication System (PECS) and assistive technology. Interventions were carried out by the children’s local speech and language teams who were not given any direction about the form or frequency of intervention sessions. On average the children received around 15 hours of input over a 12 month period, with a range from 4.5 to 24 hours. This included individual work and support for families.

As well as outcome questionnaires parents and speech and language pathologists were asked to describe changes in the child at the 6 and 12 month points.

The authors conclude that the AAC interventions made a ‘real-world’ difference to the children’s communication participation. Comments from parents and therapists support this being true across a range of communicative functions, intelligibility and peer interaction.

 


Things you may want to look into:

Early Intervention and AAC: What a Difference 30 Years Makes

Enhancing the Alternative and Augmentative Communication Use of a Child with Autism through a Parent-implemented Naturalistic Intervention

Teaching Paraeducators to Support the Communication of Young Children with Complex Communication Needs

An Examination of Relations Between Participation, Communication and Age in Children with Complex Communication Needs

The use of augmentative and alternative communication methods with infants and toddlers with disabilities: a research review

 

Added to site May 2016


 

Communicative participation changes in pre-school children receiving augmentative and alternative communication intervention (summary)

Background

Participation or ‘involvement in life situations’ is recognised as vital to children’s development. Children with special needs generally want to participate meaningfully in their communities, however this is not always easy. Children who have significant communication impairments can face limited social interactions which in turn can lead to restricted play skills and possible rejection by their peers. These restrictions reduce opportunities to practise communication skills and so can become a vicious circle.

There are a limited number of studies into the effectiveness of augmentative and alternative communication (AAC) intervention with pre-school children. Those studies that have been carried out tend to focus on particular ‘skills’ or language functions rather than the effect of AAC intervention on participation outcomes in naturalistic settings.

This study aimed to measure communication participation outcomes for eight children who were receiving AAC interventions over a 12 month period.

What did they do?

Eight pre-school children, aged from 16 months to 4 years 11 months, and their families were involved in the study. Prior to intervention the communication levels for all of the children were reported to be either ‘inconsistent sender and/or receiver with familiar partners’ or ‘seldom an effective sender and receiver even with familiar partners’.

Parents completed two outcome measures assessments at the beginning and end of the 12 month intervention period. One of these, the Focus on Communication Outcomes Under Six (FOCUS), was also completed at the six-month point.

The children were introduced to AAC after completion of the initial questionnaires. The AAC systems used varied and included signs, Picture Exchange Communication System (PECS) and assistive technology. Interventions were carried out by the children’s local speech and language teams who were not given any direction about the form or frequency of intervention sessions. On average the children received around 15 hours of input over the 12 month period, with a range from 4.5 to 24 hours. This included individual work and support for families.

As well as outcome questionnaires parents and speech and language pathologists were asked to describe changes in the child at the 6 and 12 month points.

What did they find?

The findings were positive. Six children showed significant improvements in FOCUS scores. Seven children showed improved communication skills in the second outcome measure used, the Ages and Stages Questionnaire-Social/Emotional (ASQ-SE). Only two participants showed improvements in the non-communication elements of the measures, indicating that the changes were likely to be due to the AAC intervention.

The greatest improvements were in receptive language/attention, pragmatic use of communication and social/play, with some variation between the first 6 month period and the second.

Conclusions:

The authors suggest the AAC interventions made a ‘real-world’ difference to the children’s communication participation. Comments from parents and therapists support this being true across a range of communicative functions, intelligibility and peer interaction.

Cautions:

This study involved only a small number of children and its findings might not generalise to the wider population. As the intervention was different for each child ‘cause and effect’ conclusions cannot be drawn. More and longer term studies, including measurement of the children’s perceptions and experiences are needed.


Things you may want to look into:

Early Intervention and AAC: What a Difference 30 Years Makes

Enhancing the Alternative and Augmentative Communication Use of a Child with Autism through a Parent-implemented Naturalistic Intervention

Teaching Paraeducators to Support the Communication of Young Children with Complex Communication Needs

An Examination of Relations Between Participation, Communication and Age in Children with Complex Communication Needs

The use of augmentative and alternative communication methods with infants and toddlers with disabilities: a research review

Added to site May 2016


 

Comparison of Communication using an iPad and a Picture Based System (short summary)

The communication behaviours of five pupils with ASD and/or learning disabilities were compared using either a picture symbol communication system or the 'Pick a Word' app on the iPad.

The authors found that use of the iPad did not detract from the pupil's communication; the number of communication behaviours either increased or stayed the same.

They also suggest that though iPads are now readily available they are not necessarily better than other speech generating devices and more research is needed into comparing the systems.


Things you may want to look into:

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

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

The iPad and Mobile Technology Revolution: Benefits and Challenges for Individuals who require Augmentative and Alternative Communication

Added to site March 2014


Comparison of Communication using an iPad and a Picture Based System (summary)

Background AAC interventions have been shown to improve social and communication skills in young people with Autism Spectrum Disorder (autism) and other developmental disabilities. Systems which include visual symbols might appeal to the visual strengths of some people with autism and systems such as the Picture Exchange Communication System (PECS) have been found to be effective for many people in this group.

Pictures and symbols can also be used on some speech generating devices (SGDs) and these have been found to be beneficial in improving communication and decreasing inappropriate behaviours in young children with autism.

The increased availability of mobile technology means that SGDs and apps are readily available to people with autism.

What was the aim of the study? The aim was to investigate the use of the iPad as a communication device and to compare this to the use of a picture communication system for young people with autism and developmental disabilities.

What did the authors do? Five children who were attending a summer school for pupils with learning disabilities were selected. They were aged between 8 and 11 and had a variety of disabilities. They all used some sort of picture communication system and had delayed receptive and expressive language skills.

The study took place at snack time during the summer school. The students were required to request one of 3 snack choices and a drink, using either single words or combinations including 'I want' and 'more' using either their established picture communication system or an iPad app called 'Pick a Word' which activated a spoken output or highlighted the select picture depending on whether the picture was touched and released or touched and held.

As the iPad was a novel system for all of the participants they were all given individual training in how to use it prior to the trial.

The two different communication systems were used at snack time on alternate days and each system was used on at least 3 days.

The researchers compared the frequency of the students' communication behaviours when using the two systems.

Cautions The comparison of the systems was limited to a single situational context away from the pupil's usual school setting and only requesting behaviour was assessed.

In addition the participants were already skilled in the use of the picture based systems prior to the trial, but the iPad was new to them.

Different types of symbolic representations were used on the two different systems and one might have been preferred over the other. It would be useful for future research to use the same type of symbols when comparing devices or systems.

Conclusions The authors found that use of the iPad did not detract from the pupil's communication. Communicative behaviours either stayed the same or increased in all cases.

Both systems needed preparation time from teachers and training to enable pupils to use them and within this study teachers preferred to iPad as it was felt to be more convenient to prepare and to move about and use in different settings.

They also suggest although iPads are easily and, relatively, cheaply available, this is does not mean they are necessarily better than other SGDs. They suggest that more research is needed to compare mobile technology to other currently available SGDs.


Things you may want to look into:

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

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

The iPad and Mobile Technology Revolution: Benefits and Challenges for Individuals who require Augmentative and Alternative Communication

Added to site March 2014


Creating communicatively accessible healthcare environments: Perceptions of speech-language pathologists (short summary)

Evidence is growing of the need to make changes in healthcare settings to support people who have communication difficulties, but it is unclear whose responsibility this should be. This study used focus groups to investigate the views of fifteen speech and language pathologists (SLPs) in one Australian state about whether they felt able to take on the role of modifying the wider healthcare environment and whether they believed it was part of their remit alone or should be shared more widely with other professionals.

The SLPs recognised the 'great potential of communicatively accessible environments' but felt that they could not create these without wider support. The authors agree with the suggestion that there could be a role for a 'public health communication professional' to develop better provision for patients who have communication disabilities.

Further work is needed to look into the development of 'communication resource toolkits' for use in hospitals and to engage all staff in training and support for using the systems, particularly where enabling patients to communicate more effectively might impact on the workload of nursing or healthcare staff by increasing the demands made on them.


Things you may want to look into:

Communication boards in critical care: patients' views

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Light Technology Augmentative Communication for Acute Care and Rehab Settings

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology

Nursing the patient with severe communication impairment

Added to site Dec 2015


Creating communicatively accessible healthcare environments: Perceptions of speech-language pathologists (summary)

Background

The World Health Organisation's definition of disability identifies two separate but interacting causes of disability; a person's impairment and their environment. The level of any individual's communication disability will depend on not only the severity of their communication impairment but also on factors such as the familiarity of their communication partner, levels of background noise, presence or absence of communication aids, complexity of spoken and/or written language etc. Environmental factors can have both positive and negative effects on the ability to communicate effectively.

Many people with different types of communication impairment have reported difficulties in communicating about their healthcare and in healthcare environments. The effects of this can be significant, ranging from an inability to have basic needs met to being at risk of experiencing serious, preventable adverse events. It has also been found that people with communication disabilities are less satisfied with their healthcare, possibly meaning they are less likely to trust of follow healthcare recommendations.

Evidence is growing of the need to make changes in healthcare settings to support people who have communication difficulties, but it is unclear whose responsibility this should be. This study investigated the views of speech and language pathologists (SLPs) in one Australian state about whether they felt able to take on the role of modifying the wider healthcare environment and whether they believed it was part of their remit alone or should be shared more widely with other professionals.

What did they do?

Fifteen SLPs working in hospital settings took part in a series of focus groups to consider whether they felt that working to create a communicatively accessible healthcare environment would be useful and, if so, who within the settings should address the issue. The focus groups were videoed and recorded and the data gathered was analysed into a number of themes.

What did they find?

The researchers found that the SLPs who took part in the study had a broad view of a communicatively accessible environment which would benefit a wide range of people, beyond those with aphasia or intellectual disability. They also identified a wide range of possible benefits for service providers including SLPs.

The findings were divided into two main sections each with a number of sub-themes. The first was the SLPs beliefs about the benefits of creating communicatively accessible healthcare settings, the second their perceptions of how to create these environments, including the role of the SLP.

The participants that those who might benefit potentially included all patients who used the settings, those with low levels of literacy or for whom English was not a first language, as well as people with specific communication impairments. It was also suggested that there would be benefits for healthcare administrators in improving person-centred care and reducing adverse events and complaints, and that all healthcare providers would benefit including SLPs who might benefit from improved perceptions of their role by others and from the opportunity to develop more communication resources to be widely shared in the community as well as hospital settings.

When considering how the creation of communicatively accessible environments could be achieved three main subthemes were identified; having the necessary resources easily available on wards at all times, having skilled, knowledgeable and supportive healthcare workers who see the resources as relevant and who are willing to use them and having systems in place to support the setting and evaluate the effectiveness of the strategies used.

Conclusions:

Although the SLPs felt that their role in creating a communicatively accessible environment was important they believed there needed to be a wider range of professionals and systems involved if it was to be successful. Further work is needed to look into the development of 'communication resource toolkits' for use in hospitals and to engage all staff in training and support for using the systems, particularly where enabling patients to communicate more effectively might impact on the workload of nursing or healthcare staff by increasing the demands made on them.

The SLPs recognised the 'great potential of communicatively accessible environments' but felt that they could not create these without wider support. The authors agree with the suggestion that there could be a role for a 'public health communication professional' to develop better provision for patients who have communication disabilities.

Cautions:

The participants in the study were a self-selected group who were interested in the topic being discussed, they therefore might not reflect the views of a wider range of SLPs. It is possible that in focus groups participants felt pressured to agree with the majority view, however the opportunity to provide anonymous feedback on the written summaries of group discussions should have reduced this possibility.


Things you may want to look into:

Communication boards in critical care: patients' views

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Light Technology Augmentative Communication for Acute Care and Rehab Settings

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology

Nursing the patient with severe communication impairment

Added to site Dec 2015


Developing language in a developing body (short summary)

In this paper, the author argues that there is a relationship between the motor skills and experiences of infants and their development of language and communication. Events in motor development may give infants the opportunity to practice skills that they later utilize in language development; for example, rhythmic arm movements such as hand banging may let infants practice the skills of performing highly timed movements which is then applied to babbling. Early motor experiences may also change the way an infant interacts with her body; for example, learning to sit unaided allows infants the breath control to produce new sounds in longer combinations. These types of motor experiences contribute to language development in typically developing children but remain only one aspect of the many skills necessary for successful language acquisition.


Things you may want to look into:

developmental milestones

AAC and young children with disabilities - review (short summary)

Children's joint attention in AAC (short summary)

Added to site August 2013


Developing language in a developing body (summary)

What was the aim of the study? This paper sets out the idea that the motor skills and experiences of infants in the first eighteen months of life are related to language development.

Why was the paper written? The author believes that language development should be viewed within the context of the developing body of an infant. In particular, the author argues that early motor experiences give infants the opportunity to practice skills that contribute to the development of language and communication.

What did the author do? The author reviewed literature on this topic and interpreted findings that support her claim. Importantly, the author did not perform an experiment or collect any new data for this paper. She does NOT claim that motor experiences cause language development in any way: she argues that motor experiences are part of the developmental experiences of an infant who is learning to communicate.

What did the author find? The author provides three examples that motor skills provide infants with the opportunity to practice certain skills before they are applied to language. First, infants engage in rhythmic arm movements such as hand banging around the time that they produce recurring babbling sounds. The tightly timed actions of arm movements may contribute to the development of actions displayed in babbling.

Second, infants learn to act on objects in increasingly sophisticated ways as their first words emerge. Infants first experiences with object manipulation usually involves taking objects apart, but infants then learn to put objects together. This continues with infants learning that their actions can be undone; for example, a bead that is placed inside a cup can then be dumped out of the cup. These skills allow infants to perform combinations of actions that take on increasingly specific meanings according to the context. Attaching mental meanings to specific referents is shared with word learning.

Third, infants display actions called recognitory gestures which show that they understand the specific meaning of an item. For example, an infant may pick up a toy telephone and place it to her ear or pick up a cup and touch it to her lips without drinking. These actions demonstrate that a child understands the specific purpose of the telephone and cup. Development in this area proceeds with infants carrying out these actions in different contexts, from different viewpoints and with substitute objects. By this practice, infants learn that meanings depend on context and that the same meaning may be applied to different objects in different contexts. At this time of motor development, infants use their first words in varied contexts. Thus, the general ability to use symbols which is necessary for language acquisition, may be rooted in motor development.

The author also provides three examples that acquisition motor skills contributes to the development of communication. First, there is evidence that infants' ability to follow the eye gaze of others is related to their experience of crawling. This may be explained by the change in linguistic input that infants receive when they begin independent movement. When infants begin to crawl, they receive language input from a distance source, as adults are apt to distract the infants from potential hazards.

Second, there is evidence that when infants learn to walk, they spend more time handling objects and sharing objects with their caretakers. Walking allows infants to use their hands, move in an efficient way and gain a better vantage point on their environment, and this affects the interactions and objects available to infants to experience.

Third, when infants are able to sit up unsupported, they can produce a variety of sounds that were impossible when lying down. The sitting position allows a free ribcage and better breath control, and this contributes to the increased vocalisations and production of consonant sounds at this stage. Also, mouthing objects can affect infants' familiarity with the sounds that they are able to produce.

In these ways, motor development influences infants' development of language and communication.

Cautions: The author does not argue that motor experiences are necessary or sufficient for language development. That is, the development of language and communication can occur without these typical motor experiences, and many other factors are required for language acquisition in addition to the motor skills reviewed in this paper. Motor skills are just one component that, in typically developing children, participate in language development.

Conclusions: In this paper, the author provides evidence that there is a relationship between development in motor skills and language. Some motor skills, such as arm movements, object manipulation and gestures, give infants the opportunity to practice skills that later contribute to language development. Other motor experiences, such as crawling, walking and sitting, change infants' experiences with their bodies and environments in ways that contribute to language development.


Things you may want to look into:

developmental milestones

AAC and young children with disabilities - review (summary)

Children's joint attention in AAC (summary)

Added to site August 2013


Effects of parent instruction on the symbolic communication of children using augmentative and alternative communication during storybook reading (short summary)

The authors investigated the effect of training mothers of children with little or no functional speech in the use of the Improving Partner Applications of Augmentative Communication Techniques (ImPAACT) program, and looked into how this affected their children's use of communicative turn-taking when reading story books together.

They found that there were significant benefits for all of the mother/child pairs involved in the study. All of the children at least doubled the number of communicative turns they took and maintained this increase over a period of up to eight weeks after the intervention. The mothers all gave their children more opportunities to be involved in the story-reading and would have liked further training to generalise the strategies to other activities.


Things you may want to look into:

Barriers to Participation in Kindergarten Literacy Instruction for a Student with Augmentative and Alternative Communication Needs

Clinical discourse and engagement during shared storybook reading in preschool groups

Home literacy predictors of early reading development in children with cerebral palsy

Added to site July 2014


Effects of parent instruction on the symbolic communication of children using augmentative and alternative communication during storybook reading (summary)

Background
Story books are very important in developing early language skills for all children. Children with telling than children without disabilities due to adult communication partners not facilitating their communication behaviours.

What was the aim of the study?
The authors wanted to study the effects of instruction for parents of children who use AAC in use of the Improving Partner Applications of Augmentative Communication Techniques (ImPAACT) program and to research how this influenced the use of communicative turn-taking of their children when reading story books together.

ImPAACT is an 8 stage program teaching communication partners to facilitate the early language and communication skills of children who use AAC by supplementing the adult's spoken language with use of the child's speech generating device (SGD) and building pauses into interactions to allow the child time to respond.

What did the authors do?
Six mother/child pairs took part in the study, the children were selected by a number of criteria including: having severe, congenital motor speech impairment without significant hearing or visual difficulties, using AAC systems with at least 10 symbols, being able to listen to simple stories and answer wh-questions based on these, showing low levels of communicative turn-taking during book reading.

Three sets of books were used throughout the study and individualised communication boards were produced for each. These varied slightly between the children depending on which SGD they used and their individual needs.

Baseline information was gathered about the mother's interaction strategies and the children's number of communication turns when story books were shared in the pair's usual way.

The mothers were offered individual instruction sessions in ImPAACT program and ways to encourage increased communicative turn-taking by their children.

Following the instructional sessions the intervention sessions were 10-minute long story-reading sessions for each pair, without any feedback being given to the mothers. These continued until each child took at least twice as many communication turns as their highest number in the baseline assessment, for three consecutive sessions.

After intervention there was a generalisation phase of two sessions 1 to 2 weeks after completion of the intervention phase.
In an additional maintenance phase the mothers use of the taught strategies and the children's turn-taking patterns were monitored up to 8 weeks after the generalisation.

What did they find?
None of the mothers had used the strategies that were being investigated at the baseline assessment, but all used it with at least 90% accuracy during the intervention, generalisation and maintenance sessions.

All of the children at least doubled their baseline number of communication turns within three intervention sessions and continued to do so throughout all phases of the study.

All of the children showed improved communicative turn-taking skills, with most needing only the minimal level of prompting, if any. Only one child needed a slightly higher level of prompting.

Cautions:
The number of participants was small and the study had a narrow scope, it only looked at story book reading at home.
Giving parents access to these strategies also means they need support to develop other skills such as how to create additional boards to continue to be able to use the strategy.

Conclusions:
The strategies used benefitted all of the participants in the study, however the rapid rate of improvement in the children's skills indicates that the improvement might be because the children were given additional opportunities to demonstrate abilities they already had rather than learning brand new skills. Communication partners were taught to provide the children with 'expectations' and 'opportunities' to take turns, they did not necessarily teach them how turn-taking works.

The parents felt that the instruction was beneficial and would have liked support in developing the use of the strategy to other contexts and activities.


Things you may want to look into:

Barriers to Participation in Kindergarten Literacy Instruction for a Student with Augmentative and Alternative Communication Needs

Clinical discourse and engagement during shared storybook reading in preschool groups

Home literacy predictors of early reading development in children with cerebral palsy

Added to site July 2014


Evaluating the Impact of AAC Interventions in Reducing Hospitalization-related Stress: Challenges and Possibilities (short summary)

Hospital visits and procedures can be distressing for children and their families and an inability to communicate feelings about this or to understand what is happening can increase stress.

Hospital staff often rely on parents of children with communication difficulties to act as interpreters and have little knowledge of augmentative and alternative communication (AAC) and communication disabilities.

This paper looks into some of the ways in which the effects of using AAC interventions in health care can be measured.

The authors used two measures of anxiety and stress to investigate the effects of introducing AAC strategies into a children’s day surgery unit. Staff were trained to use pictorial supports to explain what was going to happen to children and to allow them to ask questions about the procedure. Measurement of salivary cortisol levels was use to assess stress, an adapted anxiety scale was used and children’s need for premedication due to anxiety or tension was considered in evaluating the effects of the AAC intervention.

Levels of parental stress and anxiety were also investigated.

In general children who had been offered the opportunity to use AAC supports with trained nursing staff showed lower levels of stress and anxiety than those in the comparison group who had not been given this support.

The study showed that measures routinely used in healthcare can be used to evaluate the effects of access to AAC strategies on children with communication disabilities if they are adapted appropriately.

 


Things you may want to look into:

Patient Communication in Health Care Settings: new Opportunities for Augmentative and Alternative Communication

A Metasynthesis of Patient-Provider Communication in Hospital for Patients with Severe Communication Disabilities: Informing New Translational Research

Nursing the patient with severe communication impairment

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Communication rights and disability online: Policy and technology after the World Summit on the Information Society

Added to site August 2016


 

Evaluating the Impact of AAC Interventions in Reducing Hospitalization-related Stress: Challenges and Possibilities (summary)

Background

A lot of children with communication difficulties need to use hospital services frequently and have a legal right to “be informed, to communicate, and to express opinions using their preferred means of communication including augmentative and alternative forms” (United Nations 2006). However hospitals often rely on parents to act as interpreters and have little knowledge of augmentative and alternative communication (AAC) and communication disabilities.

Hospital visits and procedures can be distressing for children and their families and an inability to communicate feelings about this or to understand what is happening can increase stress.

The reduction of stress and anxiety levels has been found to be beneficial in successful rehabilitation.

There has been limited research into the possible value of AAC use in hospital with children with long term conditions, most is related to adults. The few studies that have been carried out have indicated that AAC can be successfully used in hospital settings. They also suggest that there is a need for more information about communication disabilities and a consistent approach to the use of AAC strategies in healthcare settings.

This paper looks into some of the ways in which the effects of using AAC interventions in health care can be measured.

What did they do?

The KomHIT (communication in care settings using communicative support and IT) model was used in a children’s day surgery ward and the effects of its use on stress and anxiety in children and their parents were measured using an anxiety inventory. The authors also investigated whether changes in stress levels could be measured using levels of salivary cortisol.

The KomHIT intervention is designed to support the communicative rights of children during medical and dental care. It aims to promote generalised use of AAC strategies, usually as pictorial supports, routinely in healthcare for children. The intervention includes educational resources for use with staff and communication tools and materials.

A month before the intervention period began all nursing staff in the day surgery unit attended a one day education course about communication. AAC resources designed to suit the needs of the ward were presented and demonstrated with staff given opportunities to practise their use. These same AAC resources were used in the intervention, being sent to each family before they attended hospital. Included among these were a visual schedule with six pictures of the main things that would happen during the child’s appointment and a 30 symbol communication board to support conversation about day surgery.

Parents were told how to use the materials and encouraged to do so before and after surgery as well as taking them to the hospital.

The nurses used visual schedule books to explain what would happen to each child and to allow the child to ask questions or comment. The children removed pictures after each step was complete. The nurses also had access to the communication board but reported that the schedules were most useful.

25 children, aged between 3 and 15, and their families took part in the study. 18 were assessed before the intervention began, the comparison group, and 7 after implementation of the intervention.

Samples of the children’s saliva were collected on admission, during the day and later at home for analysis of cortisol levels. A modified form of an anxiety assessment was used with the children on admission and discharge. The parents completed the same assessment in an unmodified form. The children’s medical records were also checked retrospectively to see if they had needed to be given premedication as this was done for children identified by nurses as anxious and/or tense.

What did they find?

15 children gave saliva samples. Informal feedback from staff suggested that the schedule for the saliva test procedure was useful.

The salivary cortisol results for the two groups of parents, those included in the intervention and the comparison group, were similar. There were some differences between the two groups of children, being lower for the intervention group, though some of their results could not be used.

The anxiety measurement did not show significant differences between groups of parents or children.

None of the seven children in the intervention group were found to have needed premedication, five of the comparison group had been give some form of premedication.

Conclusions:

The study showed that measures routinely used in healthcare can be used to evaluate the effects of access to AAC strategies on children with communication disabilities if they are adapted appropriately.

The authors also suggest that all children, with and without communication disabilities should have access to AAC strategies to support their communication in hospital and that the impact of this should be evaluated.

Cautions:

The study had a small number of participants and many uncontrolled variables. Some possible participants opted not to take part in the research study as they felt the extra elements would be too much in addition to the surgery.

As some cortisol measures has to be excluded it is possible that this might not be the best physiological measurement to use to monitor stress.

The limited number of questions in the adapted anxiety measure and the small number of participants make interpretation of the results difficult and, even with pictorial stimuli children with cognitive difficulties might have found it difficult to understand.

 


Things you may want to look into:

Patient Communication in Health Care Settings: new Opportunities for Augmentative and Alternative Communication

A Metasynthesis of Patient-Provider Communication in Hospital for Patients with Severe Communication Disabilities: Informing New Translational Research

Nursing the patient with severe communication impairment

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Communication rights and disability online: Policy and technology after the World Summit on the Information Society

Added to site August 2016


 

 

 

 

Evaluation of language and communication skills in adult key word signing users with intellectual disability: Advantages of a narrative task (short summary)

Narrative skills are those skills needed to tell stories or recount things that have happened. The ability to use narrative depends on a wide range of language, communication and cognitive skills. The use of narrative can be a way of gathering information about language content and form in a short period of time but in the main this type of task has not been used with adults with intellectual disability (ID), particularly those who use augmentative and alternative communication (AAC). Many adults with ID who use AAC use key word signing (KWS), meaning they use spoken language with the most important words being supported by manual signs. This group have generally been excluded from research into narrative tasks.

People who scored poorly on standard language tests often managed to express themselves at a higher level than expected when using AAC, so a narrative task might give a better indication of functional use of language with KWS than standard tests.

The authors developed a narrative task to gather information about the content and form of language used by adults with ID who used KWS. The use of a narrative task was found to be useful and valid with adults with ID and could help to evaluate both verbal language and manual signing. It could identify communication strengths and weaknesses and could be expanded to other forms of AAC and to predict the ability of people to learn to use KWS for functional communication.

The authors believe that narrative tasks should be used when evaluating the language and communication abilities of KWS users.


Things you may want to look into:

Narrative Therapy

Added to site Dec 2015


Evaluation of language and communication skills in adult key word signing users with intellectual disability: Advantages of a narrative task (summary)

Background

Narrative skills are those skills needed to tell stories or recount things that have happened. The ability to use narrative depends on a wide range of language, communication and cognitive skills. The use of narrative can be a way of gathering information about language content and form in a short period of time but in the main this type of task has not been used with adults with intellectual disability (ID), particularly those who use augmentative and alternative communication (AAC). Many adults with ID who use AAC use key word signing (KWS), meaning they use spoken language with the most important words being supported by manual signs. This group have generally been excluded from research into narrative tasks.

The use of narrative tasks with adults who use KWS might have advantages over more traditional language assessments as it can take a shorter time and is more like natural communication and everyday use of language.

The authors noted that people who scored poorly on standard language tests often managed to express themselves at a higher level than expected when using AAC, so a narrative task might give a better indication of functional use of language with KWS than standard tests.

What did they do?

A narrative task for adults with ID who used KWS was developed to gather information about language content and form, including the use of KWS.

The task, which involved retelling a story with picture support, was used with 40 adult KWS users who were also assessed on a range of language tests and in conversation with a speech and language therapist. The narrative task and conversation were recorded and transcribed, looking at both spoken language and manual signs.

What did they find?

They found a strong link between the results of the formal language assessments and the verbal elements of the narrative task and conversation, but the opposite was true of the manual signing elements of both assessments.

However the manual signing element of the narrative task did not match with the formal test scores, indicating that the formal assessments, even when non-verbal subtests were included, did not reflect the level of KWS supported communication skills.

Conclusions:

The use of a narrative task was found to be useful and valid with adults with ID and could help to evaluate both verbal language and manual signing. It could identify communication strengths and weaknesses and could be expanded to other forms of AAC and to predict the ability of people to learn to use KWS for functional communication.

The authors believe that narrative tasks should be used when evaluating the language and communication abilities of KWS users.

Cautions:

This study did not look into things such as test-retest consistency and inter-rater reliability when using the narrative task.


Things you may want to look into:

Narrative Therapy

Added to site Dec 2015


Exploring Communication Assistants as an Option for Increasing Communication Access to Communities for People who use Augmentative Communication (short summary)

13 communication assistants were trained to work with 9 people who use AAC (PWUAAC), to support their communication within their local communities and to increase opportunities for and quality of interactions with other communication partners.

AAC users used the assistants to help them prepare for communication events, support them in making phone calls, writing and using the internet and communicating directly with familiar and unfamiliar communication partners and other PWUAAC, over a 9 month period.

The PWUAAC found the use of trained communication assistants to be very helpful and wanted the project to continue. Communication partners within the community also thought it was beneficial.


Things you may want to look into:

A qualitative study of adult AAC users' experiences communicating with medical providers 

Post-School Quality of Life for Individuals with Developmental Disabilities Who Use AAC 

A summary of the articles of the UN Convention on the Rights of Persons with Disabilities 

Added to site September 2014


Exploring Communication Assistants as an Option for Increasing Communication Access to Communities for People who use Augmentative Communication (summary)

Background

Community participation and inclusion are fundamental principles within the UN Convention on the Rights of Persons with Disabilities, and communication is central to this process. It is therefore important to identify supports needed by people who use AAC (PWUAAC) to enable them to fully participate in society and to communicate with others within their communities.

People with complex communication needs (CCN) report a number of communication barriers with unfamiliar people, which can increase feelings of social isolation.

PWUAAC often rely on others to help them communicate with unfamiliar communication partners.

This paper looks at a pilot project to provide trained communication assistants to PWUAAC, to assist them in communicating within their communities.

What did the authors do?

The project took place in Canada over a period of 9 months.

A group of 9 PWUAAC were offered up to 14 hours per month each, of trained communication assistant time to help support their communication with other people, either face-to-face, over the telephone or in written communication. The assistants were to:

The nine participants had all expressed a need for communication assistance within their communities and used a range of communication methods and skills.

Thirteen communication assistants were recruited; the majority were students with no previous experience or training in working with PWUAAC.

Each participant was interviewed to find out their barriers to communication and the situations in which they wanted support or help.

The assistants were given 30 hours of classroom based training and 5 to 20 hours of practical training including coaching with PWUAAC.

The AAC users were also given training including group and individual sessions.

Each participant was paired with two communication assistants for the duration of the project. They could book an assistant, identifying on the booking system the type of support they required and the location.

What did they find?

The needs assessment found that the highest areas of need for communication support were meeting new people and communicating in a group, which might include other PWUAAC.

There were also requests for support at appointments and in specific social, educational and work-related activities, communicating over the telephone and with writing and using the internet.

8 of the 9 participants identified used the service, but all under-used their allocated time. The amount of time used increased for all participants over the duration of the project.

Overall the assistants' time was used as follows:

15% - preparing for communication events, including pre-programming messages into voice output devices

23% - making phone calls, assisting with writing and supporting internet searches

62% - communicating directly in face-to face interactions with either familiar or unfamiliar communication partners and other PWUAAC.

Participant feedback showed that all AAC users who used the service reported a high level of satisfaction and wanted the project to continue.

Feedback from community based communication partners was also positive.

Cautions

The number of participants and assistants in the project was small and so they cannot be said to reflect the views of all PWUAAC.

Training was not offered to the AAC users existing support network of family friends and paid staff to support them in facilitating communication rather than paid assistants.

The assistants were all from similar educational backgrounds, no consideration was given to the impact of different backgrounds and experiences on this type of service.

Further research into the training offered to AAC uses and communication assistants is needed.

The project took place over a relatively short time period. A longer term project and ongoing monitoring is needed.

Conclusions

The researchers believe that the project demonstrated that the use of trained communication assistants can reduce barriers to communication for PWUAAC within their communities and increase their confidence and independence in participating in their communities.


Things you may want to look into:

A qualitative study of adult AAC users' experiences communicating with medical providers 

Post-School Quality of Life for Individuals with Developmental Disabilities Who Use AAC 

A summary of the articles of the UN Convention on the Rights of Persons with Disabilities 

Added to site September 2014


Eye Gaze Technology as a Form of Augmentative and Alternative Communication for Individuals with Rett Syndrome: Experiences of Families in The Netherlands (short summary)

Background

This study looked into the use of eye gaze and eye tracking technology from the point of view of families of people with Rett Syndrome (RTT) in The Netherlands.

Over recent years the use of eye-gaze and eye tracking technology to support communication for people with RTT has increased with many families wanting high-tech eye gaze systems. Eye gaze is often reported as the most frequent form of expressive communication for people with RTT and eye tracking control can potentially give access to computers and high tech voice output communication aids (VOCAs).

The study found that most of the families surveyed who had experience of an eye gaze system were happy with it despite some frustrations.

Suggestions are made regarding the need for further research, development of loan banks, better supported trials of devices, training for families and the need for support from knowledgeable professionals. Further investigation is also needed into the reasons for families of people over the age of 25 being less interested in this technology.


Things you may want to look into:

Communication intervention in Rett syndrome: a survey of speech language pathologists in Swedish health services

Communication Intervention to Teach Requesting Through Aided AAC for Two Learners With Rett Syndrome

Rett UK

Rett Syndrome information

Added to site May 2016


 

Eye Gaze Technology as a Form of Augmentative and Alternative Communication for Individuals with Rett Syndrome: Experiences of Families in The Netherlands (summary)

Background

Over recent years the use of eye-gaze and eye tracking technology to support communication for people with Rett syndrome (RTT) has increased with many families wanting high-tech eye gaze systems.

People who have RTT are commonly non-verbal and rely on behaviours being interpreted as communication attempts by carers and communication partners. Reliable assessment of levels of understanding or cognitive ability is difficult to achieve in this population. Eye gaze is often reported as the most frequent form of expressive communication for people with RTT and eye tracking control can potentially give access to computers and high tech voice output communication aids (VOCAs).

There is limited published research into the use of this type of system for people with RTT.

What did they do?

This study looked into the use of eye gaze and eye tracking technology from the point of view of families, considering the following questions;

If so

 

190 Dutch families of people who had RTT were invited to complete an on-line survey. 67 families took part and 63 answered questions related to eye gaze technology.

What did they find?

20 families had past or current experience of using eye gaze systems, 40 families has never used this type of technology. Most of the twenty had had a short term trial of a device and all but two of these had requested funding for an eye gaze system of their own.

Of the families who had not trialled an eye-gaze device 28/43 wanted to do so, 23 of these people with RTT were under the age of 25. 10/13 people whose families did not want to trial the system were over 25.

The trial devices were found to have been used more consistently at home than in school, with custom made pages. On-going support was variable and all parents were responsible for programming devices themselves.

A large majority of families could see progress in their child’s levels of awareness and engagement and their ability to express themselves following provision of an eye-gaze system. They also felt there was increased understanding of language.

Families wanted; more support from suppliers in planning and preparation for a loan, longer trial periods and trials of a wider range of systems, increased knowledge of the technology among therapists and other professionals so that they could provide better support and cheap training workshops.

The value of self-help groups and networks was widely recognised.

Conclusions:

Most families who had experience of an eye gaze system were happy with it despite some frustrations. There is a need for further research into the use of this technology for individuals with RTT. The establishment of longer, well-supported trials and the development of a loan bank of equipment is identified as potentially beneficial.

Levels of training to support families are vital in developing successful use of these devices, as is the availability of knowledgeable professionals.

The families who took part in this survey would have liked the systems to be provided with preinstalled, personalised vocabularies and software to allow for development. The time needed to create these individually from scratch led to frustration. Commercially available pages and software widely used as a starting point in other countries are not available in Dutch.

More investigation is needed into the reasons for families of people over the age of 25 not being interested in this technology.

Cautions:

The sample use in this survey was small and restricted to The Netherlands. More follow up is needed.


Things you may want to look into:

Communication intervention in Rett syndrome: a survey of speech language pathologists in Swedish health services

Communication Intervention to Teach Requesting Through Aided AAC for Two Learners With Rett Syndrome

Rett UK

Rett Syndrome information

Added to site May 2016


 

Eye gaze technology: a South African perspective (short summary)

This study uses two South African case reports to look at Bronfenbrenner’s biological theory of human development as a framework for describing the ways in which environmental influences can support or hinder the use of assistive technology, specifically eye-gaze controlled communication for young children with disabilities.

They identify factors in a number of different ‘systems’ around the child that could influence how successful they were in developing use of high tech systems for communication.

They conclude that when a child is being introduced to a high tech communication device they and their family need support from widespread systems within their environment. Without this success can be limited.

The necessary supports include specialists visiting the child at home and in school to consider issues in a variety of settings. In addition, when resources are limited, informal supports might need to be sought.

Developing links with other families using similar technology can be positive in reducing isolation and offering emotional and practical support.


Things you may want to look into:

Alternative service delivery models for families with a new speech generating device: Perspectives of parents and therapists

Designing AAC Research and Intervention to Improve Outcomes for Individuals with Complex Communication Needs

 

Added to site May 2016


 

Eye gaze technology: a South African perspective (summary)

Background

This study looks at Bronfenbrenner’s biological theory of human development as a framework for describing the ways in which environmental influences can support or hinder the use of assistive technology, specifically eye-gaze controlled communication for young children with disabilities. The theory uses the ‘model of the ecology as nested systems’, dividing influencing factors into:

Microsystems – the immediate environment within which the child functions.

Mesosystems – the quality and quantity of connections existing between different microsystems.

Exosystems – settings that influence the child’s development but without direct participation by the child.

Macrosystems - factors within the specific culture within which the child lives.

What did they do?

Two case reports are given. These relate to young girls whose needs and disabilities superficially appear similar. Both children were preliterate and had been assessed as being likely to benefit from eye-gaze technology to access communication. The authors considered various barriers to the technology being provided and successfully used, and the possible reasons for different outcomes within the two cases. Their findings were analysed using Bronfenbrenner’s bioecological model, looking at risks and opportunities that might have influenced participation and outcomes for the children and their families.

What did they find?

One child was found to not be using the system at all for communication and the other in a limited way.

The children’s microsystems included home and educational settings and communication partners. Both families had to fund the devices independently, influencing their choice of system, and had limited support to set them up and troubleshoot problems. The mother of the child who did not use her system for communication felt it was less effective than their established ‘no tech’ communication system and thought that they would use it for communication when her daughter became literate. In the other case the mother was more confident in programming the device and had links with school to plan grids.

All communication partners for both girls felt they needed more support and training in setting up and using the device.

The immediate environment also influenced use. Lack of space and appropriate mounting systems meant that consistent use was difficult.

The mesosystems (links between different microsystems) were limited for one child. She did not attend school and eye-gaze targets were not integrated with speech and language therapy (SLT) goals. Difficulties with mounting and transport meant that the device was not taken on family visits and outside activities.

The second child had strong links between home and school and the parents worked with her each day.

The authors attribute the differences in functional use of the system largely to the differences in support at this level.

The main differences in the exosystems for the two children was one mother’s confidence in programming grids to support the system’s use in school due to her skills as a computer programmer. Neither family accessed support groups, but the family of the child who attended school had more informal support available.

The macrosystem i.e. the culture of South African services for people with disabilities, did not strongly support the provision of high-tech communication aids and has limited professional expertise in this field. The state uses a medical model of disability, looking at what the person cannot do rather than what they can. There are few environmental adaptations and there is generally limited access to community activities thus reducing opportunities to use AAC in a variety of settings and with people other than familiar communication partners.

Conclusions:

When a child is being introduced to a high tech communication device they and their family need support from more widespread systems. Without this success can be limited. The necessary supports include specialists visiting the child at home and in school to consider issues in a variety of settings. In addition, when resources are limited, informal supports might need to be sought.

Occasional multi-agency case meetings would also be beneficial to enable joint planning and goal-setting.

Developing links with other families using similar technology can be positive in reducing isolation and offering emotional and practical support.

It is suggested that establishing these things might lead to some increase in the ability to influence future government policy and practice.

Cautions:

The authors note that further research is needed into the barriers to the use of assistive technology within all of the levels described.


Things you may want to look into:

Alternative service delivery models for families with a new speech generating device: Perspectives of parents and therapists

Designing AAC Research and Intervention to Improve Outcomes for Individuals with Complex Communication Needs

Added to site May 2016


 

Fundamentals of the ImPAACT Program (short summary)

This paper provides a brief overview of some of the elements of the ImPAACT (Improving Partner Applications of Augmentative Communication Techniques) program, devised by the authors to support the development of skills in communication partners working with people who use AAC (PWUAAC). Two elements, instructional techniques and structuring interventions are discussed and examples given. Links to several other papers with related content are given. It is reported that the program was found to lead to improvements in both the PWUAAC's communication skills and the communication partners' ability to use the targeted strategies. The changes for PWUAAC included; increased turn-taking, a wider range of vocabulary used and increased length and complexity of messages.


Things you may want to look into:

Effects of parent instruction on the symbolic communication of children using augmentative and alternative communication during storybook reading

The Effect of Aided AAC Modeling on the Expression of Multi-Symbol Messages by Preschoolers who use AAC

American speech-language-hearing association conference, Partner Instruction in AAC: Strategies for Building Circles of Support (external link)

Teaching Partners to Support the Communication Skills of Young Children who use AAC: Lessons from the ImPAACT Program (pdf 344KB, external link)

Added to site October 2014


Fundamentals of the ImPAACT Program (summary)

Background

It is widely acknowledged that working with communication partners is a very important part of AAC intervention programmes for people who use AAC (PWUAAC). However it is not always easy for clinicians to structure these interventions and interactions. The ImPAACT (Improving Partner Applications of Augmentative Communication Techniques) program involves a structured, multistep approach to intervention that can be customised for use with a range of communication partners and PWUAAC, in a variety of contexts, and aims to facilitate functional communication for PWUAAC.

Communication partners have been found to use a number of inappropriate communication behaviours in interactions with PWUAAC. The program tries to overcome this by; selecting appropriate targets for communication partners which are linked to the AAC users' targets, helping effective instructional techniques to be used and structuring training programmes for communication partners.

What was the aim of the study?

This paper describes two elements of the communication partner instruction programme, instructional techniques and structuring interventions.

What did the authors do?

The set of five skills taught to communication partners of children who use AAC are discussed, these include technique to prompt communication and to reinforce communication attempts by PWUAAC. Examples of the 'Read, Ask, Answer' and 'Read, Ask, Answer, Prompt' strategies are given.

The authors also report on five teaching, or instructional techniques used within the ImPAACT program to develop the skills and confidence of communication partners in using the techniques.

What did they find?

Links are given to several other papers which give more detailed findings about the effectiveness of the ImPAACT program. However it is reported that the program was found to lead to improvements in both the PWUAAC's communication skills and the communication partners' ability to use the targeted strategies. The changes for PWUAAC included; increased turn-taking, a wider range of vocabulary used and increased length and complexity of messages.

Cautions:

This paper refers only to children who use AAC, further research is needed into ImPAACT's use with adults who use AAC


Things you may want to look into:

Effects of parent instruction on the symbolic communication of children using augmentative and alternative communication during storybook reading

The Effect of Aided AAC Modeling on the Expression of Multi-Symbol Messages by Preschoolers who use AAC

American speech-language-hearing association conference, Partner Instruction in AAC: Strategies for Building Circles of Support (external link)

Teaching Partners to Support the Communication Skills of Young Children who use AAC: Lessons from the ImPAACT Program (pdf 344KB, external link)

Added to site October 2014


Fundamentals of the ImPAACT Program

TitleFundamentals of the ImPAACT Program
Publication TypeJournal Article
AbstractResearchers widely agree that working with communication partners is a critical component of any AAC intervention program. However, it can be difficult for clinicians to know how to structure this type of indirect intervention to do more than “tell” communication partners of individuals using AAC what they “should” be doing. The ImPAACT Program is one intervention program that has been documented to yield positive results for clients using AAC. The program involves a structured multistep approach to intervention that clinicians can customize for use across a range of communication partners, clients, and instructional contexts. In this article, we provide an overview of the program’s instructional content, approach, and basis of evidence.
AuthorsKent-Walsh, J., and Binger C.
Year of Publication2013
PublicationPerspectives in Augmentative and Alternative Communication
Volume22
Issue1
Pages51-58
ISSN1940-7475 (print); 1098-9056 (online)
Publisher DOIhttp://sig12perspectives.pubs.asha.org/article.aspx?articleid=1813527
Keywords (MeSH)communication, interpersonal relations

Happy and excited: Perceptions of using digital technology and social media by young people who use augmentative and alternative communication (short summary)

The authors used semi-structured interviews to investigate how adolescents and young adults who use augmentative and alternative communication (AAC) feel about the use of digital technology (DT) and online social media (OSM).

They found that the participants had a strong desire to use the internet and the ability to do so had positive effects on a range of feelings about themselves and their social relationships. However lack of access to, or knowledge of, specialised equipment, thus preventing independent use of DT and OSM can create a form of 'digital exclusion' for PWUAAC. In addition poor literacy skills made it difficult to use the systems independently. This is not always being addressed by the website providers despite the fact that they have a duty to 'ensure people have access to cultural materials'.

The research suggests that family support is important in promoting DT use. It also indicates that support is needed from educational settings to reduce the likelihood of digital exclusion for people with CCN.


Things you may want to look into:

Technology for people, not disabilities: ensuring access and inclusion

An examination of relations between participation, communication and age in children with complex communication needs

The Loneliness Experiences of Young Adults with Cerebral Palsy who use Alternative and Augmentative Communication

Learning to use the Internet and online social media: What is the effectiveness of home-based intervention for youth with complex communication needs?

Connecting the AAC Community through Social Media


Added to site August 2015

Happy and excited: Perceptions of using digital technology and social media by young people who use augmentative and alternative communication (summary)

Background

Digital Technology (DT) and online social media (OSM) are now an important part of life for adolescents and young adults. The UK government believes that the use of these can increase opportunities for social inclusion.

Young people with severe motor impairment and complex communication needs (CCN) who use augmentative and alternative communication (AAC) have many challenges that can make social inclusion, in a traditional sense, more difficult than for other people, however the use of DT and OSM has the potential to change this.

Voice Output Communication Aids (VOCAs) and apps have been developed that enable people with CCN who also have literacy problems to use symbolised vocabulary software to post on social media in a text based format.

There is limited research into the use of DT and OSM by people who use AAC (PWUAAC).

What did they do?

The research aimed to; look at the views of PWUAAC regarding accessibility of the internet and OSM and their use of these systems, consider the role and importance of the internet and OSM for self-determination and self-representation and to establish how PWUAAC perceived OSM in terms of social ties.

Twenty five people aged from 14 to 24 were involved in the study. The participants used a range of high and low-tech AAC systems.

Videoed, semi-structured interviews were used to gather data that was analysed into six categories for further analysis.

What did they find?

They found that the participants had a strong desire to use the internet and their self-determination was felt to increase, through giving them more independence to organise their own lives. Participants felt that Facebook particularly increased opportunities for self-representation as they could choose what they posted online. Some felt that other people understood them better in writing than face-to-face. It was also found that the use of OSM made it easier to keep in contact with people and so maintain friendships.

A variety of methods were used to access the technology, but not all participants were aware of the options or had them available. PWUAAC generally valued the ability to access the technology independently, but they often relied on family members or personal staff to produce and share online content.

Conclusions:

Lack of access to, or knowledge of, specialised equipment, thus preventing independent use of DT and OSM can create a form of 'digital exclusion' for PWUAAC. In addition poor literacy skills made it difficult to use the systems independently. This is not always being addressed by the website providers despite the fact that they have a duty to 'ensure people have access to cultural materials'.

The participants used a range of sites typical of people of their age and felt frustrated if they could not go online. They would like to use DT and OSM more frequently than they were able.

The self-representation available through Facebook was viewed very positively, enhancing self-image and helping PWUAAC to be understood by others.

The use of OSM was felt by the participants to increase opportunities to 'talk' to other people more easily than face-to-face and to keep in touch over distance.

The research suggests that family support is important in promoting DT use. It also indicates that support is needed from educational settings to reduce the likelihood of digital exclusion for people with CCN.

Cautions:

The use of narrative techniques to explore the views and perceptions of people with CCN is not an obvious match, but the authors believe it was the 'best fit' for their research objectives.


Things you may want to look into:

Technology for people, not disabilities: ensuring access and inclusion

An examination of relations between participation, communication and age in children with complex communication needs

The Loneliness Experiences of Young Adults with Cerebral Palsy who use Alternative and Augmentative Communication

Learning to use the Internet and online social media: What is the effectiveness of home-based intervention for youth with complex communication needs?

Connecting the AAC Community through Social Media


Added to site August 2015

Initial Insights into Phoneme Awareness Intervention for Children with Complex Communication Needs (short summary)

This study aimed to determine if phoneme awareness skills can be taught to children with complex communication needs (CCN), to observe any transfer effects to tasks that were not directly targeted during the intervention and to their ability to produce and record written words.

Phoneme awareness is the ability to recognise and manipulate the individual sounds in spoken words and is part of the broader phonological awareness that is essential to the development of early reading skills. Children with CCN often have significant and long-term difficulties in the development of literacy; poor phoneme awareness has been suggested as possibly limiting their word recognition and spelling skills.

Two children with CCN took part in the study, with personalised targets based on assessment of their pre-intervention skills. These included improving phoneme identifying skills, increasing letter name and letter sound knowledge, improving phoneme segmentation and manipulation skills and increasing awareness of the relationship between speech and print.


Both participants showed improvements in targeted skills, indicating that children with CCN can benefit from some types of input used to develop the literacy skills of children with a recording disability or spoken language impairment, however children with CCN often take longer to give a response than typically developing peers which means that they might need a longer time to consolidate and generalise skills.

This study provided initial evidence to support the usefulness of phoneme awareness intervention for children with CCN, but further studies are needed.


Things you may want to look into:
An Analysis of Reading and Spelling Abilities of Children Using AAC: Understanding a Continuum of Competence
Introduction to direct/explicit instruction in reading for the struggling reader: Phonemic awareness, phonics, fluency, vocabulary, and comprehension
Teaching Sound Letter Correspondence and Consonant-Vowel-Consonant Combinations to Young Children who Use Augmentative and Alternative Communication
A Developmental Continuum of Phonological Sensitivity Skills
Evidence-based literacy instruction for individuals who require augmentative and alternative communication: a case study of a student with multiple disabilities

Added to site May 2016


 

Initial Insights into Phoneme Awareness Intervention for Children with Complex Communication Needs (summary)

Background

Phoneme awareness is the ability to recognise and manipulate the individual sounds in spoken words and is part of the broader phonological awareness that is essential to the development of early reading skills. Children with complex communication needs (CCN) often have significant and long-term difficulties in the development of literacy; poor phoneme awareness has been suggested as possibly limiting their word recognition and spelling skills.

To read words children need to be able to convert letters (graphemes) into sounds (phonemes) and then blend the sounds together to create words. Children who have poor phoneme awareness often find this difficult.

Children with CCN have reduced or no ability to speak the words themselves, this will reduce the amount of information they are able to store about a words’ makeup in their own mind. Indistinct word production can be difficult to break-up, or segment, into individual sounds and therefore children cannot use the information to further develop literacy skills.

Children with CCN have been found to receive reading and writing teaching that is different from that of typically developing children, both in the amount of time given and the teaching methods used. There is limited evidence regarding ‘best practice’ in these cases.

Generally children with CCN have a more limited experiential language base than their typically developing peers and as they don’t have experience of producing speech patterns orally they might need instruction and practice to recognise the links between speech and the printed word.

It is suggested that in developing reading skills children with CCN should be able to manipulate their own word productions and that phoneme awareness training might be beneficial in helping them acquire more distinct phonological representations of words.

What did they do?

The aims of this study were to determine if phoneme awareness skills can be taught to children with CCN, to observe any transfer effects to tasks that were not directly targeted during the intervention and to their ability to produce and record written words.

Two children, a boy aged 7 and a girl aged 10, took part in the study. Both had CCN, cerebral palsy and poor word decoding skills as measured by a speech to print matching task.

Both used low-tech symbol communication boards. The boy had delayed receptive language levels; expressively he could combine symbols to produce simple phrases. He had some cognitive delay and difficulty retaining new information.

The girl used a switch to access a computer and used eye-gaze to make choices from 4 items. She was said to read books at the 4-6year level but had difficulty recognising vowels and final consonants.

The children were assessed before and after the interventions. Interventions for each child were personalised, based on literacy measures before the intervention began.

Objectives for the boy were to improve his phoneme identifying skills and increase his letter name and letter sound knowledge. Six letters and their corresponding sounds were targeted. He completed seven of eleven planned hours of intervention.

The girl’s intervention programme aimed to improve her phoneme segmentation and manipulation skills and to increase her awareness of the relationship between speech and print. She received the full 11 hours of intervention.

 What did they find?

The boy’s results showed improvement in his ability to match sounds to letters and letters to sounds, and in his knowledge of trained letter names. There was no significant change in his knowledge of trained letter sounds when the written form was presented in a different font or on a different colour card from those used in the intervention. When the same coloured cards used in the intervention were used in the reassessment his responses were much more accurate than when different stimuli cards were used.

There was no improvement in his knowledge of untrained letter names and sounds following the intervention.

The girl demonstrated progress in her ability to ‘track speech sounds with letters’ i.e. identify the position of a sound change in a word and to select the sound needed to make the change.

Her phoneme segmentation skills improved and she was able to transfer the ability to breakdown words into sounds to untaught words with 2, 3 and 4 sounds. Her attempts at non-word spelling showed a decrease over the intervention period, this was linked to a reduction in her use of vowels. Before the intervention she used /u/ in 4/5 words and got two of these correct. After the intervention she did not use any vowels at all. Possible reasons for this are suggested. 

Conclusions:

The authors found improvements in the skills targeted during the interventions, indicating that children with CCN can benefit from some types of input used to develop the literacy skills of children with a recording disability or spoken language impairment.

They found that neither child was able to transfer taught skills to other skills that had not been directly trained. This might have improved with longer term support.

The fact that children with CCN often take longer to give a response than typically developing peers means that they might need a longer time to consolidate and generalise skills.

This study provided initial evidence to support the usefulness of phoneme awareness intervention for children with CCN, but further studies are needed.

 Cautions:

This was a very small scale study and therefore cannot necessarily be widely generalised. The children’s levels of language and cognitive functioning might have had an influence on the outcomes. The way the assessment task was presented might also have affected the results; the male participant’s teachers indicated that progress was seen in the classroom that was not evident during the assessment tasks.


Things you may want to look into:
An Analysis of Reading and Spelling Abilities of Children Using AAC: Understanding a Continuum of Competence
Introduction to direct/explicit instruction in reading for the struggling reader: Phonemic awareness, phonics, fluency, vocabulary, andcomprehension
Teaching Sound Letter Correspondence and Consonant-Vowel-Consonant Combinations to Young Children who Use Augmentative andAlternative Communication
A Developmental Continuum of Phonological Sensitivity Skills
Evidence-based literacy instruction for individuals who require augmentative and alternative communication: a case study of a student withmultiple disabilities

Added to site May 2016


Interpretation and Construction of Meaning of Bliss-words in Children (short summary)

During a brief teaching session a group of 43 typically developing children aged between 3 and 8 were asked to interpret 15 Bliss-characters and 12 Bliss-words made up of combinations of the chosen characters. After teaching, the participants again interpreted the meaning of the Bliss-words. The Bliss-characters and Bliss-words elicited linguistic strategies that were like those found in typical vocabulary development. There were age differences in the amount of information being retained after teaching, with children over the age of 5 retaining most of the Bliss-characters and words but younger children less so.

The children were also asked to give suggested meanings for previously unseen Bliss-words and to construct their own new Bliss-words by combining the characters. These showed that they had understood the idea of combining characters into new words or ideas, but they generally explained the word with a sentence related to their own experience.

It is concluded that Blissymbolics could be used more effectively than pictographic symbols in education, as by learning the separate Bliss-characters it is possible to create and communicate new concepts for which the symbol is not known.


Things you may want to look into:

Blissymbolics (UK)

http://www.blissymbolics.org/

Translucency Ratings of Blissymbols over Repeated Exposures by Children with Autism

Iconicity in the Development of Picture skills: Typical Development and Implications for Individuals with Severe Intellectual Disabilities

Added to site Dec 2015


It’s good to talk: developing the communication skills of an adult with an intellectual disability through augmentative and alternative communication (short summary)

A single case study is presented, looking at effects the introduction of a dynamic display speech generating device (SGD) had on the communication and pragmatic skills of a 40 year old woman who was non-verbal and had moderate intellectual disabilities (ID). The subject also had some challenging behaviours related to her wish to be able to communicate more effectively with a wide range of people.

At the end of a year-long intervention, during which both static and dynamic screen SGDs were introduced and staff working with the woman were trained to support their use, the authors found positive outcomes.

Staff working with the subject reported improvements in her verbal expression and a reduction in 'barriers to communication' thus increasing her independence. They also felt that there were changes in her social interaction, including ability to repair conversation breakdowns. No change was seen in her understanding of spoken language.

Analysis of videoed interactions showed an increase in the number of turns the subject took in conversations. Her ability to maintain topics and introduce new topics also improved when the SGD was used. The rate of communication breakdown was reduced and less clarification was requested by communication partners.


Things you may want to look into:

Survey of AAC Needs for Adults with Intellectual Disability in New Zealand

The Speech Generating Device (SGD) Mentoring Program: Supporting the Development of People Learning to Use an SGD

Added to site Dec 2015


It’s good to talk: developing the communication skills of an adult with an intellectual disability through augmentative and alternative communication (summary)

Background

People who have intellectual disabilities (ID) often have associated difficulties with communication which effect all aspects of their lives. Augmentative and alternative communication (AAC) systems have been identified by researchers as a way of improving communicative abilities and participation in interactions. There is a recognised link between communication difficulties and challenging behaviour, limited communication skills might lead to people using behaviour as a means of communicating their needs, wishes and feelings.

Portable speech generating devices (SGDs) can help improve communication for some people with ID. Evidence for this largely considers the introduction of SGDs for children, there is less evidence about their use with non-verbal adults, particularly with reference to the use of dynamic display SGDs with adults with moderate ID.

What did they do?

This paper presents a single case-study looking at the effect of using an SGD on the communication abilities and pragmatic skills of a non-verbal woman with moderate ID.

The 40 year old woman, Ann, had a history of expressing herself through behaviour including destruction of property and physical aggression. The main reason for her behaviours had been identified as her wish to interact with other people.

Ann's understanding of spoken language was better than her expressive abilities but she found it difficult to initiate or maintain conversations. She was non-verbal and used some unclear signs, gestures, facial expressions and pointing to communicate.

The authors introduced SGDs to determine whether its use impacted on Ann's communication abilities. They used a semi-structured interview and analysis of videos of communication interactions on three occasions, before the intervention, during the assessment phase and after the intervention, to gather data.

During the intervention period Ann was introduced to the SGDs and key staff members were trained in how best to support her use of the devices.

Initially low-tech, static display SGDs were used, but these did not provide enough vocabulary to meet Ann's needs, so a dynamic display system was introduced. By the end of the intervention period (12 months, with 3 months on the dynamic display) she was able to use 16 symbol icons on the device to convey a range of highly motivating personal messages.

What did they find?

Staff working with Ann reported improvements in her verbal expression and a reduction in 'barriers to communication' thus increasing her independence. They also felt that there were changes in Ann's social interaction, including her ability to repair conversation breakdowns. No change was seen in her understanding of spoken language.

Analysis of videoed interactions showed an increase in the number of turns Ann took in conversations. Her ability to maintain topics and introduce new topics also improved when the SGD was used. The rate of communication breakdown was reduced and less clarification was requested by Ann's communication partners.

Conclusions:

Therapy outcome measures indicated that Ann's communication abilities were enhanced when she used a dynamic display SGD. She was no longer dependent on familiar people, environments or schedules for effective communication and was able to communicate with a wider range of people about things beyond the immediate context. The SGD was felt to contribute positively on Ann's quality of life.

The success of the intervention needed support from all people working with and supporting Ann, and good communication between them to ensure that she was provided with the best possible opportunities to develop her communication skills.

The authors conclude that the use of SGDs might be an appropriate option for other adults with a moderate ID but that further research is necessary.

Cautions:

This was a single case study and therefore cannot be widely generalised. There was no long term follow-up to determine whether the improvements were maintained.


Things you may want to look into:

Survey of AAC Needs for Adults with Intellectual Disability in New Zealand

The Speech Generating Device (SGD) Mentoring Program: Supporting the Development of People Learning to Use an SGD

Added to site Dec 2015


Joint decision making using Talking Mats (short summary)

The authors compared the amount of involvement people with dementia and their family carers felt they had in discussions and decisions about activities of daily living using Talking Mats and their usual methods of communication.

They found that both people with dementia and their carers were more satisfied when Talking Mats were used.


Things you may want to look into:

Using the WHO-ICF with Talking Mats to enable adults with long-term communication difficulties to participate in goal setting

Added to site March 2014

Joint decision making using Talking Mats (summary)

Background It is important for people with dementia to be involved in discussions and decisions about their care, but it is often difficult for these people and their carers to discuss their preferences about activities of daily living.

Studies have shown many people with dementia are able to use Talking Mats to support their communication.

What was the aim of the study? The aim was to explore whether Talking Mats could help people with dementia and family carers feel more involved in decisions about managing their daily living than using their usual communication methods.

What did the authors do? 18 pairs of participants, each a person with dementia and their family carer, were identified as fitting the criteria for taking part in the study.

Topics for discussion were identified and options within these were converted into symbols for use with Talking Mats.

The 4 main topics were: personal care, getting around, housework and activities.

The pairs of participants were asked to discuss the topics on two separate occasions, under two different conditions, using their usual method of communication and using Talking Mats, with the researcher facilitating by asking open ended questions.

Each time the pairs were asked to agree whether the person with dementia was 'managing', 'needed assistance' or was 'not managing' each of the options within the topics.

The Talking Mats were photographed at the end of each session, to provide a record of the discussion, and the interviews were videoed for analysis.

After the interviews each individual participant completed a short questionnaire to say how involved they felt in each type of discussion.

All participants felt significantly more involved and satisfied with the discussions using Talking Mats than their usual method of communication. This was particularly significant for the carers.

There were several benefits felt by all participants from the use of Talking Mats.

Cautions: There were only a small number of participants in the study and therefore the findings cannot necessarily be generalised to a wider population.

Conclusions: The use of Talking Mats could be a valuable tool in helping people with dementia think about and express their views about their daily life and be involved in decisions about their care.


Things you may want to look into:

Using the WHO-ICF with Talking Mats to enable adults with long-term communication difficulties to participate in goal setting

Added to site March 2014


Language predictors in ASD (short summary)

This study aimed to determine characteristics of children with autism that can predict their language development over time. The authors found that the number of social games and routines - such as peek-a-book, patty cake, 'so big', singing and dancing - that children with autism could participate in at a young age predicted their future development of language production. These games rely on skills that probably lay the foundation for language development and are thus more useful indicators than other measures, like non-verbal IQ or autism severity.


Things you may want to look into:

autism (ASD) FAQ, autism spectrum disorders (ASD) glossary term, The National Autistic Society

Added to site August 2013


Language predictors in ASD (summary)

What was the aim of the study? This study aimed to describe characteristics of children with autism that can predict their language comprehension and production abilities over time.

Why was the paper written? Language development in children with autism can vary widely. It would be helpful know what kind of behaviours predict language development, because this would contribute to a better understanding of the process of language development in children with autism.

What did the authors do? The authors used a parent-report measure, the MacArthur-Bates Communicative Development Inventory, to identify the pre-speech abilities of children with autism over time. Forty-four children with ASD aged two to five years were followed for 4.5 years. The authors used a statistical method called Individual Growth Curve Modelling to identify which attributes of the children significantly contributed to their language achievements. This statistical method was important because it revealed which factors, or characteristics, were related to the language outcome more than by chance.

What did they find? The authors report two notable findings. First, the only abilities of young children with autism that predicted later language production were pre-speech and early gesture abilities, such as responding to speech, imitating speech, labelling items, communicating with gestures and playing social games like peek-a-boo. This contrasts with earlier research that reported only late gestures such as pretending to be a parent and imitating adult actions could predict this development.

Second, the number of social games and routines - such as peek-a-boo, patty cake, 'so big', chase, singing and dancing - that children with autism participated in predicted the development of language production over time. The authors were not able to identify a factor that predicted the development of language comprehension over time.

Cautions: There are three main limitations of the current study. First, only a small sample of children contributed to the results. Further research should include a greater number of participants. Second, the authors' evaluation did not account for any interventions that children were receiving throughout the study. Speech and language therapy can affect language outcomes for children with autism, but this was not accounted for in the study. Finally, the only measure used in this paper was a parent-report measure, and a wider range of tools may present different reflections of children's abilities.

Conclusions: The number of social games and routines in which children with autism could participate at a young age predicted the development of language production over time. These games require skills such as turn-taking, imitation, joint attention and social engagement. These skills probably help lay the foundation for future language development; therefore, social games and routines are more helpfully indicative of future language development than other measures such as non-verbal IQ or autism severity.


Things you may want to look into:

autism (ASD) FAQ, autism spectrum disorders (ASD) glossary term, The National Autistic Society

Added to site August 2013


Light Technology Augmentative Communication for Acute Care and Rehab Settings (short summary)

A consideration of the role of low and light-tech AAC strategies in helping people compensate for communication difficulties as a result of a stroke.

This paper looks at a number of different possible approaches to supporting communication for people with aphasia in the early stages of recovery and emphasises the importance of involving patients and their families in decisions about their care.

It concludes that the use of compensatory communication strategies is very useful and important for many people with aphasia after a stroke. AAC should be part of the rehabilitation process from the beginning and needs to be individualised for each person and carried over into the home environment on discharge from hospital.


Things you may want to look into:

Bill's experiences after a stroke

Communication difficulties 

The effect of remnant and pictographic books on the communicative interaction of individuals with global Aphasia

Weblinks - aphasia / stroke

Factsheet - What is Aphasia?

Added to site September 2014


Light Technology Augmentative Communication for Acute Care and Rehab Settings (summary)

Background

Therapists working in hospital settings with patients who have recently had a stroke try both to improve the patient's ability to communicate functionally and to give strategies to help compensate for communication difficulties that might remain.

Families often prefer to work on techniques to improve function rather than to compensate for a lack of it, but this can have a negative effect on the patient's participation in their own rehabilitation. There is some evidence that people who used a voice output device in hospital had more positive views of their care.

What did the authors do?

The author focusses on the use of light-tech communication systems for people with aphasia who were in the early stages of recovery. That is paper-based and battery operated systems which are generally able to be provided more quickly and easily than more complex devices.

The paper reports on several systems and considers there benefits and disadvantages for people who have aphasia.

The need for individualisation of resources is stressed throughout, in terms of the layout of systems, the use of symbols versus pictures/photographs and the choice of vocabulary. The benefits of a multidisciplinary approach closely involving the patient and their family is emphasised.

The author considers communication boards, which might have pictures or symbols, and suggests that using these with eye-gaze can be successful if the patient has difficulty using their arms or hands to make selections, provided any visual problems are also considered.

She mentions simple voice output devices, to attract attention to the use of a communication board or for use alongside it, and briefly discusses the use of auditory scanning, either built in to a voice output system or used with a communication partner. There is also some discussion of the use of written choices.

Throughout the article the importance of training family members in the use of appropriate compensatory strategies is emphasised, particularly with regard to discharge from hospital, to ensure that the home environment is 'communication friendly'.

Cautions

This is not a piece of research, but a paper based largely on the author's own experience. It contains several practical ideas which others might find useful.

Conclusions

The use of compensatory communication strategies is very useful and important for many people with aphasia after a stroke. AAC should be part of the rehabilitation process from the beginning and needs to be individualised for each person.


Things you may want to look into:

Bill's experiences after a stroke

Communication difficulties 

The effect of remnant and pictographic books on the communicative interaction of individuals with global Aphasia

Weblinks - aphasia / stroke

Factsheet - What is Aphasia?

Added to site September 2014


Measurement of the Visual Attention Patterns of People with Aphasia (short summary)

Eye-tracking technology was used to analyse the way in which people with aphasia engaged with photographic visual scenes. It was found that research participants fixated particularly on human figures within the scenes. When the people in the scene were engaged with an object of interest within the picture there was greater interest shown in the object than when the person was looking directly at the camera.

It is concluded that the use of human figures within visual scenes for communication is likely to be beneficial in encouraging engagement with particular areas of the picture and objects within this.


Things you may want to look into

Effect of two layouts on high technology AAC navigation and content location by people with aphasia

Speech and language therapy for aphasia following stroke

High-tech AAC and aphasia: Widening horizons?

Factsheet - What is Aphasia?

Added to site March 2015


Measurement of the Visual Attention Patterns of People with Aphasia (summary)

Background

People with aphasia who use image based AAC systems rely on their vision to find their way around devices. It is necessary to better understand how people who use augmentative and alternative communication (PWUAAC) visually interact with different images used to represent messages.

Visual scene displays are a relatively new type of image for message representation; images that represent a situation, place or experience, often including people or objects of interest. They were developed to reduce the challenges involved for some people in navigating grid-based AAC systems.

There has been little research into what makes an effective visual scene and, particularly, which elements of a scene attract and hold attention. It is important to know this to understand how best to create visual scenes for communication.

What did the authors do?

Eye-tracking technology was used to look at the visual attention patterns of people with aphasia to investigate whether they focussed on human figures in images rather than other elements. They also considered whether the person in the scene looking directly at the camera (camera engaged), or being involved in a task or with an object (task engaged), made a difference to the level of attention to the object.

Ten people with aphasia were each presented with 38 target photographs on a screen. Half of the photographs included a person looking directly at the camera, not engaging with any objects within the scene, in the other half the scenes were the same except that the human figure was engaged with an object, e.g. using a computer.

The gaze patterns of the participants were analysed.

What did they find?

In almost all cases the participants gaze fixed on the person in the scene, but there was a significant difference between the camera-engaged and task-engaged images with regard to how they fixated on the object of interest in the scene. The rate of fixation on the object was higher when the person in the scene was engaged with it, the length of time taken to fixate on the object was significantly shorter. The person in the photo held the attention for more time than the object in both situations, but the object of interest was fixated on more often when the figure in the scene was engaged with it.

The findings indicate that people who have aphasia respond in similar ways to people without disabilities when presented with scenes containing human figures.

Cautions:

The study presented the same photographs to each of the participants so the influence of personalisation of scenes cannot be known.

The participants were only having their gaze tracked and not attempting to communicate so no evidence is provided about the effect of communicative intent on attention patterns.

Conclusions:

Though there is a need for further research into this area it seems that the use of human figures in visual scenes can be used to engage attention and so, could be used in visual scenes for communication to encourage engagement with particular areas of the picture and objects within this.


Things you may want to look into

Effect of two layouts on high technology AAC navigation and content location by people with aphasia

Speech and language therapy for aphasia following stroke

High-tech AAC and aphasia: Widening horizons?

Factsheet - What is Aphasia?

Added to site March 2015


Mentoring to support people learning to use speech generating devices (short summary)

Three people who were beginning to use MINspeak systems on their speech generating devices were offer mentoring by experienced MINspeak users. The authors found that the mentoring was generally beneficial in increasing the number and range of words used, but did not significantly improve the grammatical accuracy of the language structures used. They suggest the latter areas requires specific teaching.


Added to site March 2014


Mentoring to support people learning to use speech generating devices (summary)

Background People who are given speech generating devices (SGDs) do not always go on to communicate effectively with them. This might be due to a number of factors, including lack of opportunity to observe other people using SGDs.

Few people who are beginning to use SGDs receive any input in the mode of communication they are expected to use.

What was the aim of the study? The aim was to investigate the outcome of mentoring by adults who used SGDs on mentees use of their own SGDs. To find out if mentoring led to an increase in the total number of words, the range of different words and the number of different grammatical markers used by the mentees.

What did the authors do? They selected three mentors and three mentees, all of whom used MINspeak systems on their SGDs.

They used the MINspeak Product Application and Software (PASS) Writing with icons feature to enable the mentees to see the icon sequences used by the mentor in conversation, and the Language Activity Monitoring (LAM) feature and videoing was used to collect data during the project.

Data was gathered over a 6 month period which included 4 phases: baseline, mentor training, intervention and generalisation of mentoring to a community setting.

The pairs of mentor and mentee took part in a number of 15 minute conversations, either about topics of their own choice or from a selection of pre-prepared resources. Measures of the identified variables were taken before and after mentor training and in the mentees school or disability centre and in a community location, a café or club.

The results indicated that the mentees who completed the intervention sessions showed a significant increase in the areas the number and range of words used and in interest in using their systems and developing strategies to repair communication breakdowns. There was a smaller increase in the number of grammatical markers used.

Caution: Only two of the three pairs completed all of the intervention sessions, the third pair completed 50% of the sessions. This was a very small sample and the results were mixed.

The use of PASS software means that this strategy can only be used by people using MINspeak systems.

Conclusions: The authors found preliminary evidence that mentoring could be beneficial for people beginning to use SGDs. This should take place in addition to speech and language therapy input. They indicate that the use of grammatical markers, particularly, requires specific teaching.


Added to site March 2014


Mobile Technology: Benefits and Challenges (short summary)

The authors reviewed the development of AAC apps for iPads and other mobile technology. They suggested several benefits which might be gained from the use of these, but also identified a number of potential problems. Some areas for future research and development in this area are suggested.


Added to site January 2014


Mobile Technology: Benefits and Challenges (summary)

Background Recent rapid developments in mobile and tablet technology have had great effects on the lives of many people with complex communication needs. There has been an increase in specialised apps to support communication which run on these often smaller and cheaper mainstream devices. These offer many benefits but also some disadvantages for users of AAC.

What was the aim of the study? The study aimed to consider both advantages and disadvantages of mobile technology for people who use AAC and to identify areas for future research and implications for practice.

What did the authors do? They carried out a review of literature related to mobile technology and apps and identified 5 areas of potential benefit and 4 areas of significant challenges which need to be addressed in order for the benefits to be fully realised.

What did they find?

Potential benefits:

Increased awareness and social acceptance The use of mainstream technology and availability of communication apps from the same app stores as other social or educational apps increases public awareness of AAC. This can also have a positive impact on social acceptance and self-image for AAC users.

Greater consumer empowerment in accessing AAC solutions The relatively low cost of mobile technology and apps makes it easier for people with complex communication needs and their families to buy and try out systems without having to seek funding and wait for formal AAC assessments.

Increased adoption of AAC technologies People are generally more familiar and comfortable with mobile technology than with dedicated voice output communication aids (VOCAs) and the mobile systems do not require lots of learning by communication partners to enable them to personalise the AAC content.

Greater functionality and interconnectivity The multi-purpose design of mobile technologies offer people who use AAC access to the same range of communication options that are available to everyone else, including: social networking, texting, internet access etc. Over 90% of people with CCN, surveyed in one study used their iPad for non-AAC as well as AAC purposes.

Greater diffusion of AAC research & development AAC research and development is now being undertaken by a wider range of individuals, rather than mainly by traditional assistive technology manufacturers. Some apps are developed in response to requests from users and then made freely available, leading to a greater number of resources.

Potential Challenges:

Keep the focus on communication If there is too much focus on the technology rather than the objective of supporting communication it is possible that devices might be bought without fully considering how they will be used. The lower cost of mobile systems could lead to people being expected to adapt to the technology rather than being assessed for a system that best meets their needs.

Develop innovative approaches to AAC assessment and intervention A lack of careful assessment means that AAC technologies provided might not be the most appropriate. Many people who use AAC and their families thought they did not get the professional support they needed to implement their system effectively and many speech and language therapists do not have training in the use of mobile devices.

App developers do not generally offer the level of technical support, repairs etc provided by assistive technology manufacturers who include this in the cost of the device, but families say they want technical support to be available.

Ensure ease of access for all individuals Alternative access systems for mobile technology are limited, so there are many people with CCN who cannot access them easily. The levels of skills required to use many apps mean they are often not accessible to people who have complex impairments.

The move towards low cost AAC apps means that there could be a reduction in funding available for research and development into AAC systems to meet the requirements of those with the most complex needs.

Maximise AAC solutions to support a wide variety of communication functions AAC apps often address a very limited range of communicative functions such as labelling or requesting and do not integrate with other programs to give access to the internet etc.

The authors suggest that a broader definition of communication access is needed, beyond speech output to support face-to-face interactions.

Conclusions:

The authors suggest that there is a need for research into the effects of mobile technologies with a wider range of people who use AAC of and also the effects of these systems on their facilitators .

There is a need for research into:


Added to site January 2014


Non-electronic communication aids (short summary)

This paper explored support for non-electronic communication aids. These low-tech forms of AAC may be just as valuable as high-tech aids for adults with disabilities, but most government policy and research literature addresses electronic communication aids, or speech-generating devices. The Non-Electronic Communication Aids Scheme, a pilot project run in Victoria, Australia, demonstrated that adults with a variety of diagnoses can benefit from non-electronic aids, and the project received a greater demand than it could accommodate. Future evaluation of AAC services should incorporate outcome measures that demonstrate the value of AAC to funding bodies in order to support future AAC services.


Things you may want to look into:

aided communication

FAQs - service delivery + policy

Adam's experiences with different AAC systems

Added to site January 2014


Non-electronic communication aids (summary)

Background There are two main types of communication aids. High-tech, or electronic, communication aids include speech-generating devices with a variety of ways to generate messages. Low-tech, or non-electronic, communication aids do not have speech output functions and also lack other features that may assist the speedy generation of messages.

What was the aim of the study? This paper aimed to explore whether international policy on communication aids supports access to both electronic and non-electronic aids, to report evidence from a pilot project on non-electronic communication aids, to determine whether research literature provides evidence in support of non-electronic versus electronic communication aids and to comment on the challenges in providing outcome measures relevant to policy and evidence-based practice.

Why was the paper written? Both electronic and non-electronic communication aids can form successful AAC strategies for individuals with disabilities. However, there is some evidence that individuals who lack sufficient speech skills to meet their daily needs are more likely to access non-electronic than electronic communication aids. It is unclear whether current policy and the research literature adequately addresses both electronic and non-electronic forms of communication aids.

What did the authors do? The authors reported information from a variety of sources in order to address their aims. They reviewed the literature to identify papers relevant to their research, and they reported the results of surveys that had been carried out in many different places across the globe. They also reported some original findings that evaluated a trial programme in Victoria, Australia to provide non-electronic communication aids to adults with complex communication needs, the Non-Electronic Communication Aids Scheme (NECAS).

What did they find? Though both electronic and non-electronic communication aids can benefit those with communication needs, government funding often addresses only electronic communication aids, and discussion in the literature focuses on the purchase and supply of electronic aids. In developed countries, included Australia, Canada and the United States, available funding for communication aids often does not cover the whole cost of a device, leaving individuals who need a communication aid to fund a substantial portion of the total cost themselves. The multi-agency nature of work around the provision of communication aids makes it difficult for individuals to obtain appropriate assessment, training and support in using their communication aid.

The NECAS project in Australia received more requests for communication aids than it was able to meet, illustrating the very high demand for services in the area of AAC. Most communication aids provided under this scheme went to adults with developmental disabilities, and speech and language therapists were most often the source of the request. Other individuals who received aids from the NECAS project included adults with cerebral palsy, aphasia, traumatic brain injury and degenerative diseases. This demonstrates the wide range of individuals who could benefit from this type of communication aid service.

The authors identified 205 published studies that addressed electronic and non-electronic communication aids. The majority of research pertained to electronic communication aids, followed by research that addressed both types of communication aids. The least amount of research focussed exclusively on non-electronic communication aids. Most research also pertained to individuals with developmental disabilities, though information on adults with acquired disabilities, combined diagnoses and no disabilities was also available. This literature consisted mostly of case studies of individual participants. This is problematic because this type of research does not allow authors to make causal claims about the use of AAC; for example, even if positive outcomes are reported after an AAC intervention, the methodology does not allow the researcher to claim that they resulted from the use of AAC. There is also limited evidence available on individual diagnoses and how generalizable such findings are outside the very contrived research setting.

The most successful AAC intervention makes a positive impact on the everyday communication of an individual. However, it is difficult to find measures that represent this outcome. Several authors have suggested that a variety of people related to an AAC intervention be involved in determining its goals, methods and evaluation, including the client, communication partners, peers and family. There is only limited evidence that this suggestion has been taken up be those implementing and reporting on AAC interventions, and lack of doing so can lead to negative experiences with AAC.

Conclusions: Future research needs to address the extent to which non-electronic communication aids assist the functional communication and social participation of adults with disabilities. The policy and literature relating to communication aids is dominated by a focus on electronic aids, but this does not necessarily reflect demand from adults with disabilities, who may choose a non-electronic aid to best fit their personal circumstances. Future research should also include outcome measures relevant to funding bodies in order to support the continuation of services for those who need communication aids.


Things you may want to look into:

aided communication

FAQs - service delivery + policy

Adam's experiences with different AAC systems

Added to site January 2014


Nursing the patient with severe communication impairment (short summary)

This paper looks at information from interviews with nurses about their positive and negative experiences of nursing patients with severe communication impairment.

They generally found communication to be difficult, largely due to the additional time required, but also found some effective strategies to facilitate it.

Many problems resulted from the lack of an easily understandable communication system that both nurse and patient could use.

It is concluded that nurses need training in AAC and access to a range of simple AAC devices. Also that speech and language therapists should work with nurses on the development of preadmission information for patients with SCI and bedside training for people with SCI who are admitted to hospital.


Things you may want to look into:

Nurses' perceptions of communication training in the ICU 

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology 

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication 

Communication boards in critical care: patients' views 

Added to site September 2014


Nursing the patient with severe communication impairment (summary)

Background

Good communication between hospital nurses and their patients is very important and the need for pre and post-qualification training in communicating with a wide range of patients is essential. This paper aims to get a better understanding of the experiences of nurses in communicating with patients who have severe communication impairment (SCI).

Patients who are unable to speak, either permanently or temporarily, have been found to experience anxiety and frustration because of difficulties in communicating with nurses.

There is evidence that communicative interactions between nurses and patients SCI are minimal and often ineffective.

The researchers look at possible reasons for this, how it could be improved and issues that were identified by nurses working with people with SCI.

What did the authors do?

Twenty nurses who had cared for at least two patients with SCI in the previous 12 months were interviewed using a standard set of questions that were developed by a working group made up of nursing professionals and people with communication impairment.

The nurses worked on a number of different ward types, but not intensive care, geriatric units that focussed on dementia or units focussing on laryngectomy or head and facial surgery.

The interview aimed to explore the nurses' views and of positive and negative experiences of issues related to communication.

What did they find?

The results are summarised under a number of different headings.

Cautions

The sample of nurses interviewed was small and they were all from the same city. In addition they were not randomly selected, but although their nursing experiences were varied their responses were quite consistent.

Conclusions

The nurses identified several possible strategies to improve care for patients with SCI, particularly the need for training in the use of AAC and better access to AAC systems.


Things you may want to look into:

Nurses' perceptions of communication training in the ICU 

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology 

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication 

Communication boards in critical care: patients' views 

Added to site September 2014


Parenting a child who needs AAC (short summary)

Parents and caregivers of children who need AAC were interviewed about their children's communication and its impact on family life. Parents could be considered experts on their children and on AAC, and professionals working with these parents should recognize the unique situation facing these parents and their families.


Things you may want to look into:

Complex communication needs

Developmental disability

Case study family intervention, eye gaze-multimodal (short summary)

1Voice

Added to site August 2013


Parenting a child who needs AAC (summary)

What was the aim of the study? This study considers the experiences of British parents whose children have need of AAC. It focuses on how children's need and use of AAC influences family life and communication.

Why was the paper written? Previous findings, based mainly on research performed in the United States, suggest that families are very important to interventions for communication impairment. The relationship between caregivers and professionals of children who use AAC is central to interventions, as professionals must support and communicate with caregivers. Cultural differences between families and professionals can also have an effect on AAC intervention.

Though the perspectives and experiences of parents are a key component of successful AAC intervention, professionals may have difficulty accessing these views. This paper makes this information available to interested parties.

What did the authors do? The authors arranged eleven semi-structured interviews with parents and caregivers of children who use AAC. The interviewer was a school teacher unknown to the participants so that parents could express their ideas about speech and language therapy freely. Interviews began with a discussion of a typical day for a child who uses AAC and could have included information on a child's communication and its importance, AAC and speech and language therapy.

The researchers used a method called thematic analysis to analyse the interview data. This method is a six-stage process that results in Basic Themes that are grouped into Organizing Themes, which are placed under Global Themes. These Global Themes reflect major issues that came across from the interviews.

What did they find? The authors identified three Global Themes from the interviews:

1. CHILD'S COMMUNICATION AND INTERACTION

This theme included parents' ideas about and experiences of their children's communication. It had six Organising Themes:

A. How parents communicate with their children and about what. This sub-theme encompassed findings that children often had many different modes of communication, and some parents were responsible for developing communication systems. Parents often communicated with their children about everyday wants and needs but found it more difficult to cover things that happened outside the home. Parents showed knowledge of communication strategies for their children but some admitted that not all these strategies would be recommended by professionals and were rather used for speed or simplicity. Parents empathized with their children and included them in family conversations.

B. Child's level of communication. This sub-theme showed that parents could describe and evaluate their children's skills and difficulties.

C. Comprehension and intelligibility difficulties. This sub-theme showed that parents were concerned about barriers to communication such as their own understanding.

D. How the child communicates choices. This sub-theme revealed that parents have a system to enable their children to make choices, and this is an important aspect.

E. Impact of the child's personality. This sub-theme demonstrated that all parents described their children's personalities and the impact of personality on communication.

F. Child's social inclusion or exclusion. This sub-theme showed that parents thought communication skills impacted on social inclusion.

2. WIDER SOCIETAL ISSUES

Parents had ideas about wider societal issues that affected them. This theme had two Organizing Themes:

A. Social attitudes toward AAC. This sub-theme demonstrated that adults familiar with the children responded positively and attempted interaction while unfamiliar adults were less positive about AAC.

B. Financing of AAC. Parents often mentioned lack of money as a limiting factor of facilitating AAC and speech and language therapy.

3. PARENTS' VIEWS AND EXPERIENCES

Parents of children who need AAC mentioned pressures and issues, which were grouped into six Organizing Themes:

A. Parent as expert. Parents reported close relationships with their children and high levels of knowledge about their children's conditions. Sometimes they sought out certain knowledge and other times it was offered to them. Some parents wanted to be treated as experts on their children, and some viewed support from other parents as important.

B. Decision-making in AAC. Experiences of the extent and desire to be involved in decisions about communication varied, as did the amount and timeliness of information from professionals.

C. Parents' views on services. Some parents expressed concern about the quality and quantity of speech and language therapy, and some felt that professionals needed a better background in their own experiences.

D. Parents' reflections on communication. Parents reflected on their children's communication and none of them were concerned about introducing their children AAC; some wished it had been available earlier. High-tech communication aids could be difficult to implement, and parents tried to understand their children's feelings about communication impairment.

E. Parents' feelings and emotional responses. Parents expressed feeling isolated, devoting time and energy to their children's needs, feeling guilt and frustration about limits to their time and prioritizing their children's communication.

F. Demands on parents. Many parents felt they were not given sufficient information about AAC and that learning to communication via AAC involved considerable effort. Some parents felt they had to be 'pushy' in order to access services for their children.

Conclusions: The information that parents gave in interviews demonstrated that parents have extensive knowledge and understanding of their children and their children's communication abilities and limitations. The research showed that parents could benefit from professionals' explicit acknowledgement of the unique demands their situation makes on them and consideration of their child as an individual.


Things you may want to look into:

Complex communication needs

Developmental disability

Case study family intervention, eye gaze-multimodal (short summary)

1Voice

Added to site August 2013


Participation of children with CCN (short summary)

The authors of this study distributed a survey to parents of children with complex communication needs that evaluated the intelligibility of the children's speech, the perceived usefulness of their communication aid and their frequency of participation in recreational, social and self-improvement activities. Younger children were reported to have experienced greater levels of participation than older children, especially in recreational activities. For younger children, those with some speech participated more than those with no speech in recreational and social activities. It is important to remember that the quality of children's interactions, which was not evaluated in this study, is also valuable.


Things you may want to look into:

Emily's story about making new friends

General paediatric AAC

Added to site January 2014


Participation of children with CCN (summary)

Background Participation, or involvement in life situations, is an important aspect of children's development. A number of factors affect the level of participation that children with developmental disabilities experience, such as age, physical abilities, personality traits, communication abilities and learning disability. Children with communication disabilities experience different levels of participation depending on the activity. Little is known, however, about the participation of children with complex communication needs who use communication aids, despite the acquisition of an aid representing a significant investment of resources and increased participation being a possible outcome of an AAC intervention.

What was the aim of the study? This study aimed to explore the frequency of children's participation in terms of their age, level of speech intelligibility and their parents' perceived usefulness of their communication aid.

What did the authors do? The authors distributed a survey to parents of children with complex communication needs. They measured speech intelligibility and how useful children's communication aids were in supporting children's interaction with others. They also asked parents how often their children participated in recreational, social and self-improvement activities. Examples of these types of activities included playing games or collecting things (recreational), going on a day out or visiting other people (social) and doing homework or chores (self-improvement).

What did they find? Information on 69 children contributed to the analysis. Younger children, aged three to eleven years, were rated as having experienced more participation than older children, aged eleven to twenty-one years, particularly on recreational activities. Within the group of younger children, children with partially intelligible speech scored more highly than children with no speech in terms of recreational and social participation.

Cautions: The sample size in this study was small, so some relationships that may actually exist could have been missed.

Conclusions: Clear differences in participation exist between younger and older children with complex communication needs, and speech intelligibility affects participation of younger children. However, it is important to bear in mind that increasing participation absolutely is not necessarily the most desirable outcome, as the quality of children's interactions and participation is also valuable.


Things you may want to look into:

Emily's story about making new friends

General paediatric AAC

Added to site January 2014


Please listen, it's my turn: Instructional approaches, curricula and contexts for supporting communication and increasing access to inclusion (short summary)

Four children with severe speech and physical impairments (SSPI) attended a four week summer school which used a 'language immersion' approach to language and literacy development and technology use. Their parents and carers were also involved in the programme which involved constant modelling of AAC use throughout all activities.
All four children made progress during the intervention period, but only two maintained this at follow up. Possible reasons for this are considered.


Things you may want to look into:

Immersive Communication Intervention for Speaking and Non-speaking Children with Intellectual Disabilities

Supporting the Communication, Language, and Literacy Development of Children with Complex Communication Needs

Teacher literacy expectations for kindergarten children with cerebral palsy in special education

Evidence-based literacy instruction for individuals who require augmentative and alternative communication: a case study of a student with multiple disabilities

Added to site July 2014


Please listen, it's my turn: Instructional approaches, curricula and contexts for supporting communication and increasing access to inclusion (summary)

Background
Children who use AAC are often believed to have fewer opportunities to interact with literacy materials than their speaking peers for many different reasons; physical, environmental, technological and social. They have also often been found to be rather passive communicators, responding to others rather than initiating interactions.

What was the aim of the study?
The study aimed carry out a language and literacy programme for children with complex communication needs (CCN) that included an integrated approach to communication including oral language, literacy and technology skills, constant modelling of AAC use, family involvement and follow up visits to schools, and to consider the effects this had on children's language and literacy skills and use of technology.

What did the authors do?
Four children with severe speech and physical impairments (SSPI) were selected to take part in a 4 week summer school. The participants were aged between 5 and 9 years old, used AAC and were classed as 'beginner' or 'non-fluent' readers. They and their families had to commit to attending five 2-hours sessions a week for four weeks, with four follow-up visits to their schools.

Prior to the intervention information was gathered from the parents, by questionnaire, about the children's language and literacy experiences and other interests, preference and friends. School staff also provided information and were invited to visit and take part in the study programme.

The children's oral language, literacy and technology skills were assessed and they were surveyed about their perceptions of themselves as communicators.

The project was staffed by a researcher/teacher, a speech and language therapist, an adult AAC user, an educational assistant and 3 speech and language therapy students.

The focus of the sessions was to promote communication, including verbal communication skills, supporting literacy skills and group reading and writing activities and developing independence with technology.

Several themes were covered with vocabulary relevant to these being provided in symbol form and on speech generating devices (SGDs). The themes were; 'conversations', 'feelings', 'ourselves' and 'others'. There was emphasis on the importance of conversational control and reducing the dominance of speaking partners in interactions with AAC users, self-expression of feelings and emotions, initiating and maintaining interactions.

The intervention was in the form of 'total language immersion' with individual teaching sessions and group work. The adults used AAC alongside spoken language at all times.

Six to eight weeks after the summer school follow up sessions were undertaken to support the carryover of newly acquired skills into the children's schools and to information with school staff.

What did they find?
The results indicate that the 'mixed-methods' approach, combining language, literacy and technology skills in individual teaching and group activities, with consistent modelling of AAC use, can be beneficial in developing all of these areas, possibly partly by increasing adult communication partner's awareness of the need to provide AAC users with appropriate vocabulary in a suitable format, and in slowing adults rate of communication, thus giving the children more time to respond.

All four children made progress during the intervention, but only two maintained this at follow-up.

The author is not able to give definite reasons for this but makes several possible suggestions; the parents of the children who maintained progress were successful advocates for their children's needs in school, these children also had typically developing siblings, meaning their parents were familiar with typical language and literacy development and they were returning to schools they attended prior to the intervention. The children who did not maintain the progress changed school and so the school staff were not familiar with their needs and abilities. The children who maintained the progress also had no recognisable words, possibly increasing staff's motivation to continue to support SGD use, and they used computers with communication software as their SGD which might be less threatening to unfamiliar people than dedicated communication systems.

Cautions:
The study was very small meaning the results cannot be generalised more widely, and the combined use of several strategies means that it is possible to identify the specific effects of individual elements. Only one child's school took part in the intervention period and teachers were not often available to attend meetings in the follow up sessions meaning they were not necessarily able to then support carryover into settings.

Conclusions:
While the methods used in the study can be beneficial maintenance of progress is dependent on the AAC user having someone to advocate for them to ensure their educational needs are met, and their school's willingness to work closely with their parents and ensure staff are trained to support them in the systems they use.


Things you may want to look into:

Immersive Communication Intervention for Speaking and Non-speaking Children with Intellectual Disabilities

Supporting the Communication, Language, and Literacy Development of Children with Complex Communication Needs

Teacher literacy expectations for kindergarten children with cerebral palsy in special education

Evidence-based literacy instruction for individuals who require augmentative and alternative communication: a case study of a student with multiple disabilities

Added to site July 2014


Post-school quality of life (short summary)

This paper reports the results of surveys and interviews about the experiences of young people with complex communication needs after they leave school. The eight young people in this study all used an AAC device whilst in school, however, only one continued to do so after leaving school. Overall, the young people were found to be out of employment or education, to lack personal resources and to require better access to communication support services. These results indicate the urgent need for high-quality support for young people with developmental disabilities who have left school, especially with regard to communication.


Things you may want to look into:

Employment FAQs

Case story: funding a communication aid

Jeff's experiences after leaving school

Mark's experiences in day centres

Added to site January 2014


Post-school quality of life (summary)

Background Evaluations of post-school outcomes for young people with disabilities have shown that they drop out of school more frequently than their non-disabled peers, rarely enrol in post-secondary education and often experience unemployment and poverty. However, many people with disabilities also report satisfaction with the people in their lives, participation in various recreational activities and a sense of optimism about the future. Unfortunately, this literature rarely addresses outcomes for individuals with complex communication needs who use AAC.

What was the aim of the study? This study aimed to evaluate the experiences of individuals with complex communication needs, who had used AAC whilst in education, after they left school. The study aimed to determine the individuals' objective outcomes such as employment, education and living circumstances, their subjective outcomes such as quality of life, their satisfaction with their modes of communication and any relationships between these outcomes.

What did the authors do? The authors invited young people who had completed high school in British Columbia, Canada between 1998 and 2003, and who had received communication technology during that time, to take part in the study. Packages were posted to the thirty available young people with two surveys to complete. These packages included a Communication Survey and a Quality of Life Profile. Participants were instructed to complete the surveys as independently as possible, and if helpers such as parents assisted in filling out the surveys, they were instructed to do so from the perspective of the young person.

The authors also conducted interviews with some participants in order to gain a more detailed view of the young person's experiences after leaving school.

What did they find? Information about eight young people was returned via paper surveys, and four families agreed to participate in interviews. The young people ranged in age from 19 to 24 years and lived primarily in urban areas. All but one spoke English in the home, and the participant group consisted of six women and two men. Half the participants had a diagnosis of more than one disability, including autism, intellectual disability, deafblindness, cerebral palsy and Rett syndrome.

All eight young people required support for activities of daily living, and only one young person lived in her own residence. None were employed or in education, and only one was looking for work. Parents reported a need for greater resources in vocational areas and commented that services were inadequate because they were not able to cope with the individual needs of the young people.

Results from the survey on quality of life indicated that all but one participant scored in the 'adequate' or 'very good' range. However, only two participants were able to respond positively to 'things I do to improve myself'. Participants in interviews reported that young people felt 'stuck' in their lives and had few resources to grow on a personal level.

All of the young people used many different means of communication, including gestures, vocalisations, eye blinks and signing. Five young people used a form of aided communication such as communication books or computers. Only one young person used the AAC device that was provided to her in school, and she was the only participant who reported satisfaction with her current method of communication. The other young people did not use the AAC devices they had in school for a variety of reasons: the device was felt to be inappropriate for the young person, the device was too expensive to purchase, it was not possible to purchase the device when leaving school or the device had broken. Participants felt they needed better access to AAC resources and communication support. Three of the four families who were interviewed reported that the young person frequently engaged in problem behaviours, and this was attributed to a lack of any successful way for the young person to express themself. Overall, the quality of communication for all but one participant was considered poor and required remediation.

There was a strong relationship between the young people's quality of life and the quality of their communication. Previous studies have reported a similar relationship between these two factors.

Cautions: Only eight young people took part in this study, and these people were from a very restricted subset of people who use AAC. Their opinions therefore may not represent the entire population of young people leaving school who have complex communication needs. Importantly, the surveys in this study were, for the most part, completed by parents of the young people who used AAC. It is impossible to determine the extent that the views and experiences of the young people themselves were accurately reflected in the survey data.

Conclusions: The results of this study demonstrate the urgent need for high-quality services for individuals with developmental disabilities who have left school. Support for the use of communication technology is also paramount, as gaining the device itself is only half of the equation for successful communication. Finally, post-school transitions need to be considered and planned long before students who use AAC leave school.


Things you may want to look into:

Employment FAQs

Case story: funding a communication aid

Jeff's experiences after leaving school

Mark's experiences in day centres

Added to site January 2014


Predicting progress in Picture Exchange Communication System (PECS) use by children with autism (short summary)

The Picture Exchange Communication System (PECS) is a communication system designed mainly for use by non-verbal children with autism. It has generally been found to have positive outcomes in a range of areas, including social communication skills, decrease in challenging behaviour and possible increases in the use of spoken language. However there is limited information available to support professionals to make predictions about the amount of progress individuals might make using PECS.

In this study retrospective analysis was used to look into whether children’s Total Developmental Age (TDA) scores on the Psycho-Educational Profile-Revised (PEP-R) before intervention could predict the progress children aged 5 to 6 with autism towards using PECS at level 3.

The findings indicated that children who had a TDA of over 16 months achieved success at PECS level 2, those with a TDA of 16 months or less did not.

The authors concluded that assessment of the developmental level of children with autism who are being considered for the introduction of PECS might give useful information about the likely degree of progress.


Things you may want to look into:

The Effects of PECS Teaching to Phase III on the Communicative Interactions between Children with Autism and their Teachers

Long-term effects of PECS on social–communicative skills of children with autism spectrum disorders: a follow-up study

A Communication-Based Intervention for Nonverbal Children With Autism: What Changes? Who Benefits?

Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: a meta-analysis

The Picture Exchange Communication System (PECS) What Do the Data Say?

The Picture Exchange Communication

Added to site June 2016


 

Predicting progress in Picture Exchange Communication System (PECS) use by children with autism (summary)

Background

The Picture Exchange Communication System (PECS) is a communication system designed mainly for use by non-verbal children with autism. It has generally been found to have positive outcomes in a range of areas, including social communication skills, decrease in challenging behaviour and possible increases in the use of spoken language. However there is limited information available to support professionals to make predictions about the amount of progress individuals might make using PECS.

PECS is broken down into six phases, from the exchange of a single symbol for a desired object with support to spontaneous requesting and commenting using symbols.

It has been suggested that the cognitive levels of individual children might influence their ability to progress through the levels of PECS.

This study investigated this further.

What did they do?

The authors used retrospective analysis to look into whether children’s scores on the Psycho-Educational Profile-Revised (PEP-R) before intervention could predict the progress children aged 5 to 6 with autism made in PECS use. They used an achievement of level 3 PECS (discrimination between an array of symbols) as the point of differentiation between most and least progress.

The PEP-R assessment gives a Total Developmental Age (TDA) score which provides an estimate of an individual’s overall ability level. 

23 children took part in the study. All had had PECS intervention in school. The children were assessed to find the highest PECS phase they had achieved and where then allocated to one of two groups; group A had mastered PECS level 3 group B had not.

What did they find?

The children in group A were found to have had significantly higher PEP-R TDA scores at the start of intervention than those in group B. All in group a scored at an age equivalent of 16 months or above, all but on in group B scored below 16 months.

The authors suggest that awareness of developmental age could offer professionals a way of setting realistic and achievable targets for children.

Conclusions:

An assessment of the developmental level of children with autism who are being considered for the introduction of PECS might give useful information about the likely degree of progress.

Cautions:

There are a number of limitations to this paper. As a retrospective study the participants were not matched or preselected in any way.  There was no baseline assessment other than the

PEP-R, and no independent confirmation of the children’s diagnoses. The study was relatively small and the assessment of PECS levels was not carried out by an independent person. There was also a lack of information about the way in which PECS was implemented by school staff.

 


Things you may want to look into:

The Effects of PECS Teaching to Phase III on the Communicative Interactions between Children with Autism and their Teachers

Long-term effects of PECS on social–communicative skills of children with autism spectrum disorders: a follow-up study

A Communication-Based Intervention for Nonverbal Children With Autism: What Changes? Who Benefits?

Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: a meta-analysis

The Picture Exchange Communication System (PECS) What Do the Data Say?

The Picture Exchange Communication System

A pilot evaluation study of the Picture Exchange Communication System (PECS) for children with autistic spectrum disorders

 Added to site June 2016


 

Professionals’ and parents’ shared learning in blended learning networks related to communication and augmentative and alternative communication for people with severe disabilities (short summary)

Researchers looked into the use of Blended Learning Networks, on-line groups consisting of parents and professionals, as a way to share learning and experience about the use of augmentative and alternative communication (AAC) with people with severe disabilities who have complex communication needs (CCN).

The groups considered a number of topics related to AAC and evaluated their experiences of the BLNs at the end of the study period.

A number of common themes were identified in the analysis of data gained from the groups and the feedback was that the group experience was generally very positive for both professionals and parents.


Things you may want to look into:

Communication is everything I think. Parenting a child who needs Augmentative and Alternative Communication (AAC)

Supporting the Communication, Language, and Literacy Development of Children with Complex Communication Needs

Added to site Dec 2015


Professionals’ and parents’ shared learning in blended learning networks related to communication and augmentative and alternative communication for people with severe disabilities (summary)

Background

People with severe disabilities (SD) often have complex communication needs (CCN) and are dependent on other to support them to be able to participate in activities of daily living. Their communication is often difficult for unfamiliar people to understand and might be supported by the use of various forms of augmentative and alternative communication (AAC). People with whom they spend a lot of time have in-depth knowledge of how to communicate with people with SD and are often very skilled communication partners.

Parents and carers of people with SD can find it difficult to meet others in similar situations to share knowledge and experience. Parents are often best placed to support others, including professionals, in learning about the communication needs of their children.

Blended Learning Networks (BLNs) are groups of people who share a common interest or learning need and who come together, using the internet, to offer mutual support and learning.

What did they do?

This study took place in Sweden. It use BLNs to investigate the understanding of parents, teachers and support staff about AAC for people with SD.

36 caregivers (15 parents and 21 professionals) took part in the study.

Participants were divided into four BLNs, each a mixture of parents and professionals. People were able to take part, via the internet, from their own homes or work places. The topics considered were; communication in general, communication/AAC in school, communication/AAC and technology and communication/AAC and a holistic perspective. There was also an evaluation session. Before each BLN session participants were sent two questions to consider and some suggestions for related reading.

The BLN meetings were recorded and minutes created and circulated to group members.

What did they find?

A number of themes came out of analysis of the BLN minutes.

• Communication in General – the importance of communication in all forms, including a wide variety of AAC systems, and the way in which people in the environment respond to it.

• Communication/AAC in School – the importance of multimodal approaches to communication and how to identify and enhance communication.

• Communication/AAC and Technology – the main discussions were about iPads and apps. Themes included new technology, boosting confidence and how iPads can support this and the way technology can support links between different environments used by people with SD. Some people also had some anxiety about using and learning about technology and its possible benefits.

• Communication/AAC and a holistic perspective – again two themes emerged. The first was 'facilitating and limiting aspects' including personal traits of people with SD and their communication partners, lack of time and lack of knowledge about AAC. A further limiting factor was lack of clarity about who was responsible for ensuring that the communication needs of the person with SD were understood and addressed. The second theme was the 'interaction is developmentally stimulating' with AAC being an integral part of communication and vice versa.

In general BLN participants viewed them as positive, finding the mix of parents and professionals beneficial.

Conclusions:

Parents and professionals involved with people with SD and complex communication needs found being part of the BLNs an overwhelmingly positive and empowering experience.

The authors conclude that both home and school need to clarify communication goals for people with SD and be open to the use of new technology for this group.

Cautions:

The participants were self-selected and therefore very motivated to take part. There was a lack of male participants, possibly reflecting the proportion of women working as carers and that mothers often offer more frequent personal care to their children than fathers.

The use of questions to provide a framework for the BLN discussion was useful but could have had some influence on the results.


Things you may want to look into:

Communication is everything I think. Parenting a child who needs Augmentative and Alternative Communication (AAC)

Supporting the Communication, Language, and Literacy Development of Children with Complex Communication Needs

Added to site Dec 2015


Providing instructional support for AAC service delivery in low- and middle-income (LAMI) countries (short summary)

Many people with disabilities live in poverty. Providing augmentative and alternative communication (AAC) services for people with complex communication needs (CCN) who live in low and middle income (LAMI) countries can be challenging. Many individuals in LAMI countries do not receive communication rehabilitation services.

In recent years there has been increasing recognition of the need to provide AAC support and training to the communication partners of people in LAMI countries who have CCN, but this has challenges. The training needs to be appropriate to the needs of adult learners, based on adult learning theory. It must be delivered in a manner that is responsive to local needs, culturally sensitive and sustainable. There are rarely enough AAC experts in local areas to offer this and therefore AAC professionals from other countries are sometimes invited to provide training and support.

This study aimed to investigate the experiences of experienced AAC professionals who have offered training and support to professionals, family members and people with CCN from LAMI countries and to consider these within recommendations for AAC training.

Experienced AAC professionals from seven countries were recruited to take part in an on-line focus group. Participants had an average of 28 years’ experience in providing training/instruction in AAC in 29 countries, including 17 different LAMI countries.

The study identified four major themes considered important when delivering training to professionals and communication partners in LAMI countries, these were: investigate learner needs, provide contextually relevant instructional content, use engaging instructional activities and assess the impact of instructional activities.

They conclude that training local professionals and communication partners to provide AAC support in LAMI countries is very important. Careful planning of the training in terms of adult learning theory is relevant in both LAMI and developed countries.


Things you may want to look into:

Life-skill and employment training for young adults with mental disabilities

Teachers’ perceptions of implementation of aided AAC to support expressive communication in South African special schools: a pilot investigation

Eina! Ouch! Eish! Professionals’ Perceptions of How Children with Cerebral Palsy Communicate About Pain in South African School Settings: Implications for the use of AAC

Caregiver Perceptions of Children who have Complex Communication Needs Following a Home-based Intervention Using Augmentative and Alternative Communication in Rural Kenya: An Intervention Note

 

Added to site February 17


 

Providing instructional support for AAC service delivery in low- and middle-income (LAMI) countries (summary)

Background

Many people with disabilities live in poverty. Providing augmentative and alternative communication (AAC) services for people with complex communication needs (CCN) who live in low and middle income (LAMI) countries can be challenging. Many individuals in LAMI countries do not receive communication rehabilitation services. There are numerous reasons for this; in low-resource conditions rehabilitation services can be difficult to obtain and are not viewed as high priority by governments and there are only a small number of speech and language pathologists in many LAMI countries. The multi-lingual nature of many LAMI countries is an additional complicating factor, as is the limited awareness of the potential of AAC to benefit people who have CCN even with very basic provision and intervention.

In recent years there has been increasing recognition of the need to provide AAC support and training to the communication partners of people in LAMI countries who have CCN, but this has challenges. The training needs to be appropriate to the needs of adult learners, based on adult learning theory. It must be delivered in a manner that is responsive to local needs, culturally sensitive and sustainable. There are rarely enough AAC experts in local areas to offer this and therefore AAC professionals from other countries are sometimes invited to provide training and support.

Some issues common to people with disabilities throughout the world may be more extreme in LAMI countries, these include negative attitudes towards people with disability, too few professionals trained in AAC, the expense of AAC technologies and challenges in providing AAC supports that are culturally and linguistically appropriate.

This study aimed to investigate the experiences of experienced AAC professionals who have offered training and support to professionals, family members and people with CCN from LAMI countries and to consider these within recommendations for AAC training.

 

What did they do?

Eight experienced AAC professionals from seven countries, including both developed and LAMI countries were recruited to take part in an on-line focus group. Participants had an average of 28 years’ experience in providing training/instruction in AAC in 29 countries, including 17 different LAMI countries.

The focus group took place over a six week period with five different questions posted and participants responding to these and to other people’s responses.

 

What did they find?

Four main themes emerged in the final results:-

Investigate learner needs – It is important to find out as much as possible about the learners and their needs, either formally or informally. This includes knowing the local context to provide information that is culturally acceptable, affordable and useful. Videos and video-conferencing were often used to gather information.

It is also vital to know about the individuals and families that the learners work with including, where possible, observing their day to day lives to gain a better understanding of their community and how they participate in it.

Provide contextually relevant instructional content – It was said to be important to share basic knowledge about AAC and to help learners to fully understand the ‘power of communication’ to support the development of friendships, developing independence, getting an education, opening up employment opportunities etc.

Topics covered typically included; populations that would benefit from AAC, AAC assessments and functions of communication, types of AAC, creation of AAC systems, including selecting vocabulary and graphic systems. The emphasis of training was influenced strongly by the needs of the audience.

Training also focussed on promoting everyday use of AAC, incorporating it into existing and new activities and using a variety of communication functions. The importance of translating materials and making it culturally relevant whilst not making assumptions about prior levels of knowledge or availability/lack of technology.

Using real life stories of users made easier to focus on broader participation.

Use engaging instructional activities – This included using a learner focussed approach to training, acknowledging the learners experience and contribution to the training and encouraging informal discussions, working collaboratively and through discussion.

The use of interaction, role play, discussions and consideration of a child the learners know well is important.

Videos of people the learners are working with make the training more relevant. Creating resources and role playing the use of these was also found to be helpful.

Involving people who use AAC (PWUAAC) in delivery of the training, either being present or via video was very important in addressing both content and attitudes and supported the credibility of the person offering the training. It was also considered vital that the trainers were knowledgeable and experienced enough to be trusted and able to answer all questions.

Assess the impact of instructional activities – Trainers involved in the focus group used a range of methods to evaluate changes in the trainee’s knowledge and skills. These included observation of role plays and considering resources created during training. Evaluation forms were also used. Seeing that training resources were shared with other professionals when the trainees returned to their work places was also considered a positive benefit.

Longer term impacts were not easy to measure and tended to take the form of looking at how services improved.

Some participants used the internet to watch videos of PWUAAC and discuss how to move forward.

It was recognised that it is important to promote sustainability and continued use of AAC following training e.g. encouraging trainees to identify one thing they would try to implement and ensuring AAC interventions had an impact that was valued by the community.

It was felt that it was important to develop teams of AAC workers rather than individuals and to develop support networks and an ‘AAC community’.

The importance of ongoing interaction with learners following the initial training was recognised, though it could be difficult. Possible ways to maintain these links were identified.

 

Conclusions:

Training local professionals and communication partners to provide AAC support in LAMI countries is very important. Careful planning of the training in terms of adult learning theory is relevant in both LAMI and developed countries.

 

Cautions:

The small number of group participants and limited number of questions asked mean that only a small element of the needs of LAMI countries was considered. The diversity of cultures in these countries mean that individual needs must always be considered.

Other experienced AAC workers might have provided different experiences.


Things you may want to look into:

Life-skill and employment training for young adults with mental disabilities

Teachers’ perceptions of implementation of aided AAC to support expressive communication in South African special schools: a pilot investigation

Eina! Ouch! Eish! Professionals’ Perceptions of How Children with Cerebral Palsy Communicate About Pain in South African School Settings: Implications for the use of AAC

Caregiver Perceptions of Children who have Complex Communication Needs Following a Home-based Intervention Using Augmentative and Alternative Communication in Rural Kenya: An Intervention Note

 

Added to site February 17


 

SPEACS-2: Intensive Care Unit ‘‘Communication Rounds’’ with Speech Language Pathology (short summary)

The authors investigated the use of a web-based training package for nurses working with non-speaking elderly patients in intensive care units (ICUs) and the benefits of speech and language therapy (SLT) led 'communication rounds' on ICUs.

Case studies are used to demonstrate the types of communication strategies that were useful in improving communication for patients, families and nursing staff.

The training was found to have positive effects on nurses' awareness of the role of the SLT beyond swallowing. Direct observation of recommended techniques was found to increase motivation to complete the on-line training later.

Further investigation is needed to find out whether the strategies recommended are implemented by the nurses and which are used most often but in general the use of shared communication case conferences was found to be of benefit to all concerned.


Things you may want to look into:

Nurses' perceptions of communication training in the ICU

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Communication boards in critical care: patients' views

Added to site October 2014


SPEACS-2: Intensive Care Unit ‘‘Communication Rounds’’ with Speech Language Pathology (summary)

Background

Intensive Care Unit (ICU) nurses are extremely important in supporting the communication of critically ill patients who are unable to speak, but they usually have very limited training in how best to do this, and insufficient access to speech and language therapists (SLTs). The authors looked at the impact of a web-based training package for nurses on care quality and clinical outcomes for older patients on ICU.

The paper describes weekly communication case conferences held by an SLT in a hospital and describes the SPEACS-2 communication skills training program that was available to the nurses.

What did the authors do?

The SPEACS-2 training program is made up of 6 self-learning modules available on-line. The modules cover choosing and applying AAC strategies and requesting SLT input with ICU patients. This package was made available to all nurses on the ICU. In addition some nurses on each unit were given additional training to enable them to act as peer mentors and champions for the program. During the 3 month training period teaching posters highlighting communication strategies were displayed in the units and communication support materials were provided on the wards.

The paper uses 3 case-studies to demonstrate various strategies and techniques that were helpful to the patients, their families and nursing staff and the way in which SLTs leading 'communication rounds' on the ward was beneficial.

What did they find?

The use of 'case conferences' and bedside modelling of different communication support strategies in ICU can help nurses to identify adaptations needed to communication materials for individual patients.

A need is identified for transition planning about communication as patients move from ICU to other settings, and for involving families in the use of AAC.

A number of possible barriers to successful implementation of communication rounds, including SLT time, willingness of nurses to act as Communication Resource Nurses and the demands on ICU staff making attendance at communication rounds difficult, are identified.

The availability of a 'Communication Care Plan' at the bedside was helpful in disseminating information.

Cautions:

Although the paper states it is to 'explore the impact of an innovative, web-based instructional package' its' focus is primarily on the SLT input, there is limited information given about the specific skills targeted in the training package.

Conclusions:

The training was found to have positive effects on nurses' awareness of the role of the SLT beyond swallowing. Direct observation of recommended techniques was found to increase motivation to complete the on-line training later.

Further investigation is needed to find out whether the strategies recommended are implemented by the nurses and which are used most often but in general the use of shared communication case conferences was found to be of benefit to all concerned.


Things you may want to look into:

Nurses' perceptions of communication training in the ICU

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Communication boards in critical care: patients' views

Added to site October 2014


Skydive of communication interaction (short summary)

The authors of this paper use skydiving as a metaphor for aided communication. Both activities are centred around an individual participant, involve the use of a specialized piece of equipment and require certain skills and competencies that are developed over time. Participation in each activity is the result of a long-term learning process, and each occasion of involvement in the activity reflects an autonomous choice in a certain set of conditions. Importantly, the evaluation of outcomes in aided communication can and should account for individual accomplishments against a background of ongoing development.


Things you may want to look into:

VOCA

Added to site January 2014


Skydive of communication interaction (summary)

Background Outcome measures are an important aspect of evidence-based practice, the bringing together of research evidence, clinical experience and client input to determine the best course of action for an individual in the therapy setting. Outcome measures can be the result of the goals that have been agreed by a client and therapist, and they can show the progress that a client makes throughout therapy and over a longer-term period of development. A number of researchers have suggested factors that are important to the achievement of successful outcomes, including social relationships, community involvement, personal autonomy, positive self-belief and psychological safety.

What was the aim of the study? The authors of this paper wanted to present a metaphor that can represent the situation of goal setting and outcome measures in the context of aided communication. Metaphors can be a powerful tool for representing complex situations, and the authors chose to use the metaphor of skydiving to represent aided communication because many different elements must work together for a successful outcome. A skydive consists of a skydiver, a target destination and a parachute, which includes a canvas, ripcord and ropes.

What did the authors do? The authors analysed interview data that they previously collected in connection with other projects. Thirty-eight adults in Ireland and the UK aged 18-45 years were interviewed about their experience of aided communication. They all had a diagnosis of cerebral palsy with complex communication needs, and they all had been using aided communication for more than ten years. The skydiving metaphor arose out of discussion between the authors about their data.

What did they find? The findings were presented in relation to the metaphor of skydiving.

The parachute represented the technology of aided communication. Both the canvases used in skydiving and the devices used in aided communication can obscure the visibility of their users, are offered in a wide variety of options, are costly and must be adapted as users' skills change over time.

Many of the adults in the research had a clear idea of what they expected from their devices, whether it was technical features and requirements such as Internet connectivity or a long battery life, or functions that related to the personality of the user, such as a certain voice. Limitations to devices were described in terms of position, such as not being able to use a device in bed or while lying down, context, such as not being able to use a device in certain lighting or weather conditions, and technical, such as the frequency of devices breaking down.

The ropes that connect a skydiver and the canvas of the parachute represented the strategies and competence of an aided communicator. The effectiveness of the ropes arises from their system working together, just as the success of communicators depends on the range of skills they possess. Skydiver's ropes and a communicator's skills impact the success of the activity.

Interview participants reflected on their own skills and competencies, commenting that juggling all the aspects of a communication exchange is not easy. Such competencies were operational, such as knowledge of how to troubleshoot or programme devices, linguistic, such as reading, and social, such as managing conversations in stressful situations.

The skydiver is a unique individual with a certain set of resources and experiences, just like individual aided communicators. Both types of people may experience injury, age-related changes and fluctuating desire to engage in their activities. The ripcord represented the motivation and resilience of AAC users. Both skydivers and aided communicators have to decide when to deploy their technology and how to use it in the most effective way.

Many research participants indicated their persistence and resilience in using AAC and identified contexts where they took control over their use of a device. Some individuals commented that aided communication is 'very very hard but keep going' and that 'it opens a world of communication'. Another learned to programme a Pathfinder. The decision to use a device was governed by the health and energy level of the user, the activity and location of the interaction and the communication partner.

The jump of a skydive represented the journey of aided communication. The initial stage of the jump is determined to a large extent by external forces but only occurred because of the decision of the skydiver. Though each jump follows a predictable course of action, each jump is also varied and distinctive. This is like the combination of aided and unaided communication strategies. After choosing to use aided communication, an AAC user combines different strategies and different types of communication, and each journey in an opportunity to practice new skills. Landing at the destination of a sky dive represented the personal life goals of an aided communicator. Even though a skydiver may not land exactly where he intended, the landing allows the skydiver to share in a community of other skydivers and can be the start of another new and exciting part of their journey.

Interview participants mentioned many aspects related to the ongoing use of aided communication and desired outcomes of continued practice. They made gains in education, inclusion and independence and had goals related to employment and leisure.

In addition to these elements, a skydiver can only jump independently after appropriate apprenticeship and learning opportunities. Other factors, such as weather conditions, will continue to influence whether a skydiver wishes to participate in the activity on every occasion.

Interview participants also made reference to their learning experience and factors that affected their decision to use an aided communication device. Learning was affected by practice and an individual's support system and advocates. Barriers to the use of a communication device included the skills and attitudes of communication partners, lack of time and noisy environments.

Conclusions: In this paper, the activity of skydiving was used as a metaphor for the use of aided communication. Participants in both activities have individual needs and aspirations that change across time. In particular, the outcome measures used to evaluate aided communication can and should relate to the attainment of specific goals in relation to a certain longer-term destination. In skydiving and aided communication, the development of proficiency is marked by ongoing accomplishments, and each occasion of participation in the activity is the result of an autonomous choice, requires the intersection of a range of skills and is subject to a variety of external factors.


Things you may want to look into:

VOCA

Added to site January 2014

Social Interactions of Students with Disabilities Who Use Augmentative and Alternative Communication in Inclusive Classrooms (short summary)

The authors investigated the social communication interactions of 16 pupils with intellectual disabilities and/or autism, in mainstream classes. All participants used some form of augmentative and alternative communication (AAC), and were supported in school by one to one support workers.

They found that the students who used AAC had significantly more interactions with adults than with their typically developing peers. They also tended to initiate fewer interactions and these were for different communicative functions.

It was also found that AAC systems were not the primary form of communication used in most interactions.


Things you may want to look into:

Enhancing the Alternative and Augmentative Communication Use of a Child with Autism through a Parent-implemented Naturalistic Intervention

Comparative Efficacy of the Picture Exchange Communication System (PECS) versus a Speech-Generating Device: Effects on Social-communicative Skills and Speech Development

Disentangling the social threads within a communicative environment: a cacophonous tale of alternative and augmentative communication (AAC)

Social Participation of School-aged Children Who Use Communication Aids: The Views of Children and Parents

Exploring Communication Assistants as an Option for Increasing Communication Access to Communities for People who use Augmentative Communication

Added to site May 2015


Social Interactions of Students with Disabilities Who Use Augmentative and Alternative Communication in Inclusive Classrooms (summary)

Background

The importance of peer interaction for students with severe disabilities has been recognised for a long time, with peer interactions promoting development and learning in school-age children. There is evidence that good peer interaction experiences are associated with a range of positive outcomes whilst the reverse is true of a lack of peer relationships.

Peer interactions and friendships are often limited for students with intellectual disabilities or autism and this can particularly be the case for pupils in these groups who use augmentative and alternative communication (AAC).

There is little research into this group of students’ interactions in mainstream classrooms, particularly when students have one to one adult support. Some earlier papers have reported that in social interactions with typically developing peers students with intellectual disabilities who used AAC primarily responded rather than initiating interactions, and used AAC systems less than other communication modes. In addition interactions with adults were a lot more common than with peers.

What did the authors do?

The researchers aimed to describe the social interactions of students with developmental disabilities and who used AAC, within mainstream classes in America.

Sixteen students with intellectual disabilities and/or autism took part in the study. The participants used a range of aided and unaided AAC. Most were the only pupil with special needs in their mainstream lesson.

The students were observed in classes that specialist teachers had identified as providing most natural peer interaction opportunities and teachers were asked to continue their typical lesson delivery. Each student was observed on four separate occasions.

What did they find?

Some form of social interaction between students with disabilities and the peers and/or adults occurred in around two-thirds of the observation periods. The majority of these were exclusively with adults. Less than 5% of interactions involved only peers and less than 6% both peers and adults. 3 of the participants were never seen to interact with their peers.

The length of the interactions was very variable and less than 15% were initiated by the student with disabilities.

When the students who used AAC took part in interactions the modes of communication most often used were facial expression, gestures and vocalisations.

The functions of the initiated interactions varied between the typically developing students and those with disabilities. The former group most often provided instructions or comments, the latter expressing wants and needs and trying to develop social closeness.

Across all of the various different teaching contexts: large group teaching, independent working and small group teaching, around 90% of interactions for the people who used AAC involved adults. Moat interactions with adults were with the participant’s 1:1 support workers who were usually in close proximity throughout the lessons. There was more variation in interaction with peers, with most occurring during small-group teaching.

Conclusions:

It can be difficult for people who use AAC to develop good peer relationships through communicative interactions in mainstream settings. Communication tended to be mainly with individual support workers. This was not the case for typically developing students who communicated extensively with their peers throughout the observation periods.

The authors believe further research is needed into training of support staff to facilitate strategies to increase classroom interaction between these two groups of students.

Students with disabilities tended to be largely passive communicators, possibly partly due to a lack of appropriate initiations from their communication partners.

Aided AAC systems were not frequently used in interactions. Sometimes because they were not made available in the classroom, but also due to user preference, despite unaided systems not always providing good quality communication in classrooms.

It is also argued that requesting wants and needs is not the most important communication function for people young people who use AAC and who were found to be using communication initiation to try to develop social closeness. The authors identify that further research is needed into how best to support them in developing these skills.

Cautions:

The authors identify several limitations to their study, including a lack of information about the students’ history in inclusive education the limited number of classes observed and the type of sampling used to gather the information.

They also acknowledge that they did not fully address the complexity of social interactions in their observation schedules.


Things you may want to look into:

Enhancing the Alternative and Augmentative Communication Use of a Child with Autism through a Parent-implemented Naturalistic Intervention

Comparative Efficacy of the Picture Exchange Communication System (PECS) versus a Speech-Generating Device: Effects on Social-communicative Skills and Speech Development

Disentangling the social threads within a communicative environment: a cacophonous tale of alternative and augmentative communication (AAC)

Social Participation of School-aged Children Who Use Communication Aids: The Views of Children and Parents

Exploring Communication Assistants as an Option for Increasing Communication Access to Communities for People who use Augmentative Communication

Added to site May 2015


Social media experiences of adolescents and young adults with cerebral palsy who use augmentative and alternative communication (short summary)

Recent developments in technology have increased opportunities for communication through social media, however for people who use augmentative and alternative communication (PWUAAC) the new opportunities are not always matched by improved access.

A much lower percentage of people with disabilities use the internet than those without disabilities across all age groups.

This study looked at the views and experiences of adults who have cerebral palsy about using social media.

An online focus group was used to gather evidence about participant’s views of the benefits and disadvantages of social media use for people with complex communication needs (CCN). A number of benefits, disadvantages and barriers were identified and some recommendations were made for professionals, support personnel, policy makers and technology developers to support the use of social media by PWUAAC.


Things you may want to look into:

Social media experiences of adolescents and young adults with cerebral palsy who use augmentative and alternative communication

A grounded theory of Internet and social media use by young people who use augmentative and alternative communication (AAC)

‘‘We definitely need an audience’’: experiences of Twitter, Twitter networks and tweet content in adults with severe communication disabilities who use augmentative and alternative communication (AAC)

Happy and excited: Perceptions of using digital technology and social media by young people who use augmentative and alternative communication

 

Added to site December 16



 

Social media experiences of adolescents and young adults with cerebral palsy who use augmentative and alternative communication (summary)

Background

Recent developments in technology have increased opportunities for communication through social media.

For people who use augmentative and alternative communication (PWUAAC) the new opportunities are not always matched by improved access.

A much lower percentage of people with disabilities use the internet than those without disabilities across all age groups. People who do not have internet access might become isolated compared to those who do.

There is limited research into whether people with complex communication needs (CCN) use social media for communication, social participation, leisure and learning opportunities. Research that has been carried out found that social media use has many positive benefits. The main barriers to independent use are lack of access to equipment, mobility issues and limited literacy skills. All of this work that has been carried out with adolescents; there is no previous research into social media use by adults who use AAC.

 

What did they do?

This study looked specifically at the views and experiences of adults who have cerebral palsy about using social media. It aimed to investigate:

An online focus group was used. Nine adults were involved, all had cerebral palsy, CCN and functional literacy skills. They had internet access, used some form of social media at least three times a week and were prepared to commit to participating in an online forum for 6 to 8 weeks.

The focus group took part in online discussions with topics and questions posted before the group began. New topics were introduced approximately every four to seven days. One of the researchers acted as moderator.

The group continued for six weeks. Following the closure of the group all participants were sent information summarizing the themes and sub-themes discussed, enabling them to confirm its accuracy and completeness.

 

What did they find?

The posts to the focus group were analysed into themes and sub-themes related to the areas being investigated.

Advantages of using social media - six main advantages emerged; connecting with other individuals, feeling typical, making communication easier, gaining independence, getting help and supporting employment.

This included being able to talk to several people in a short space of time, developing relationships, communicating in a ‘normal’ way and more easily than face-to-face, a reduction in the influence of slow communication speeds, being able to use social media independently to contact companies or distant friends and to ask for help or manage personal carers. Several participants reported that social media had helped them get or promote their work.

Disadvantages of social media use – five disadvantages were identified; managing cyber security threats, lack of direct contact, lack of personal connection, lack of immediate responses and over reliance on technology.

Participants were concerned about the anonymity of social media and not knowing whether contacts are genuine. The issue of a lack of direct and physical contact was raised as a disadvantage, as was a lack of personal connections; with communication being to the ‘masses’ rather than at an individual level. The lack of immediate response in online conversations concerned some participants.

Whilst appreciating the benefits of technology to support communication participants were concerned that it can lead users to forget about or ignore people who are physically present with them.

Barriers to use of social media included technology, mainly issues with the way their AAC device worked with websites, difficulties with speed of typing in real-time communications, making ‘live chat’ features unpopular, and physical access barriers due to motor control difficulties making using mobile technology with small buttons very challenging.

Supports for social media use - specific technology features such as prediction, abbreviation expansions were viewed positively. Most participants liked having supports on their dedicated communication devices to help them access sites or use shortcuts.

The idea of educating communication partners on social media was highly valued, for example telling people that typing will be slow before starting to use instant messaging so they will understand.

The importance of using social media safely was emphasised, such as managing friends requests and being careful about what is posted.

The focus group had some recommendations about the use of social media related to other individuals using AAC and support personnel, including the need to teach safe use and help to overcome barriers.

Recommendations for policy makers were mainly around funding of unlocked AAC devices so social media can be accessed.

For technology developers participants wanted a range of additional or changed features depending on individual needs and ideas.

 

Conclusions:

Whilst the use of social media was important to all participants in the study they had to overcome a number of barriers to use it successfully and also saw some disadvantages to it.

The study suggests that there are; core implications for practice in supporting PWUAAC to access social media safely, implications for training of professionals to extend beyond face-to-face interactions and written communication implication for technology development to more fully meet the needs of people with CCN and implications for policy makers in funding devices.

 

Cautions:

The study only considers the perspective of a small number of individuals and the findings might not be transferable to the wider population of people with cerebral palsy who use AAC.

The study does not consider how people’s views might change over time.

In addition the views of people who are not literate and/or do not use social media were not taken into account.

 


Things you may want to look into:

Social media experiences of adolescents and young adults with cerebral palsy who use augmentative and alternative communication

A grounded theory of Internet and social media use by young people who use augmentative and alternative communication (AAC)

‘‘We definitely need an audience’’: experiences of Twitter, Twitter networks and tweet content in adults with severe communication disabilities who use augmentative and alternative communication (AAC)

Happy and excited: Perceptions of using digital technology and social media by young people who use augmentative and alternative communication

 

Added to site December 16 


Speaker Transfer in Children’s Peer Conversation (short summary)

Two eleven year old boys, one a VOCA user, one without communication difficulties, were videoed having a non-directed conversation. Their conversation was analysed with particular focus on turn-taking within the interaction and how the end of VOCA users turns was indicated and understood.

They found that, in general the boys managed the transfer of conversational turns quite well. The use of questions and some conversational prompts by the non-VOCA user provided some expectations about what the VOCA user might do next and the use of non-verbal behaviours such as eye gaze help to indicate when VOCA utterances are complete.

The authors also considered the speaking child's interaction with the VOCA and the way in which it can fulfil additional social functions including being part of a 'guess ahead' game during an interaction, so that the VOCA user can either confirm or reject the others attempts to guess what he is going to say. They suggest that in peer to peer interaction the use of communication aids is collaborative in nature and not simply related to the giving and receiving of information.


Added to site February 2014


Speaker Transfer in Children’s Peer Conversation (summary)

Background In conversations in which one speaker uses a communication aid the AAC users contributions are generally more slowly produced and might lack other subtle features such as intonation and changes in volume. These factors have an effect on the way in which conversational turns are managed between communication partners. The use of communication aids, particularly by children with complex motor disabilities can lead to delays between the end of a natural speaker's conversational turn and the beginning of the VOCA users spoken output.

What was the aim of the study? The aim was to use conversational analysis to look at the way in which a child with cerebral palsy who used a high-tech communication aid and his peer, who had no physical or communication difficulties, managed the conversational turn-taking in an interaction. This was to focus particularly on points at which a VOCA generated utterance was due to end and the child without communication needs was next to speak.

What did the authors do? They used a single case study of a conversation between two eleven year old boys, one of whom had no known physical, learning or communication disabilities, the other had cerebral palsy and used a very limited range of speech sounds, he used an infra-red head pointer to access his VOCA and had no learning disabilities.

The boys were videoed as they had a conversation. Their interaction was transcribed in a very detailed form which looked at non-verbal behaviour, vocalisations and non-vocal sounds such as beeps from the VOCA, as well as spoken output.

Caution: This was a single case study and therefore the findings cannot necessarily be generalised more widely.

Conclusions: They found that, in general the boys managed the transfer of conversational turns quite well. The use of questions and some conversational prompts by the non-VOCA user provided some expectations about what the VOCA user might do next and the use of non-verbal behaviours such as eye gaze help to indicate when VOCA utterances are complete.

The need for the VOCA user to look at his device whilst constructing an utterance meant that looking away from it towards his friend indicated that he had finished his turn, continuing to look at the device signalled that he had more to say.

The authors also considered the speaking child's interaction with the VOCA and the way in which it can fulfil additional social functions including being part of a 'guess ahead' game during an interaction, so that the VOCA user can either confirm or reject the others attempts to guess what he is going to say. They suggest that in peer to peer interaction the use of communication aids is collaborative in nature and not simply related to the giving and receiving of information.


Added to site February 2014


Speech and language therapists’ approaches to communication intervention with children and adults with profound and multiple learning disability? (short summary)

The authors looked into how speech and language therapists (SLTs) made decisions about communication interventions they used with people with profound and multiple learning disabilities (PMLD).

They surveyed a number of SLTs who worked with people with PMLD about what sort of intervention approaches they used and on what basis these choices were made.

They found that there is a very limited evidence base for communication interventions with this population, but even where some evidence exists this was not often the primary reason SLTs elected to use a particular strategy. Most often choices were based on client factors, mainly the benefits to the person with PMLD rather than on clinical expertise or research evidence. However more evidence is needed as to whether the perceived benefits can be attributed to the interventions.

The paper concludes that approaches reported as being used by SLTs working with people with PMLD and those evaluated in published research do not match. Further research is needed to evaluate commonly used intervention approaches. In-service training is also needed to raise SLTs awareness of the evidence base to support certain approaches.


Things you may want to look into:

Profound and multiple learning difficulties

Developing communication in adults with profound and multiple learning difficulties using objects of reference

Implementing AAC with children with profound and multiple learning disabilities: a study in rationale underpinning intervention

Micro-switch programmes for students with multiple disabilities and minimal motor behaviour: Assessing response acquisition and choice

Added to site May 2015


Speech and language therapists’ approaches to communication intervention with children and adults with profound and multiple learning disability? (summary)

Background

Impaired communication skills are one of the defining characteristics of people with profound and multiple learning disabilities (PMLD).

The communication skills of this group might include idiosyncratic behaviours which are interpreted by their communication partners. These interactions with other people are very important for quality of life.

There is a limited evidence base for speech and language therapists (SLT) intervention with people with PMLD, though Royal College of Speech & Language Therapists (RCSLT) clinical guidelines indicate that it should be available to them.

There are several intervention approaches for which there is some evidence available. These are; intensive interaction, objects of reference (OoR), creative arts therapies, micro-switch technology, symbolic approaches and environmental support and modification or staff training.

What did the authors do?

This study aimed to provide information through a survey of SLTs looking at:

Fifty five SLTs who worked for all or part of their time with people with PMLD completed the survey.

What did they find?

The most commonly used approaches were intensive interaction and OoR. Communication passports were used more often with adults than children and symbolic interventions more commonly with children. Creative arts i.e. sensory stories and music were used exclusively with children.

The rationales for selection of intervention approach were divided into four main categories:

The most commonly given rationale across all of the intervention approaches was related to the empowerment, needs development and behavioural preferences of the people with PMLD.

Developing communication partner’s skills and the communicative environment were also commonly mentioned.

The use of published research evidence was given as a rationale in only a limited number of interventions.

The authors found that SLTs rationales were largely based on client factors, mainly the benefits to the person with PMLD rather than on clinical expertise or research evidence. However more evidence is needed as to whether the perceived benefits can be attributed to the interventions.

Cautions:

There are a number of limitations identified in the paper including whether sufficient information was sought regarding indirect as opposed to direct interventions, particularly in relation to staff training.

Further research is also needed about the combinations of communication interventions used for people with PMLD.

The participants in the survey were self-selecting and there is no information about the representativeness of the sample.

Each of the intervention methods needs further evaluation to develop a more robust evidence base about the ‘best’ interventions.

Conclusions:

The approaches reported as being used by SLTs working with people with PMLD and those evaluated in published research do not match. Further research is needed to evaluate commonly used intervention approaches. In-service training is also needed to raise SLTs awareness of the evidence base to support certain approaches.


Things you may want to look into:

Profound and multiple learning difficulties

Developing communication in adults with profound and multiple learning difficulties using objects of reference

Implementing AAC with children with profound and multiple learning disabilities: a study in rationale underpinning intervention

Micro-switch programmes for students with multiple disabilities and minimal motor behaviour: Assessing response acquisition and choice

Added to site May 2015


Speech segmentation (short summary)

The authors of this study designed and tested a computational model of speech segmentation, which is the process by which infants learn to identify individual words in speech. The model that the authors developed fulfilled more criteria for ideal models of this process than other, older models. Results suggested that children may learn to identify their own names early in development and use this knowledge as a way to begin to identify the words that surround their name in speech. The words most useful to speech segmentation in this model were also important for the acquisition of grammar, which suggests that both speech segmentation and grammatical skills share a similar basis of words.


Things you may want to look into:

Developing language in a developing body (short summary)

Working memory in children's language comprehension (short summary)

Added to site August 2013


Speech segmentation (summary)

Background As infants begin to learn the language spoken around them, they face the problem of 'speech segmentation'. That is, infants hear speech in a continuous stream without any pauses between words, yet, in order to acquire language, they must learn how to separate continuous speech into individual words.

What was the aim of the study? The authors of this study designed and tested a computational model of speech segmentation.

Why was the paper written? While other computational models of speech segmentation exist, the authors suggest a set of criteria that the most successful models should share. Models of speech segmentation should be able to identify individual words, plausibly reflect the cognitive processing abilities of an infant, have a limited number of external components and reflect what researchers know about how infants learn to speak. The authors developed a new model that could more completely meet these criteria than older models.

What did the authors do? The authors built a computational model of speech segmentation. They focussed on using boundaries in speech, such as pauses between words and changes in speakers, and word frequency to segment speech. The model segmented continuous speech based on whether any components of the speech were familiar. For example, if the model encountered a word in isolation, such as 'car', that word could be identified when it occurred in longer strings of speech, such as 'look it car'. If another phrase contained the phrase 'look it', then the model could recognize 'look it' as an independent item.

The authors were interested in whether the model would be able to identify single words, what words were identified most easily and how words were discovered over time.

What did they find? The model was able to successfully identify many real words in the data, which included speech that adults directed to six different children aged two-and-a-half years and younger. The model was able to identify single words quickly, including the children's names. The authors found that the words that the model segmented overlapped with the kinds of words that are useful for the acquisition of grammar.

Conclusions: The model designed by these authors was just as successful as older models of speech segmentation, but it fulfilled the criteria of successful models better than others. The model demonstrated that a child's name may have an important role in speech segmentation, as children may learn to recognize their name early in development and use this knowledge to segment the speech they hear surrounding their names. Importantly, the words that were useful for segmenting speech were also useful for grammar acquisition, which suggests that the same words may form an important basis for both skills.


Things you may want to look into:

Developing language in a developing body (summary)

Working memory in children's language comprehension (summary)

Added to site August 2013


Speech-Generating Devices Used at Home by Children With Autism Spectrum Disorders (short summary)

Difficulties with language and communication are a feature of autism spectrum disorder (ASD), and many people who have ASD might benefit from the use of augmentative and alternative communication (AAC) either permanently or in the short-term. The development of technology and a range of speech generating devices (SGDs) can be effective for some people with ASD who have limited or no functional speech.

This study looked at the use of speech generating devices (SGDs) at home and with children who had some functional speech.

It considered three elements:

The findings of the report indicate that the effects of introducing SGDs to three young boys who had ASD and their families were variable across a number of different communicative behaviours but concluded that the use of SGDs can be beneficial for children with ASD who have some functional speech, supporting them to communicate more effectively at home. The authors also make it clear that further research into this area is needed.

 


Things you may want to look into:

Effects of synthetic speech output on requesting and natural speech production in children with autism: A preliminary study

Comparing Acquisition, Generalization, Maintenance, and Preference Across Three AAC Options in Four Children with Autism Spectrum Disorder

Enhancing the Alternative and Augmentative Communication Use of a Child with Autism through a Parent-implemented Naturalistic Intervention

Added to site June 2016


Speech-Generating Devices Used at Home by Children With Autism Spectrum Disorders (summary)

Background

Difficulties with language and communication are a feature of autism spectrum disorder (ASD), and many people who have ASD might benefit from the use of augmentative and alternative communication (AAC) either permanently or in the short-term. The development of technology and a range of speech generating devices (SGDs) can be effective for some people with ASD who have limited or no functional speech.

Studies have also suggested that the use of SGDs by people in the environment of children with ASD to model language is important in developing successful SGD use, as is the child’s willingness to independently explore their device. Most of these research studies have considered children at a prelinguistic or very early stage of linguistic development in their schools or a clinical setting.

This study aimed to extend this to look at the use of SGDs at home and with children who had some functional speech.

It considered three elements:

 

What did they do?

Three boys aged between 5and 7 and their families took part in the study. The parents were interviewed before and after the intervention using a standardised assessment to measure outcomes for children with ASD.

All of the boys had diagnoses of some form of autism. One had previously used a small SGD, but not for spontaneous communication, he has learned to imitate words used on the device and used these functionally. The other boys had not used SGDs. All of the children had difficulty making themselves understood consistently.

The authors used a family-centred, collaborative model as a basis for the intervention. The choice of activities for intervention, (two for each child), communication goals and the vocabulary selected were decided in meetings between the parents, local service providers and the researchers. The activities were different for each child depending on their interests and motivations.

The SGDs used had dynamic screens on portable touch-screen computers. The number of vocabulary items programmed ranged from 115 to 279; mainly short phrases as sentence starters and single words.

The parents were given training in the use of the programs and if appropriate in story reading and the use of assistive technology for children with disabilities. They were also given guidance about using the SGDs in daily communication and encouraged to use them to augment their own speech and to model use of the device for their child. In addition to using the SGDs in specifically planned interventions they were encouraged to use them at other times too.

The families were supposed to video their chosen activities once a week on at least 4 occasions before the intervention began and 4 times following the introduction of the SGD; only one of the three families managed to do this according to the target schedule.

The video recordings were analysed and coded by the researchers considering a number of communicative behaviours: degree of engagement, role in turn taking, mode of communication and effectiveness of communication. 

 

What did they find?

The results varied between the three participants but all were found to have increased communicative effectiveness through the use of SGDs.

There was some increase in engagement in at least one activity for all three boys when they had SGDs and in 2/3rds of the activities the rate of communicative responses increased.

The mode of communication used did not show any consistent pattern across all participants though prelinguistic forms of communication reduced when an SGD was introduced.

The results of the parental interviews, pre- and post-intervention suggested positive changes including increased expressive communication effectiveness for all 3 and decreases in ‘maladaptive’ behaviour for 2 of the participants. Two also increased their speech production.

 

Conclusions:

This small study indicated that the use of SGDs can be beneficial for children with ASD who have some functional speech, supporting them to communicate more effectively at home. The authors also make it clear that further research into this area is needed.

 

Cautions:

This study involved only a small number of participants meaning that the results cannot be generalised more widely across the population of children who have ASD. The recording system used by the families was not entirely consistent and therefore the possible influence of the children maturating over time and this having an effect on the outcomes cannot be totally discounted.

The range of messages selected to be into the devices could also have had an influence on the outcomes.


Things you may want to look into:

Effects of synthetic speech output on requesting and natural speech production in children with autism: A preliminary study

Comparing Acquisition, Generalization, Maintenance, and Preference Across Three AAC Options in Four Children with Autism Spectrum Disorder

Enhancing the Alternative and Augmentative Communication Use of a Child with Autism through a Parent-implemented Naturalistic Intervention

Added to site June 2016


 


 

Study of Gaze Toward Humans in Photographs by Individuals with Autism, Down Syndrome, or Other Intellectual Disabilities (short summary)

Eye tracking technology was used to investigate the gaze and fixation patterns of adolescents with and without disabilities when looking at visual scene displays (VSDs) that included a human figure taking up a relatively small percentage of the total area of the scene. They found that all of the participating groups, including those with autism, Down syndrome and other intellectual disabilities, fixated on the person in the majority of the photographs and for a significant percentage of the time spent engaged with the picture.

Further research is needed into this area, but indications are that the inclusion of human figures into VSDs being used to support communication might be beneficial in increasing visual engagement with the scene.


Things you may want to look into:

Designing AAC Systems for Children with Autism: Evidence from Eye Tracking Research

Eye Tracking as a Measure of Receptive Vocabulary in Children with Autism Spectrum Disorders

Hidden communicative competence: Case study evidence using eye-tracking and video analysis

The Potential Influence of Stimulus Overselectivity in AAC: Information from Eye Tracking and Behavioral Studies of Attention with Individuals with Intellectual Disabilities

Added to site March 2015


Study of Gaze Toward Humans in Photographs by Individuals with Autism, Down Syndrome, or Other Intellectual Disabilities (summary)

Background

Visual Scene Displays (VSDs) might be a useful tool for AAC interventions for some people with complex communication needs (CCN), supporting the learning of language within a social setting and learning vocabulary meaning within a shared and familiar social experience with a communication partner, but research is needed into their optimum design.

There is evidence to suggest that the attention of people without disabilities is drawn to human figures within VSDs and the authors wanted to look into whether this is also true of individuals with various disabilities, even when the figures are not the most obvious element in the picture.

What did the authors do?

The authors investigated gaze fixation patterns of adolescents with autism, Down syndrome and other intellectual disabilities and children and adolescents without disabilities, to human figures in scenes where they are small or not the most obvious element. They also looked into differences between the responses of the various trial groups.

The participants with disabilities had significant language disabilities associated with their conditions.

Each participant was shown eight target photographs in which a human figure took up less than 20% of the total area and there was another element, e.g. a statue, fountain, Christmas tree, that would be expected to attract attention. Eye tracking technology was used to identify the areas of focus and the time spent fixated on various elements of the picture and the time taken to first fixate on the figure.

What did they find?

In all groups the participants fixated on the human figure in over 80% of the photographs. The groups with disabilities fixed on the photograph as a whole for significantly less time than those without disabilities but the fixation on the person was not significantly less as a proportion of the total fixation time.

In all groups the human figures attracted longer and more intense fixation than would be expected on size alone.

Cautions:

The sample size in each group was small so the findings cannot be widely generalised, nor were other variables such as visual acuity and communication functioning taken into account.

In this study the all of human figures were looking directly at the camera rather than being engaged in the event in the photograph which might have altered the engagement with elements of the VSD.

The authors also suggest that different types of images and static versus moving scenes should be investigated. They also note that fixation on an element does not guarantee that the viewer is attending to it; another area that requires further investigation.

Conclusions:

The inclusion of people as an integral part of VSDs would seem to be important for all groups.

The groups with disabilities spent less time than those without focussing on the photograph in general. The reasons for this are not clear and require further investigation.

The use of eye tracking technology to obtain information that might otherwise be difficult to access was beneficial.


Things you may want to look into:

Designing AAC Systems for Children with Autism: Evidence from Eye Tracking Research

Eye Tracking as a Measure of Receptive Vocabulary in Children with Autism Spectrum Disorders

Hidden communicative competence: Case study evidence using eye-tracking and video analysis

The Potential Influence of Stimulus Overselectivity in AAC: Information from Eye Tracking and Behavioral Studies of Attention with Individuals with Intellectual Disabilities

Added to site March 2015


Systematic Review of the Effects of Interventions to Promote Peer Interactions for Children who use Aided AAC (short summary)

People who use augmentative and alternative communication (AAC) have been found to be at risk of social isolation and often lack interaction with their peer groups. Children who use AAC face the same barriers as others with disabilities in developing communication with peers and in addition might struggle to communicate using their AAC systems.

It is important that peer interaction is encouraged as a way to develop friendships.

This systematic review of studies involving children with disabilities who use AAC considered studies that used interventions to increase or improve peer interaction, looking into the strengths and limitations of available evidence and discussing implications of this for practice and possible future research.

The studies included in the systematic review showed that, with support, children who use AAC and their peers could interact more often throughout the school day. Adults supporting peer interaction for children with complex communication needs might lead to increased time spent in peer interaction.

In providing these interventions consideration needs to be given to the individual AAC user, communication partners and the context in which communication takes place. Focussing on all three of these areas increases the likelihood of a positive benefit to the communicative competence of the child who uses AAC.

 


Things you may want to look into:

Communication Opportunities for Elementary School Students who use Augmentative and Alternative Communication

Children’s attitudes toward interaction with an unfamiliar peer with complex communication needs: comparing high- and low-technology devices

‘‘He Cares About Me and I Care About Him.’’ Children’s Experiences of Friendship with Peers who use AAC

 

Added to site January 17


 

Systematic Review of the Effects of Interventions to Promote Peer Interactions for Children who use Aided AAC (summary)

Background

People who use augmentative and alternative communication (AAC) have been found to be at risk of social isolation and often lack interaction with their peer groups. Children who use AAC face the same barriers as others with disabilities in developing communication with peers and at the same time might struggle to communicate using their AAC systems. Adults are more likely than other children to respond to communication attempts and to do so in predictable ways.

It has been found that whilst the number of turns taken in interactions between children who use AAC and their peers is more equal than when an adult is the communication partner the children using AAC still initiate less and respond more. Only around 5% of interactions by children who use AAC take place with their peers alone, 89% are only with adults and around 6% with adults and peers.

It is important that peer interaction is encouraged as a way to develop friendships.

This project aimed to review studies involving children with disabilities who use AAC. The authors carried out a systematic review of studies that used interventions to increase or improve peer interaction, to consider the strengths and limitations of available evidence and to discuss the implications of this for practice and possible future research.

 

What did they do?

Following initial searches 19 studies were included in the review. 56 participants took place in the selected studies, there was an age range from 3 to 21 years and a variety of developmental disabilities. All of the studies measured peer interactions at school and three also included interactions during breaks at job placements.

The studies all looked at communication outcomes for children who used AAC, several different variable were considered; interventions with the child who used AAC, interventions with peers and environmental interventions.

 

What did they find?

All of the studies reported some positive gains in peer interaction though it was not easy to say which particular elements of interventions were most beneficial. Studies looking at multiple intervention types generally showed greater results i.e. those that included child-specific, peer and environmental interventions.

In general older children showed larger gains than younger.

Physical disabilities and social communication issues are not specifically addressed but are acknowledged to be possible influences on outcomes.

The quality of evidence found in the review was of the highest standard in 3 of the studies with 5 more being considered very good. 11 papers had some minor weaknesses in research design meaning further research into these is needed.

 

Conclusions:

The studies included in the systematic review showed that, with support, children who use AAC and their peers could interact more often throughout the school day. Adults supporting peer interaction for children with complex communication needs might lead to increased time spent in peer interaction.

In providing these interventions consideration needs to be given to the individual AAC user, communication partners and the context in which communication takes place. Focussing on all three of these areas increases the likelihood of a positive benefit to the communicative competence of the child who uses AAC.

 

Cautions:

This study does not consider children who use unaided AAC and whether interventions used with this group would also be beneficial to children who use aided AAC.

It is possible that some studies relevant to the research were not included in the review, and papers that are not peer-reviewed were not included though they might have provided some insight.

In addition it is possible that unpublished studies that were not included in the review might have given more information about ineffective interventions thus leading to suggestions for further research.


Things you may want to look into:

Communication Opportunities for Elementary School Students who use Augmentative and Alternative Communication

Children’s attitudes toward interaction with an unfamiliar peer with complex communication needs: comparing high- and low-technology devices

‘‘He Cares About Me and I Care About Him.’’ Children’s Experiences of Friendship with Peers who use AAC

Added to site January 17


 

Teaching 1:1 workers to support young children with CCN (short summary)

The authors gave 2 hours of individual training to a small number of one to one support workers who each worked with a preschool child with complex communication needs.

They found that in each case the number of communication opportunities offered to the children in play sessions and the number of communication turns taken by the children increased.


Things you may want to look into

www.aacknowledge.org.uk/biblio/use-augmentative-and-alternative-communication-methods-infants-and-toddlers-disabilities-rese

Added to site January 2014


Teaching 1:1 workers to support young children with CCN (summary)

Background In school and preschool settings 1:1 support workers (paraeducators) are important and frequent communication partners for young children who have complex communication needs. There has been little research into impact of training on the way these support workers communicate with the children during play.

What was the aim of the study? The authors aimed to look at the effect of training for the workers on the number of communication opportunities provided for children during play activities and the number of communication turns taken by children.

What did the authors do? They worked with 3 support workers and the children they worked with, within an early years setting. They initially measured the communication behaviours of the workers and children in play sessions and then offered two hours of individual training to each of the workers. Focussing on the following strategies:

Following the training five maintenance play sessions were carried out and communication behaviours were measured again. They also asked the participants how they felt about the training undertaken and looked at whether the children's teachers saw any value from the intervention.

What did they find? Each of the workers was found to offer a large increase in the number of communication opportunities they offered to the child they worked with after the training, however over time the level of increase reduced. All 3 of the children showed an increase in the number of communication turns during the training period.

The support workers and teachers all believed that the training had been beneficial.

Cautions: The small number of participants all from the same place, and the variability in the results, means that generalisations cannot be made about the potential effectiveness of this training to a wider range of people.

There was no direct intervention with the children, or training in adding vocabulary to their AAC systems. The result might have been different if these things had also been addressed.

This paper focussed only on play without peers and individual training for support workers. There is also a need to look into training workers to support group play activities and to consider training offered to teams or groups of educators.

Conclusions: Offering training packages on skills to support communication can increase the number of communication opportunities offered and the number of communication turns taken by children who have CCN. Further research is needed into this area.


Things you may want to look into:

The use of augmentative and alternative communication methods with infants and toddlers with disabilities: a research review

Added to site January 2014


Teaching Early Numeracy Skills Using Single Switch Voice-Output Devices to Students with Severe Multiple Disabilities (short summary)

The authors of this paper investigated the ‘effect of a systematic instructional package with individualized adaptations on the acquisition of numeracy skills’ on students with multiple disabilities. The research involved three children with severe multiple disabilities and complex communication needs (CCN) who attended a special school.

The intervention took the form of five different maths lessons being delivered a minimum of 3 times each either to individuals or groups of two pupils. The lessons followed a scripted ‘maths story’ and each had 12 early numeracy skills objectives built in together with a range of modified curriculum support resources adapted to make them accessible to the students. The use of maths stories gave the children opportunities to perform maths skills such as rote counting, identifying numbers, making sets etc. The children actively responded in different ways; using yes/no switches, number-lines, touching story –related resources etc.

The found that all of the participants showed a significant increase in scores from the baseline to the final assessment, indicating improvement in their ability to demonstrate early numeracy skills within the lessons.

The results of the research indicate that the ‘systematic instructional package with individualized adaptations … was effective for teaching … targeted early numeracy skills’. However the use of single switch voice-output systems was limiting, only enabling responses to questions not supporting comments, questions or voicing of opinions. Informally the participants were all observed to use other non-verbal communication to convey a range of meanings in addition to activating switches.

The authors support the idea that AAC and other assistive technology helps improve student outcomes and increase opportunities to learn and show their learning.


Things you may want to look into:

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

Where are teachers' voices? A research agenda to enhance the communicative interactions of students with multiple and severe disabilities at school

Added to site May 2016


 

Teaching Early Numeracy Skills Using Single Switch Voice-Output Devices to Students with Severe Multiple Disabilities (summary)

Background

There is limited research evidence into teaching students with severe disabilities, possibly due to the difficulties imposed by their limited communication. The research that there is tends to focus on literacy and communication rather than maths or numeracy skills. The authors of this paper therefore chose to investigate the ‘effect of a systematic instructional package with individualized adaptations on the acquisition of numeracy skills’. The research involved three children with severe multiple disabilities and complex communication needs (CCN).

What did they do?

Three children, one aged 9 and two aged 11 took part in the study. All had multiple disabilities including severe intellectual disability, one had no vision and did not respond to visual stimuli. All of the children demonstrated some early receptive language skills and used a variety of simple augmentative and alternative communication (AAC) systems, including single switch voice-output systems, expressively.

The intervention took the form of the teacher being given two hours of training and then delivering five different maths lessons a minimum of 3 times each either to individuals or groups of two pupils. The lessons followed a scripted ‘maths story’ and each had 12 early numeracy skills objectives built in. The use of maths stories gave the children opportunities to perform maths skills such as rote counting, identifying numbers, making sets etc. The children actively responded in different ways; using yes/no switches, number-lines, touching story –related resources etc.

The researchers carried out baseline assessments prior to the intervention starting and probes to monitor progress at various points throughout the intervention period.

Only one of the children completed participation in all 5 scripted lessons, one took part on 4 and the third only 2.

What did they find?

All of the participants showed significant increase in scores from the baseline to the final assessment, indicating improvement in their ability to demonstrate early numeracy skills within the lessons. The teacher also gave very positive responses when interviewed about her views of the intervention. She indicated that she would use the same approach again with other pupils despite the amount of time needed to adapt materials to make them accessible and to provide voice output devices for participants.

Conclusions:

The results indicate that the ‘systematic instructional package with individualized adaptations … was effective for teaching … targeted early numeracy skills’. However the use of single switch voice-output systems was limiting, only enabling responses to questions not supporting comments, questions or voicing of opinions. Informally the participants were all observed to use other non-verbal communication to convey a range of meanings in addition to activating switches.

The authors support the idea that AAC and other assistive technology helps improve student outcomes and increase opportunities to learn and show their learning.

The participants’ communication difficulties posed challenges for teaching and learning that were not related to the curriculum. The authors identify that communication development activities should be integrated into academic lessons and other activities rather than being taught in isolation. Without AAC it is concluded that the children would not have been able to actively engage in maths lessons and demonstrate their learning.

Cautions:

One of the three participants had very limited interventions and still showed significant improvement form her baseline score, however it is not possible to know whether this rate of improvement would have been maintained with further intervention. This child was visually impaired (VI) and needed to develop strategies for making choices from a range of options; the need for involvement of VI specialist teachers working with other specialist teachers is recommended as important.

The amount of time needed to prepare and adapt curriculum support materials to make them accessible is identified as a limitation of this type of intervention, but once prepared the resources could be used over a number of academic years.

This research only considered children who were taught in special school provision and did not include any students with disabilities educated in mainstream settings.


Things you may want to look into:

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

Where are teachers' voices? A research agenda to enhance the communicative interactions of students with multiple and severe disabilities at school

Added to site May 2016


 

Teaching Graphic Symbol Combinations to Children with Limited Speech During Shared Story Reading (short summary)

The authors aimed to extend research into interventions that might help develop expressive use of symbol combinations. They looked at three types of language structures that are typically used in early language development and modelled them in symbol combinations while reading stories to children who needed symbols to support their use of spoken language.

Their findings were not conclusive, only 4 children took part in the research and while two of them showed improvement in their ability to combine symbols expressively the other two showed less clear and consistent improvement.


Things you may want to look into:

The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech

Shared storybook reading with a student who uses alternative and augmentative communication: A description of scaffolding practices

The effect of shared book reading on the acquisition of expressive vocabulary of a 7 year old who uses AAC

The Effect of Aided AAC Modeling on the Expression of Multi-Symbol Messages by Preschoolers who use AAC

The effect of shared book reading on the acquisition of expressive vocabulary of a 7 year old who uses AAC

 


Added to site August 2015

Teaching Graphic Symbol Combinations to Children with Limited Speech During Shared Story Reading (summary)

Background

The use of graphic symbols can be helpful for children who do not develop enough spoken language to meet their communication needs but it is not always easy to combine symbols into messages of more than one word, particularly for those children whose understanding of spoken language is also delayed. There could be a number of reasons for this.

The skills needed to develop the use of symbol combinations do not seem to develop without direct teaching. Some studies have shown that the use of adult modelling of word combinations using the symbol format (aided input) helps promote use of symbol combinations by children who use augmentative and alternative communication (AAC). Modelling combined with direct teaching strategies might be even more effective.

What did they do?

The authors aimed to extend research into interventions that might help develop expressive use of symbol combinations. They looked at three types of language structures that are typically used in early language development.

They used a matrix training technique which is fully explained in the paper. It aimed to support participants to generate new combinations of words that have not been specifically taught, but the elements of which have been taught in different combinations, e.g. the combinations 'the dog cries' and 'the boy falls' were taught with the aim of generalising these to 'the boy cries' or 'the dog falls'.

Instead of teaching the structures out of context the researchers built them in to a story reading situation; looking at whether targeting two-symbol combinations using a hierarchy of prompts during story reading could facilitate the production of symbol combinations in response other to picture stimuli.

Four children who fulfilled strict selection criteria were selected to participate. A baseline assessment of their ability to combine symbols was completed. Five symbol combinations for each of three different semantic relations, agent- action e.g. 'the boy runs', possessor-possession e.g. 'the bunny's shoe' and attribute-entity e.g. 'broken car', were selected as intervention targets. A further five for each set of relations were the generalisation targets. Each child was given a colour-coded symbol board with the 21 symbols needed to generate the target combinations.

A story was developed to teach expressive use of each of the target sets. The intervention involved the researcher reading the stories to the children individually and using a five point hierarchy of prompting strategies to support the participant to use the target combinations as they occurred in the story. Repetition of the original assessment took place at regular intervals throughout the intervention period and between one and five weeks after the intervention ended.

What did they find?

Two of the participants showed an improvement in their ability to combine symbols which was largely maintained after the end of the intervention. These were the children with higher levels of receptive language ability and English as their home language and responded well to the first level of the prompting hierarchy.

The other two participants showed less clear and consistent improvement in the assessment task, though they did show improved ability to combine symbols within the story telling activity. These children needed more supports from higher up the hierarchy of prompts.

Conclusions:

A number of factors that might have accounted for the variation in performance between the participants are discussed. These included levels of receptive language skills, home language and the participant's initial ability to identify the symbols used. Previous exposure to expressive use of symbols might also be significant.

The authors note that the results might have been poorer than expected because the assessment task was a 'test' in which no feedback on the correctness of responses was given. This might not have been particularly motivating, there is some evidence that this might be the case as the less successful participants performed better in the story reading intervention phase than in the testing element.

Cautions:

There are many issues identified as possible problems with the project: the responses of the weaker participants in the intervention tasks are not reflected in the assessment results, thus the gain in skills might not be fully represented in the results, there was a wide range of receptive language levels across the participants and two did not hear English as their home language which could account for the variability in the results. A more similar group of participants would have been more successful in isolating the effects of the intervention.

The limited number of teaching sessions offered might have been too few, leading to a lack of maintenance of the newly acquired skills after the intervention. No long term follow-up was undertaken.


Things you may want to look into:

The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech

Shared storybook reading with a student who uses alternative and augmentative communication: A description of scaffolding practices

The effect of shared book reading on the acquisition of expressive vocabulary of a 7 year old who uses AAC

The Effect of Aided AAC Modeling on the Expression of Multi-Symbol Messages by Preschoolers who use AAC

The effect of shared book reading on the acquisition of expressive vocabulary of a 7 year old who uses AAC


Added to site August 2015

Teaching Sound Letter Correspondence and Consonant-Vowel-Consonant Combinations to Young Children who Use Augmentative and Alternative Communication (short summary)

The authors wanted to examine the effectiveness of an intervention strategy to teach sound-letter correspondence and the spelling of consonant-vowel-consonant (CVC) combinations to young children who use AAC in a mainstream classroom by arranging the environment to create learning opportunities, providing adaptations to support the participation of AAC users and using specific instructional strategies.

Both children who took part in the study showed, and maintained, a significantly increased ability to match sounds to letters and to spell CVC words they had been taught and some to novel words too.

Preschool staff were found to have positive responses to the intervention and felt that the strategies could be used within the classroom for non-AAC users too. Most staff said they would be likely to continue using the strategies after the end of the study.


Things you may want to look into:

Simply a Speech Impairment? Literacy Challenges for Individuals with Severe Congenital Speech Impairments

A Developmental Continuum of Phonological Sensitivity Skills

Barriers to Participation in Kindergarten Literacy Instruction for a Student with Augmentative and Alternative Communication Needs

Initial insights into phoneme awareness intervention for children with complex communication needs

Reading and spelling in children with severe speech and physical impairments: a comparative study

The Effects of Phonological Awareness Instruction on Beginning Word Recognition and Spelling

Added to site July 2014


Teaching Sound Letter Correspondence and Consonant-Vowel-Consonant Combinations to Young Children who Use Augmentative and Alternative Communication (summary)

 

Background
For children who are at a pre-reading (emergent literacy) level phonological awareness and sound-letter knowledge are two of the strongest predictors of future reading ability. Phonological awareness is the ability to recognise that spoken words are made up of sequences of sounds, part of this is phonemic awareness; the understanding that words can be broken down into phonemes, the smallest sounds that make up words.

Children who use AAC are often found to have less advanced literacy skills than those who do not and teaching strategies need to be adapted to provide appropriate input, for example using means other than sounding out words aloud in reading and modifying the environment and prompts given to support learning.

What was the aim of the study?
The authors wanted to examine the effectiveness of an intervention strategy to teach sound-letter correspondence and the spelling of consonant-vowel-consonant (CVC) combinations to young children who use AAC in a mainstream classroom by arranging the environment to create learning opportunities, providing adaptations to support the participation of AAC users and using specific instructional strategies.

What did the authors do?
The study involved two pre-school children who could point to target symbols from a choice of 8, responded to 75% of adult directions in the classroom and used fewer than ten intelligible words.

The children showed no knowledge of sound-letter correspondence and had not had any teaching related to this or spelling.

The study took place in the children's preschool classrooms during free-choice times. The researcher was based in a 'literacy' area with a selection of boards with 8 letters. Each of 36 boards had the same letters in a different layout.

To check pre-intervention knowledge three target letters were selected and the children were encouraged to 'Touch the letter that says ...' or 'Spell ...', a word made up of those three sounds. A different board was used for each trial.

The intervention took place in the same situation with the target child encouraged to ask others to join in the activity. The same instructions were used, but followed by the researcher modelling the correct response by pointing to the letters on the boards.

When the children began to demonstrate correct responses a time delay was introduced before the prompt to allow the children to respond first. Reward activities were given after correct responses.

Following success and a maintenance phase, generalisation activities were carried out using paper copies of upper and lower case keyboards for the sound-letter recognition tasks. The original boards were used for the spelling tasks in which CVC combinations that had not been taught, but used the same selection letter sounds were targeted.

What did they find?
Both children showed, and maintained, a significantly increased ability to match sounds to letters and to spell CVC words they had been taught and some to novel words too. However one participant showed no generalisation to the upper-case keyboard at all.

Preschool staff were found to have positive responses to the intervention and felt that the strategies could be used withinthe classroom for non-AAC users too. Most staff said they would be likely to continue using the strategies after the end of the study.

Cautions:
It is not possible to generalise the findings from only two participants more widely. Further investigations are needed to determine if a broader range of children would achieve the same results.

Conclusions:
The use of specific teacher-child interventions with adaptations to response methods seems to be beneficial in teaching sound-letter correspondence and early spelling to children who use AAC.
It is important to be aware that many AAC devices use upper-case letters and knowledge of these might not be generalised from the lower-case forms more commonly used in preschool settings.


Things you may want to look into:

Simply a Speech Impairment? Literacy Challenges for Individuals with Severe Congenital Speech Impairments

A Developmental Continuum of Phonological Sensitivity Skills

Barriers to Participation in Kindergarten Literacy Instruction for a Student with Augmentative and Alternative Communication Needs

Initial insights into phoneme awareness intervention for children with complex communication needs

Reading and spelling in children with severe speech and physical impairments: a comparative study

The Effects of Phonological Awareness Instruction on Beginning Word Recognition and Spelling

Added to site July 2014


Technology for people, not disabilities: ensuring access and inclusion (short summary)

The authors discuss ways in which technology designed to benefit people with disabilities can actually create subtle forms of social exclusion.

They argue that it would be preferable for all new technologies to be 'accessible' for all, rather than 'assistive' for people with disabilities. They believe it would be beneficial for people with disabilities to be included in the development of new technologies and for accessibility options to be included in the original design rather than as a retrofit or add-on. This would have universal benefits and, hopefully reduce the rate of rejection found when people with disabilities are offered specifically designed assistive technology.

They believe that technology cannot be isolated from social context and must be designed with inclusion in mind, not as an afterthought.


Things you may want to look into:

Improving web access for individuals who rely on augmentative and alternative communication

The iPad and Mobile Technology Revolution

Added to site February 2014


Technology for people, not disabilities: ensuring access and inclusion (summary)

Background The authors considered that the recent rapid development of communication technology should break down barriers and increase access for people with disabilities. However they believe that although they are associated with access and integration the new technologies can actually create social exclusion for disabled people, either around the way in which they are used and prescribed or, less obviously, where the design of technology assumes that users will confirm to societal norms.

What was the aim of the study? The authors aimed to look at the way in which assistive technology can result in new forms of social exclusion and to suggest ways in which inclusive and accessible technology can promote greater access and flexibility for disabled people.

What did the authors do? The paper aims to shift the focus from 'assistive' technologies to consider what it might mean for all technologies to be inclusive and accessible. They advocate for a more inclusive view of technology being accessible to all.

They look at the way in which assistive technology creates subtle forms of exclusion, for example on line forums and social networking sites sometimes fail to meet accessibility guidelines, meaning some people with disabilities are excluded from a central part of current social life for young people.

The authors believe that some assistive technology is designed to 'fix' disabled people, to get them to approximate able-bodied norms rather than accept a range of normality. They state that this 'ensures that there is technology that is designed for disabled people and technology designed for presumed non-disabled people' and 'that the latter need not be accessible because of the former'.

They discuss that exclusion can be because accessibility is designed into technology as a retrofit or add-on, rather than being an integral part of the original design.

Conclusions: The authors argue that by offering technology that is accessible to all, rather than assistive to people with disabilities, there would be universal benefits. It might also reduce the rate of rejection of assistive technology which might be perceived as out dated or unacceptable by younger disabled people.

They suggest including disabled people in the design, development, implementation and marketing of technologies with the aim of developing technology that is accessible and responsive and which would increase accessibility and usability for all users.

They believe that technology cannot be isolated from social context and must be designed with inclusion in mind, not as an afterthought.


Things you may want to look into:

Improving web access for individuals who rely on augmentative and alternative communication

The iPad and Mobile Technology Revolution

Added to site February 2014


The Effects of PECS Teaching to Phase III on the Communicative Interactions between Children with Autism and their Teachers (short summary)

The majority of young children with autism spectrum disorder (ASD) have limited or no spoken language when they start school at around the age of 5. It has been suggested that up to two-thirds never acquire useful spoken language.

The Picture Exchange Communication System (PECS) was developed for use with children with ASD to enable them to develop communication without first having to have speech. The system is built around a child ‘exchanging’ a picture or symbol of a highly motivating item for the actual, desired object or event in a way that is integrated in to daily activities.

This study considered whether developing children’s spontaneous communicative initiation through the early stages of PECS up to phase III, which involves picture/object discrimination using a range of pictures, has any effect on interactions between children with ASD and their teachers.

24 young children with ASD received 15 hours of PECS training integrated into a variety of school activities over a five week period. A control group of 17 children did not receive any communication intervention in addition to their usual school input.

Over the intervention period significant increases were found in the total number of child to adult initiations, child to adult initiations with an adult response, adult to child initiations with an opportunity for the child to respond plus a response from the child and there was a significant decrease in the total number of adult initiations with no opportunity for the child to respond. Almost all of the increased initiations by children in the intervention group were PECS based.

No similar increase in initiations or responses were found in the control group.

The authors conclude that under optimum conditions the first half of the PECS program can be a very effective AAC tool for use with children with ASD and enable access to the curriculum.

 


Things you may want to look into:

Effectiveness of the Picture Exchange Communication System as a Functional Communication Intervention for Individuals with Autism Spectrum Disorders: A Practice-Based Research Synthesis

The Picture Exchange Communication System (PECS) What Do the Data Say?

A Review of the Efficacy of the Picture Exchange Communication System Intervention

The effectiveness of Picture Exchange Communication System (PECS) training for teachers of children with autism: a pragmatic, group randomised controlled trial

A Communication-Based Intervention for Nonverbal Children With Autism: What Changes? Who Benefits?

The Picture Exchange Communication System

Predicting progress in Picture Exchange Communication System (PECS) use by children with autism

National Autism Resources

PECS UK

 

Added to site June 2016


 

The Effects of PECS Teaching to Phase III on the Communicative Interactions between Children with Autism and their Teachers (summary)

Background

The majority of young children with autism spectrum disorder (ASD) have limited or no spoken language when they start school at around the age of 5. It has been suggested that up to two-thirds never acquire useful spoken language.

Teaching speech to this group can be a very lengthy process and throughout this children do not have an effective means of communication.

In addition children with a diagnosis of ASD often find it difficult to initiate communication, either spoken or using augmentative and alternative communication (AAC) systems, and need support to develop the ability to use spontaneous communication. This can be made worse by the fact that early attempts at communication are often difficult to understand and are therefore not effective. It has been identified as very important that children with ASD are provided with a clear and easy to use system of communication to enable them to develop their skills.

Many children who have ASD are less motivated than typically developing children by the social effects of communication such as praise and interaction, they are more rewarded by concrete effects such as getting an item they want.

Some teaching procedures used with children with ASD focus on the use of spoken communication and therefore require the child to have at least some spoken words. The Picture Exchange Communication System (PECS) was developed for use with children with ASD to enable them to develop communication without first having to have speech. The system is built around a child ‘exchanging’ a picture or symbol of a highly motivating item for the actual, desired object or event in a way that is integrated in to daily activities.

PECS has a specific structure of 6 phases, from exchange of a single picture for an item – initiating a request- to commenting spontaneously and in response to a question.

In most studies looking at the effectiveness of PECS there are no control groups of children who are not offered interventions to compare with the group receiving intervention. This study aimed to address this issue.

 

What did they do?

This study considered whether developing children’s spontaneous communicative initiation through the early stages of PECS up to phase III, which involves picture/object discrimination using a range of pictures, has any effect on interactions between children with ASD and their teachers.

The study intervention group was made up of 24 children who had a diagnosis of ASD and attended special education settings or specialist ASD units. In addition 17 children who also met the ASD criteria and attended similar educational settings formed a control group.

The children were all aged between 3 and 7 and were not PECS users prior to the study.

Each child in the intervention group received 15 hours of PECS teaching from members of the research team and, once they had achieved phase II, from their teachers. The intervention took place in a variety of school activities over a period of around five weeks. Control group children had no change in their usual classroom provision.

Observational assessments took place 6 weeks and one week before the intervention and in the week following its completion for the intervention group, and on two occasions around 6 weeks apart for the control group.

The observational assessment was divided into 5 categories of communicative intervention:

 

What did they find?

No significant difference was found between the first and second observations in all categories of communicative interaction considered for both groups of children.

Between the second and third observations there were significant increases in the total child to adult initiations, child to adult initiations with an adult response, adult to child initiation with an opportunity for the child to respond plus a response from the child and a significant decrease in the total adult initiations with no opportunity for the child to respond. The increased initiations by children in the intervention group were almost all PECS based.

The children in the control group did not show similar positive changes between the two observation sessions, there was an observed increase in the number of communication initiations by an adult that gave an opportunity for the child to respond, but the rate of child response did not increase.

 

Conclusions:

The authors believe that their study shows that PECS can be used to develop spontaneous communicative initiations in children with ASD within 15 hours of teaching. This included generalisation across a variety of objects, activities settings and people. They state that including generalisation of PECS use to classroom activities at phase II, as was the case in this study, was critical in securing positive results. Involving teachers who would then continue to provide consistent reinforcement might mean that changes would be maintained. They conclude that under optimum conditions the first half of the PECS program can be a very effective AAC tool for use with children with ASD and enable access to the curriculum.

 

Cautions:

The teaching of discrimination of pictures/symbols at PECS phase III was not fully completed during the intervention, so findings about errors in discrimination and teacher’s responses to these are not available.

The PECS trainers were extra staff in the classroom, so the intervention group had more adult support than the control group which might have influenced the outcome.

The fact that teachers were aware of the researchers carrying out observations meant that it is possible that they increased the amount of PECS related communications used and aimed for the best possible outcomes for PECS; this level of support might not be possible to maintain over the long-term in a classroom.


Things you may want to look into:

Effectiveness of the Picture Exchange Communication System as a Functional Communication Intervention for Individuals with Autism Spectrum Disorders: A Practice-Based Research Synthesis

The Picture Exchange Communication System (PECS) What Do the Data Say?

A Review of the Efficacy of the Picture Exchange Communication System Intervention

The effectiveness of Picture Exchange Communication System (PECS) training for teachers of children with autism: a pragmatic, group randomised controlled trial

A Communication-Based Intervention for Nonverbal Children With Autism: What Changes? Who Benefits?

The Picture Exchange Communication System

Predicting progress in Picture Exchange Communication System (PECS) use by children with autism

National Autism Resources

PECS UK

 

Added to site June 2016


The Loneliness Experiences of Young Adults with Cerebral Palsy who use Alternative and Augmentative Communication (short summary)

Communication is a significant factor in the maintenance of friendships for young adults. Communicative interactions can be difficult for people who use augmentative and alternative communication (PWUAAC) which can make it harder to form and maintain friendships and other relationships, thus increasing the risk of loneliness.

The authors used interviews with five young adults with cerebral palsy who used AAC to investigate their experiences of loneliness and their experiences of developing and maintaining friendships.

All participants felt that their communication difficulties were a factor in them feeling lonely. They said that lack of time and appropriate service support created difficulties in developing social networks.

Some suggestions are made about provision of services that could be beneficial in supporting young adults with cerebral palsy to develop and maintain social networks.


Things you may want to look into:

To what extent do children with cerebral palsy participate in everyday life situations?

Exploring Communication Assistants as an Option for Increasing Communication Access to Communities for People who use Augmentative Communication

Long-term outcomes for individuals who use augmentative and alternative communication: Part I – what is a “good” outcome?

Experiences of adults with complex communication needs receiving and using low tech AAC: an Australian context

Post-School Quality of Life for Individuals with Developmental Disabilities Who Use AAC

Added to site May 2015


The Loneliness Experiences of Young Adults with Cerebral Palsy who use Alternative and Augmentative Communication (summary)

Background

Communication is a significant factor in the maintenance of friendships for young adults. Communicative interactions can be difficult for people who use AAC (PWUAAC) which can make it harder to form and maintain friendships and other relationships, thus increasing the risk of loneliness.

A large social network/group of friends has been found to be very important during the transition from teenage years into adulthood. People with life-long disabilities such as cerebral palsy (CP) often have smaller groups of friends and rely more on families and carers for social activities than their peers without disabilities. This might be especially true of young adults who use AAC.

These factors can lead to an increased risk of loneliness. This has been found to be the case for people over the age of 40 who have CP but little research has been done into loneliness in young adults with CP.

What did the authors do?

This study aimed to explore the experiences of loneliness of young adults, aged 18 to 30, who had CP and used AAC.

Six people participated in the study. All used some form of AAC system as their main form of communication.

Each participant was interviewed on two occasions, firstly to get basic personal information, look into the participants’ experiences of loneliness and to discuss their views on the services available when they felt lonely.

The second session built on the information given in the first and gave the participants opportunities to clarify or correct information.

What did they find?

The information gathered was analysed and five major themes emerged: support networks, AAC system use, technology, school and employment and access and living arrangements. The first three occurred in all participant responses and the data from these is presented in the paper.

Family was found to be the main support network for most of the participants, when family were not available for any reason feelings of loneliness increased. All participants also said that friends were important when they felt lonely. They all reported difficulties in developing friendships with other people with communication or other disabilities.

All participants talked about the importance of AAC in helping improve their communication, keeping friendships going and helping to overcome loneliness. This included increasing independence by improving access to the community and giving control over the environment, thus enabling more time to be spent with friends.

Some negative experiences with AAC use were also reported. These included intelligibility problems, the increased time taken for communication and the difficulty of low-tech systems for communication partners. The availability and reliability of AAC systems were also raised as difficulties.

All participants said that communication technologies other than AAC helped communication with family and friends, thus reducing loneliness. These included telephones, mobile phones, the internet and e-mail. There were, however, difficulties in accessing these. Most people had difficulties using telephones, possibly needing to rely on other people to speak or interpret for them, thus meaning conversations were not private, and this was also true of text messages when support was needed.

Cautions:

The study was very small and cannot be generalised further. Only one participant was male and the effects of gender on the experience of loneliness was not investigated.

Conclusions:

All participants in the research believed that their communication difficulties were a factor in them feeling lonely. They said that lack of time and appropriate service support created difficulties in developing social networks.

PWUAAC need ongoing information and professional support to identify the most appropriate communication systems and to develop their skills in using them. The development of literacy skills for PWUAAC is also identified as being important in maintaining friendships.

Work is needed to train families, friends and support workers in how best to support PWUAAC without being too intrusive or speaking for them.

The authors suggest that ‘education of the general public and increasing community’s knowledge and acceptance of AAC use may help to increase the social interactions of young adults with cerebral palsy’.


Things you may want to look into:

To what extent do children with cerebral palsy participate in everyday life situations?

Exploring Communication Assistants as an Option for Increasing Communication Access to Communities for People who use Augmentative Communication

Long-term outcomes for individuals who use augmentative and alternative communication: Part I – what is a “good” outcome?

Experiences of adults with complex communication needs receiving and using low tech AAC: an Australian context

Post-School Quality of Life for Individuals with Developmental Disabilities Who Use AAC

Added to site May 2015


The Oral Core Vocabulary of Typically Developing English-Speaking School-Aged Children: Implications for AAC Practice (short summary)

Researchers investigated the vocabulary used by typically developing children aged 7 to 14 years in school lessons and activities. The participants included native English speakers and children who spoke English as a second language (ESL).

They found that a small core vocabulary of 100 to 200 words accounted for 75-85% of the vocabulary used for both native English and ESL speakers with great overlap in the most commonly used words in both groups.

Their findings supported other researchers' findings that a large proportion of total words used by most people is made up of a small set of words.

The implications of these findings for the selection of vocabulary provided on augmentative and alternative communication systems is discussed.


Things you may want to look into:

Teaching Conceptually Referenced Core Vocabulary for Initial Augmentative and Alternative Communication

Social Validation of Vocabulary Selection: Ensuring Stakeholder Relevance

Added to site May 2015


The Oral Core Vocabulary of Typically Developing English-Speaking School-Aged Children: Implications for AAC Practice (summary)

Background

The selection of appropriate vocabulary for AAC systems can be challenging for professionals working with people who use AAC (PWUAAC). Typically they rely on a range of sources to help select vocabulary, one of these is core vocabulary lists, which are generated from research into the frequency of words used by typically developing individuals of similar age to the AAC user.

Core vocabulary includes a variety of word classes e.g. pronouns, verbs, prepositions, question words, nouns etc. Whilst fringe vocabulary is vocabulary that is more specific to particular topics or events.

Core vocabulary is potentially useful to PWUAAC because it is relatively small in size, shows little variation between people and locations, can be used to combine words and generate new utterances and allows for consistency of positioning on AAC systems or devices which, in turn, can lead to improved fluency of use.

Core vocabularies have been developed for speaking people in a side variety of populations and situations. In most of these between 200 and 300 words account for 75-80% of the total vocabulary used.

For school-age children who use AAC the vocabulary provided needs to meet multiple needs; interaction with family and friends, classroom participation, language and literacy development and academic achievement.

Some research has found a significant overlap between the vocabulary used in the spoken and written language of typically developing English speaking children.

This study aimed to identify the words that typically developing English speaking school-age children, including those for whom English is a second language, use most frequently in a variety of school activities.

What did the authors do?

Thirty typically developing children aged from 7 to 14 years took part in the study. Eight of them spoke English as a second language (ESL).

Data was collected by recording the children during school activities and the recordings were transcribed. The language samples were analysed and the words used allocated to different classes.

What did they find?

A small core vocabulary of 100 to 200 words accounted for 75-85%of the vocabulary used for both native English and ESL speakers with great overlap in the most commonly used words in both groups.

The number of content words or 'fringe' vocabulary; nouns, adjectives and verbs, increased between the top 100 and 300 words used by each group in contrast with the percentage of function (core) words which reduced between the top 100 and 300 words. This can be explained by the fact that most function words belong to closed word classes which have a relatively small number of frequently used items.

Cautions:

The sample size was small, with a broad age range, and the data collection did not take place over specific activities. Further research, in narrower age groups and specific academic versus non-academic activities, is indicated.

The vocabulary used might have been influenced by the participants knowing they were being recorded and being aware of the microphones, recorders etc. The top 200 words used reflected the times the recordings were made e.g. lunchtimes and specific lessons.

Further research is needed to compare the oral core vocabulary of typically developing children with that of children with disabilities.

Conclusions:

The results of this study supported other researcher's findings that a large proportion of total words used is made up of a small set of words.

Though function words form the largest part of a core vocabulary they need to be combined with other content words to form meaningful utterances. Core vocabulary is essential for language learning but would not be enough to meet the needs of typical school activities. Vocabulary is needed to reflect individual interests, personalities and contexts of interaction. Therefore individually relevant fringe vocabulary needs to be included in vocabulary selected for AAC devices. The authors note that the teaching of function words needs a different approach to that of teaching content words, involving planning of multiple opportunities for children to hear and use the vocabulary throughout the day.


Things you may want to look into:

Teaching Conceptually Referenced Core Vocabulary for Initial Augmentative and Alternative Communication

Social Validation of Vocabulary Selection: Ensuring Stakeholder Relevance

Added to site May 2015


The Phonological Awareness Abilities of Children with Cerebral Palsy who do not Speak (summary)

Background
It is sometimes assumed that people who cannot speak are also unable to understand what is said to them, possibly because they haven't had the opportunity to develop an 'articulatory code' or a mental representation of words that are said to them because they have not been able to learn the motor patterns needed to use typical speech.

However most children with cerebral palsy who do not speak have intact or only mildly delayed understanding of language but research indicates that they might be disadvantaged in processing spoken and written language.

What was the aim of the study?
The study aimed to investigate 'whether a congenital inability to speak invariably affects performance on phonological awareness tasks'. The authors aimed to look at the importance of the connection between being able to speak and the development of phonological awareness; that is the ability to detect, identify and manipulate the sound structure of language.

What did the authors do?
They compared 11 children with cerebral palsy, 5 of whom could speak and 6 who were non-verbal, with 10 children without disabilities on several phonological awareness tasks: judgement of written rhyme, syllable segmentation and phoneme manipulation. The groups of children were matched for non-verbal intelligence but the children without disabilities were slightly younger. The children with cerebral palsy had little experience of literacy.

The research used a standardised assessment of phonological awareness skills which was adapted to enable non-verbal responses to be given. The tasks the participants carried out were:

What did they find?
The research found speaking children with cerebral palsy performed better on phoneme manipulation and visual rhyming tasks than those who were non-speaking, but no other significant differences were found between those groups.

There were no significant differences found between the children with cerebral palsy and the children without disabilities overall.

Cautions:
The children with cerebral palsy were older than the non-disabled group and therefore might have had more literacy experience and reading ability which could account for some of the differences.

Conclusions:
The results indicated that the ability to speak is not essential for the development of phonological awareness, but it might have an influence on some tasks. It might, therefore, be that speaking children with cerebral palsy have an advantage over non-speakers in the acquisition of literacy skills.


Things you may want to look into:

Reading and spelling, phonological awareness, and working memory in children with severe speech impairments: A longitudinal study

Words in puddles of sound: modelling psycholinguistic effects in speech segmentation

Initial insights into phoneme awareness intervention for children with complex communication needs

Added to site July 2014


The Phonological Awareness Abilities of Children with Cerebral Palsy who do not Speak (short summary)

The authors compared the performance of groups of speaking and non-speaking children with cerebral palsy and a group without disabilities in a number of tasks which looked at their ability to detect, identify and manipulate the sound structure of language (phonological awareness).

They found few statistically significant differences between the groups in the tasks they were asked to carry out, but concluded that the ability to speak is important in some aspects of sound processing which meant that speaking children might have an advantage over non-speaking in the acquisition of literacy skills.


Things you may want to look into:

Reading and spelling, phonological awareness, and working memory in children with severe speech impairments: A longitudinal study

Words in puddles of sound: modelling psycholinguistic effects in speech segmentation

Initial insights into phoneme awareness intervention for children with complex communication needs

Added to site July 2014


The Vocabulary of Beginning Writers: Implications for Children with Complex Communication Needs (short summary)

This study investigated the vocabulary used in the self-selected writing of typically developing young school age children in USA and New Zealand and considered whether the information gathered could be beneficial in selecting vocabulary available on augmentative and alternative communication (AAC) systems to support the development of writing for children with complex communication needs (CCN).

It was found that a small core vocabulary accounted for a large percentage of the written work and this was largely grammatical words.

The single word core vocabulary was broadly similar across age groups and countries however there were more differences between multiword sequences used and fringe vocabulary needed to be modified to reflect differences in vocabulary even across two different English speaking countries.

There are implications for helping children with CCN develop effective writing skills, perhaps by focussing on teaching some of the high frequency core words in reading and spelling lessons and giving fast access to them on AAC devices so children can focus on generating less frequently occurring words.

The authors suggest that core vocabularies that change over time are important to AAC users and that providing some multiword sequences as whole units might be useful, though these would need to vary between countries.


Things you may want to look into:

An Analysis of Reading and Spelling Abilities of Children Using AAC: Understanding a Continuum of Competence

Teaching Sound Letter Correspondence and Consonant-Vowel-Consonant Combinations to Young Children who Use Augmentative and Alternative Communication

Evidence-based literacy instruction for individuals who require augmentative and alternative communication: a case study of a student with multiple disabilities

Core vocabulary in written personal narratives of school-age children

 Added to site December 16


 

The Vocabulary of Beginning Writers: Implications for Children with Complex Communication Needs (summary)

Background

This study explored vocabulary used in typical written language development and whether knowledge about this could be applied to developing vocabulary sets for children with complex communication needs (CCN).

Several papers have been published that investigated the spoken vocabulary of typically developing children but there is limited research into vocabulary used in developing writing. The authors suggest that issues facing children as they develop writing skills are similar to those facing children who use augmentative and alternative communication (AAC), so understanding written language development might be relevant to work with children with CCN.

Most studies of the written vocabulary used by typically developing children were undertaken some time ago and the teaching of writing and expectations of children have changed. Most of these studies do not include children with very little time in school and it is this group’s written language that will be most relevant to children with CCN. In addition previous studies have not generally collected information about self-selected writing topics and have not compared the written language of children in different countries.  

Understanding of the way typically developing children acquire different language forms and the types and numbers of words used at different developmental stages might be useful in deciding what vocabulary should be included in AAC systems. It has been suggested that a limited set of words are used as a significant proportion of spoken and written language used by typically developing children and that this ‘core’ vocabulary can be used when determining some vocabulary choices available to AAC users, though it will not meet all of their needs. It is also the case that core vocabulary might vary between different groups of children, particularly in different countries, even when they speak the same language. There are, for example, vocabulary differences between United States and New Zealand English.

What did they do?

The study aimed to address the question: Are there school age and country-related differences in the vocabulary words used by typically developing beginning writers who reside in the United States and New Zealand when they compose about self-selected topics, and if so, what are these differences?

113 young school age children from New Zealand and 125 from USA were involved in the study. They were grouped by ‘school age’ i.e. the length of time they had been attending school. This took into account differing school starting ages between the two countries. A total of 30 teachers took part in the study.

The teachers were asked to give the children opportunities to write about self-selected topics at least three times a week over a six week period. The writing was without prompts, topic suggestions or other guidance. All of the samples were copied and analysed.

What did they find?

The number of samples produced by each child reduced as school age increased, some children produced a different sample each day, and others worked on the same piece over several days, adding to what they had written previously.

The vocabulary used was analysed to provide information on word frequency, total number of words used and total number of different words. The occurrence of multiword sequences was also analysed.

The samples generated a total of 85759 words including 5724 different words. The average number of words produced per writing session increased with school age. There was also an increase in the variety of content with increases in the amount of time in school.

The total number of words and total of different words were broadly similar between USA and New Zealand in the three younger age groups. In the oldest school age group the children in New Zealand produced more words and different words from those in the USA.

163 words made up 70% of total words used and 39 words accounted for 50% of the total. Many of these were grammatical words.

Seven of the top ten words were the same across all age groups. Nine of the top ten and 15 of the top 20 were the same in both countries though with some differences in their rankings. There were some differences when the school ages in the two countries were considered separately.

There were significant differences in the use of multiword sequences, with the children in USA using more two word sequences than those in New Zealand. The types of sequences were different between the two countries when all school ages were combined, 9 of the two word sequences  and 16 of the three word sequences in the USA top 25 did not occur in the New Zealand top 25.

Conclusions:

As has been previously suggested this study found that a small core vocabulary makes up a large proportion of written language produced by young, typically developing children.

This has implications for helping children with CCN develop effective writing skills, perhaps by focussing on teaching some of these words in reading and spelling lessons and giving fast access to them so children can focus on generating less frequently occurring words.

The authors also suggest that core vocabularies that change over time are important to AAC users and that providing some multiword sequences as whole units might be useful, though these would need to vary between countries.

There are some differences in the high frequency vocabulary used in different countries and fringe vocabulary is often different, so modifications to standard vocabulary packages will need to be made between countries.

Overall this paper stresses the need to consider a child’s school age and country when making decisions about AAC systems.

Cautions:

The contextual influences on the children’s writing was not considered in this study so it is not appropriate generalise the findings widely.

The differences between the two countries methods of teaching could have influenced what was written but this was not investigated.

The small sample size, particularly in one school age group in New Zealand is likely to have distorted the findings about three word sequences.

The fact that some children produced one piece of writing at each time of sampling and others returned to the same piece several times is only partially accounted for in the data analysis.

1.2% of the total number of written words were considered unintelligible and so were excluded from the overall analysis.


Things you may want to look into:

An Analysis of Reading and Spelling Abilities of Children Using AAC: Understanding a Continuum of Competence

Teaching Sound Letter Correspondence and Consonant-Vowel-Consonant Combinations to Young Children who Use Augmentative and Alternative Communication

Evidence-based literacy instruction for individuals who require augmentative and alternative communication: a case study of a student with multiple disabilities

Core vocabulary in written personal narratives of school-age children

 Added to site December 16 


The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech (short summary)

The authors investigated the effect the use of Aided Language Stimulation (ALS) had on the vocabulary development of a group of four children with little or no functional speech. They used a strategy of speakers pointing to symbols as they spoke during selected activities to promote knowledge and understanding of 24 vocabulary items over a period of three weeks.

It was found that during the period of the intervention all of the children increased their vocabulary knowledge.


Things you may want to look into:

Cognitive and language acquisition in typical and aided language learning: A review of recent evidence from an aided communication perspective

Framework for studying how children with developmental disabilities develop language through augmented means

Immersive Communication Intervention for Speaking and Non-speaking Children with Intellectual Disabilities

What is ALS? (PDF, 375KB)

Added to site July 2014


The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech (summary)

Background
There has been limited research into the role of the use of graphic symbols in helping the development of understanding of either spoken language or AAC symbols for people who use AAC.

Using augmented communication input can be a way of teaching the meaning and use of symbols to people who use AAC. It also provides a model of how an augmented system can be used and demonstrates the use of symbols in real situations. In addition this can transmit the message that using AAC systems to communicate is valued and to be encouraged and provides language input in the same mode as AAC users are later expected to use for expression.

What was the aim of the study?
The aim was to consider the effect of the use of Aided Language Stimulation (ALS), which refers to the communication partner of an AAC user pointing to pictures or symbols alongside the use of spoken language, on the vocabulary development of children with little or no functional speech over a three week period.

What did the authors do?
The research was carried out with a group of four children, aged from 8 to 12 years, who attended a school for pupils with learning disabilities. They all had expressive vocabularies of fewer than 15 intelligible words, no previous AAC intervention, and could select one from four line drawings in response to a spoken word.

The authors carried out the ALS intervention over a three week period. It consisted of three activities; arts and crafts, food preparation and story time, each carried out five times and with eight vocabulary items targeted in each. The sessions were all carried out with the whole group of participants together and a communication board was created for each activity. These were made up of 16 core symbols, the same on all boards, and 8 additional target items which varied for each activity.

The sessions lasted between 15 and 25 minutes and each activity was carried out for 5 consecutive days over the 3 week intervention period. During each session the target vocabulary items were each used three to five times by the researcher, combining the spoken word with pointing to the corresponding symbol. The target vocabulary was made up of three nouns and the rest mainly adjectives. The researchers aimed to use ALS to support at least 70% of their spoken output and a ratio of 80% comments to 20% questions.
What did they find?

All four of the participants showed an increase in their knowledge of the target vocabulary in all three activities over the period of the intervention. This was maintained in the weeks when an activity was not carried out.

The authors believe that this increase was most likely due to the use of ALS.

Cautions:
This was a small study and it cannot be concluded that the introduction of ALS was the only factor influencing changes or that the same effects would be found in all children with little or no functional speech. In addition no further assessments were carried out after the three week intervention period, so it is not known whether the increase in vocabulary knowledge was maintained.

Conclusions:
The use of ALS to support the development of vocabulary knowledge and understanding seems to be beneficial for children with little or no functional speech, but further research is required.


Things you may want to look into:

Cognitive and language acquisition in typical and aided language learning: A review of recent evidence from an aided communication perspective

Framework for studying how children with developmental disabilities develop language through augmented means

Immersive Communication Intervention for Speaking and Non-speaking Children with Intellectual Disabilities

What is ALS? (PDF, 375KB)

Added to site July 2014


The effect of shared book reading on the acquisition of expressive vocabulary of a 7 year old who uses AAC (short summary)

A single case study aimed to look at whether taking part in a book reading intervention programme improved the expressive vocabulary of a 7 year old girl who used AAC. The study is described in some detail.

Increases were found in the total number and range of words used and the types of words these were. There was also an increase in the number of multi-word utterances. These gains were at least partially maintained at the follow up point.

During the intervention the child was also found to use an increased number of story elements, but this was not maintained after the intervention period ended.


Things you may want to look into:

The Vocabulary of Beginning Writers: Implications for Children with Complex Communication Needs

The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech

Added to site October 2014


The effect of shared book reading on the acquisition of expressive vocabulary of a 7 year old who uses AAC (summary)

Background

Children with complex communication needs (CCN) often have difficulties in many aspects of language acquisition compared to typically developing children.

Vocabulary knowledge has been found to be a predictor of potential educational achievement, but can be difficult for children with CCN to achieve. They often need more specific, individual and repeated exposure to new words in order to acquire new vocabulary. Shared book reading can potentially provide a way of enabling this teaching to take place within a naturalistic language learning context at home and in school.

It has been found that training adults to support interactions with children during shared book reading activities can help develop vocabulary, sentence complexity and print knowledge.

What was the aim of the study?

The study aimed to look at whether taking part in a book reading intervention programme improved the expressive vocabulary of a 7 year old girl who used AAC.

What did the authors do?

A single case study of a child who has a congenital neurological condition is presented. The child had delayed receptive and expressive language development, used a Voice Output Communication Aid (VOCA), was an emergent reader and had letter-sound correspondence.

An intervention programme was carries out by a specialist teacher who worked with the child. The programme used six early reading books, each of which had at least five words which were unfamiliar to the child and which were targeted in the intervention.

Following baseline assessments the intervention took place over a six week period, with three one hour individual reading sessions each week. A different book was the focus of the sessions each week and one session per week was spent on each of the following: a pre-reading activity, a shared reading activity and a post-reading activity.

Following the intervention, generalisation and maintenance of the skills acquired were reviewed.

What did they find?

The child's responses at each of the baseline, intervention and maintenance stages were analysed, looking at the number of different words used, the total number of words and the number of multi-word utterances. The number of story elements used by the child when retelling were also counted, looking at her use of the 'Who? What? When/Where? How? and Why?' of the story.

Increases were found in the total number and range of words used and the types of words these were. There was also an increase in the number of multi-word utterances. These gains were at least partially maintained at the follow up point.

During the intervention the child was also found to use an increased number of story elements, but this was not maintained after the intervention period ended.

Cautions:

This was a single case study so its findings cannot be generalised to the wider population. The structure of the project does not allow the researchers to show which element of the programme had the greatest effect on vocabulary development and it did not consider whether there was any generalisation of new vocabulary use to different contexts and activities.

Conclusions:

The authors believe that repeated exposure to new vocabulary, in a targeted way, encouraged vocabulary learning, but that to develop expressive use it is necessary to have repeated opportunities to use the new vocabulary in response to questioning.

Shared book reading provides a good context to support language development if particular strategies are used.


Things you may want to look into:

The Vocabulary of Beginning Writers: Implications for Children with Complex Communication Needs

The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech

Added to site October 2014


Theory of mind in children with severe speech and physical impairment (SSPI): a longitudinal study (short summary)

The researchers looked at the development of Theory of Mind (ToM) in a group of young children with severe speech and physical impairments (SSPI) compared to a typically developing peer group over a four year period.

The term theory of mind (ToM) relates to being able to attribute thought beliefs and feelings to ourselves and other people and to understand that how we behave is linked to these things.

They found that children with SSPI followed the same sequence of development of these skills but at a significantly delayed rate, and that their development of ToM was also more delayed than their general developmental delay.

They believe that this is likely to be related to their reduced opportunities for initiating and managing interactions with others in their early childhood, compared to typically developing children.


Things you may want to look into:

Blissymbols

Added to site July 2014


Theory of mind in children with severe speech and physical impairment (SSPI): a longitudinal study (summary)

Background
The term theory of mind (ToM) relates to being able to attribute thought beliefs and feelings to ourselves and other people and to understand that how we behave is linked to these things. Children also need to understand that beliefs are not always true and can represent the world incorrectly. Testing a child's ability to recognise this 'false-belief' is the most commonly used way of determining whether a child has developed ToM.

Possible causes for impairment in the development of ToM include a lack of experience of conversation about mental states, this has mainly been researched in relation to deaf children, and a reduction or difference in early social interactions such as pretend play.

Children with severe speech and physical impairments (SSPI) have been found to have fewer, or different, opportunities for pretend play and interaction with other children and different communication interactions with their carers than typically developing peers.

What was the aim of the study?
The study was to look at the development of ToM in a group of children with SSPI over a long time period to consider whether they showed a delay in the development of ToM over and above their general development, and whether, despite this, they followed a typical sequence of ToM development.

What did the authors do?
Six children with SSPI were included in the study that involved collecting information about their ToM development over a period of several years. At the first testing point all of the participants had very little speech that was intelligible to unfamiliar listeners and communicated using either Bliss symbols or a combination of Bliss symbols and other communication modes such as signs, gestures and body movements. They were aged from 5 to 7 years and had a mental age assessed as being 4 years or more. A group of typically developing children matched for age and non-verbal abilities were also tested. At the first assessment the children with SSPI were found to have lower levels of understanding of spoken language than the others.

Only one test of Tom was carried out at the first testing stage. At the second stage around four years later 7 tests were carried out enabling the researchers to look at the developmental progression of ToM.

The same tests were given to each of the children individually and they were able to respond using whatever mode of communication they were most comfortable with, usually pointing or indicating 'yes' or 'no'.

What did they find?
All of the typically developing children passed all of the tests at both testing points. In the group with SSPI only one child passed the first task.

At the second testing point all of the children with SSPI passed all or some of the tasks, but their results showed a delay in the development of their ability to pass the 'false-belief'.

The results indicated that the children with SSPI developed the ability to pass the ToM tasks in the same sequence as typically developing children, but that this took place significantly later in terms of their mental age, even when their language levels were similar to the comparison group.

Cautions:
The research involved only a small number of children and looked at a limited range of ToM functions so the findings cannot be widely generalised.

Conclusions:
Compared to their typically developing peer the children with SSPI had a specific delay in developing ToM that is greater than their general cognitive delay, but follows a typical pattern of the order of development.

The authors believe that although children with SSPI are constantly exposed to spoken language and conversation their lack of active participation and reduced opportunities for initiating and managing interactions slows the development of skills in the area of understanding their own and other people's perceptions of the world. It is therefore important that children with SSPI are provided with the appropriate tools and opportunities to develop these skills to reduce the chance that expectations of them are lowered.


Things you may want to look into:

Blissymbols

Added to site July 2014


Typical children’s graphic sequences (short summary)

This study investigated how typically developing three- and four-year-old children produced and understood graphic symbol sequences. The children did not display one-to-one correspondences between elements in spoken language and graphic symbols in sequences. This suggests that symbol selection, rather than sequencing, could be an appropriate target of AAC intervention for young children and that communication partners must be flexible in their interpretation of graphic symbol sequences produced by young children.


Things you may want to look into:

AAC

Graphic symbol systems

Added to site August 2013


Typical children’s graphic sequences (summary)

What was the aim of the study? This study explored the abilities of typically developing three- and four-year-old children in producing and understanding graphic symbol sequences.

Why was the paper written? Though typically developing children utilize spoken language for both comprehension and production, children who use AAC face a 'modality mismatch', because they comprehend spoken language but must produce language in a visual, or graphic, modality. A number of factors influence children who are acquiring language through AAC, including their development in symbolic representation, artistic representation and the syntax of the language in their environment. Though research is underway about these individual elements of development, little is known about how they converge when children who use AAC must produce sequences of graphic symbols.

What did the authors do? This study investigated graphic symbol sequences in typically developing children. The authors examined typically developing children rather than children with disabilities because the issue at stake was primarily theoretical. This strategy is common in the field of AAC when little is known about the research question, so optimal conditions are required.

The researchers performed two tasks with children aged between three and four years. The first task tested production of graphic symbol sequences. Children saw a picture and had to tell the 'story' of the picture using symbols. The pictures for this task represented sentences with a subject, verb and object, where an agent 'pushed' or 'pulled' another character. The second task tested comprehension of graphic symbol sequences. A symbol sequence was presented to children on a computer screen, one symbol at a time and accompanied by voice output, and children had to select which of four pictures depicted the sequence. As in the first task, the sequences consisted of a subject, verb and object.

What did they find? On the first task, almost all the children selected the correct symbols to include in their sequences. However, there was a great variety in the order of those symbols, and most children did not place the symbols in a consistent order. Only one of the thirty children in the study consistently placed symbols in the order that would be expected in spoken language.

On the second task, about half the children responded consistently, but not always in the manner predicted by spoken language. There was no relationship between children's performance on the two tasks.

Cautions: The study was carried out with French speaking children, though the word order used in this study, subject-verb-object, is also found in English.

Conclusions: This study showed that three- and four-year-old children do not simply transfer their knowledge of spoken language to graphic symbols. Children did not perform one-to-one correspondences between words and graphic symbols. Rather, consistent patterns of responses requires more skills than those developed by spoken language acquisition. Thus, young children do not approach language and graphic symbols in the same way.

These findings have important clinical implications. Children had more difficulty sequencing that selecting correct graphic symbols, which suggests that an appropriate AAC intervention target for young children may be the selection of symbols. Communication partners should remain flexible in their interpretation of symbol sequences produced by young children.


Things you may want to look into:

AAC

Graphic symbol systems

Added to site August 2013


Use of augmentative and alternative communication strategies by family members in the intensive care unit (short summary)

The use of AAC strategies by families of critically ill patients in an intensive care unit (ICU) was reviewed. 44% of families were found to use some form of AAC support in their communication with ill relatives. Their views about AAC and confidence in using it were rated more positively when the nurses they were working with had been given some training in communication strategies.

Despite difficulties in communication with family members use of AAC strategies is limited; this might contribute to increasing stress for patients and family members. Interventions to improve knowledge and ability to use AAC strategies might be beneficial. Further research is required into this area.


Things you may want to look into:

Nurses' perceptions of communication training in the ICU

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Communication boards in critical care: patients' views

Added to site October 2014


Use of augmentative and alternative communication strategies by family members in the intensive care unit (summary)

Background
Family members are often relied upon to act as spokesmen for critically ill patients, but do not always have the skills needed to support patients' communication.

Little is known about how families are able to use AAC systems and how they feel about these forms of communication.

There has been little investigation into the involvement of families in use of AAC with non-speaking patients in intensive care units (ICUs).

The purpose of this study was to describe family involvement with assistive communication when nurses and patients had different levels of training. The authors looked into which AAC tools families used and how they used them, and the views of families and nurses about the communication of non-speaking patients on ICU.

What did the authors do?
They looked at information gathered in a previous study in which nurses on ICU were given varying amounts of training in the use of AAC systems and provided with communication support materials on the ward.

As part of the study nurses were asked about family involvement in AAC strategies. Family members' comments about communication were also noted.

The authors reviewed observation notes from the previous study and noted any family involvement with AAC strategies and which family members were involved. The tools and devices used were identified and themes around what nurses and family members said about communication were identified.

What did they find?
Families of 44% of the patients in the study were found to have used AAC, most often this was spouses or adult children.

Five main themes were identified including families being unprepared and unaware and their perception of communication effectiveness.

Families tended to be more positive in their view of AAC when the nurses they were working with had had some communication training.

Cautions:
The study was not initially established to look at family use of AAC and only looked at a limited number of observed episodes so might not represent the full extent of involvement. Alternatively because the observation took place in a unit where various communication resources were available they might have been used more frequently than in typical ICUs.

Conclusions:
Despite difficulties in communication with family members use of AAC strategies is limited, this might contribute to increasing stress for patients and family members. Interventions to improve knowledge and ability to use AAC strategies might be beneficial.


Things you may want to look into:

Nurses' perceptions of communication training in the ICU

SPEACS-2: Intensive Care Unit 'Communication Rounds' with Speech Language Pathology

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Communication boards in critical care: patients' views

Added to site October 2014


Using AAC to communicate with medical staff (short summary)

The authors used semi structured interviews and a focus group to find out how people who use AAC felt about communication with primary health care staff e.g. GPs. They found that AAC users felt it was easier to communicate with doctors who were specialists or who had known them for a long time than with those who were less familiar with AAC systems.

They concluded that everyone involved in these consultations needed to take time to prepare and that there is a need for on-going communication training for doctors throughout their careers.


Added to site January 2014


Using AAC to communicate with medical staff (summary)

What was the aim of the study? The study aimed to find out about the experiences of people who use AAC in communicating with primary care health professionals (e.g.GPs).

Why was the paper written? There is evidence that people with disabilities are less likely than the population in general to use primary or preventative health care services. The authors wanted to find out about AAC users experiences of non-hospital based healthcare and identify any barriers to effective communication and strategies used to overcome these.

What did the authors do? Semi-structured interviews were carried out with 12 people who use AAC, 4 participants also contributed to an online focus group. Participant's responses were analysed to identify themes.

The AAC users used a range of different communication systems and strategies, and had a mixture of acquired and congenital conditions. All had good enough language and cognitive skills to be able to participate fully with the study.

What did they find?

Although all of the AAC users were generally satisfied with the quality of care they received there were many frustrations expressed. The people who used AAC wanted to take responsibility for decisions about their own health care but this was not always easy. They felt that doctors often assumed that they were not able to understand what was said to them or to make decisions about their care themselves.

Almost all of the participants took a family member or carer with them to appointments to act as an assistant and/or interpreter and to take part in decision making. This was felt to be very important but could cause problems as the doctors often talked to the carer instead of the patient.

AAC users believed it was important that everyone involved in the appointment prepared in advance and it was beneficial if they knew the doctor well and additional time could be given for their appointment. Sometimes doctors seemed rushed and unable to wait for the patient to construct their answers. AAC users thought that it was their responsibility to teach the healthcare worker about their communication system.

Participants felt that it was doctors who were specialists or who had known the AAC user for a long time found it easier to communicate with them than primary care workers.

Cautions: The study involved a small, self-selected group of participants who came from similar areas and had a limited range of types of disorders and they therefore might not represent the views of the majority of people who use AAC.

Conclusions:

Improving patient-provider communication needs a team approach with all participants contributing.

There is a lack of knowledge among primary health care staff about how best to communicate with people who use AAC, and a need for on-going training for doctors throughout their career to ensure that they acquire and maintain skills.


Things you may want to look into:

Communication in the ICU (summary)

Added to site January 2014


Using Talking Mats to support communication in persons with Huntington's Disease (short summary)

The authors investigated the use of Talking Mats (TM) in supporting the communication of five people with advanced Huntington’s Disease (HD). They compared unstructured and structured interactions and the used of TM when the same topics were discussed.

It was found that for all of the participants communicative effectiveness was increased by the use of TM.

The authors conclude that the use of TM could increase participation in life-planning for people with HD but is dependent on good support from trained communication partners.


Things you may want to look into:

Huntington's Disease

Talking Mats

Talking Mats in a discussion group for people with Huntington’s disease

The use of Talking Mats to support people with dementia and their carers to make decisions together

Added to site May 2015


Using Talking Mats to support communication in persons with Huntington's Disease (summary)

Background

Huntington’s Disease (HD) is a progressive degenerative neurological condition which usually leads to speech and communication difficulties. People with HD often develop a reduction in cognitive abilities, with language elements such as a lack of communication initiation, reduced sentence complexity and word-finding problems as well as difficulties in speech production. The ability to understand spoken language is also likely to be affected but there is less research into this than into the effects on expressive language.

In the later stages of the condition communication can be very difficult but there are few published studies looking into the effectiveness of communication interventions for people with HD.

Talking Mats (TM) is a low-tech augmentative and alternative (AAC) technique that has been used successfully to support the communication of people with a variety of progressive and non-progressive conditions. It is used alongside peoples usual communication systems to help those with communication difficulties express their views.  

What did the authors do?

The authors investigated whether TM is suitable for people who have advanced HD. They compared communicative effectiveness using TM with structured and unstructured communication interactions.

Five people with HD participated in the study.

Researchers examined communication about three topics: interests and activities, personal information and communication. Each participant was visited three times, the first to demonstrate TM and then to undertake the communication activities. One visit focussed on structured and unstructured communication, the other on TM. The topics covered in the structured and TM sessions were the same, differing only in the provision of mats and pictures related to each topic when TM were used.

What did they find?

They looked at the participants understanding of the options presented, engagement with the interviewer and task and ability to keep on task and the interviewers understanding of the participants views.

The results were analysed using the Effectiveness Framework of Functional Communication (EFFC). Each topic was rated separately as well as in a total score for each participant. A descriptive analysis was also completed.

The results indicated that structured communication was more successful than unstructured, and communicative effectiveness was significantly higher when TM were used than without. This was the case for all participants though only two of them achieved ‘acceptable communicative effectiveness’ as rated by the EFFC.

Communication with TM led to increased time spent communicating.

Cautions:

This was a small sample group and therefore the results cannot be generalised to all people with HD. There might have been factors other than TM alone that influenced the results, e.g. the structured presentation of topics with visual support, communication partners slowing their rate of speech and the number of words used.

Conclusions:

All participants seemed to enjoy using TM so increasing their motivation to communicate. TM also supported the people with HD’s communication partners, making it easier to follow lines of reasoning and giving a joint focus of attention leading to more balanced interaction patterns than the other formats.

People with HD can find their communicative effectiveness is improved by the use of TM and also by structured approaches to communication interactions rather than unstructured. TM is particularly recommended when more abstract or difficult topics are being discussed.

The use of TM could increase participation in life-planning for people with HD but is dependent on good support from trained communication partners.


Things you may want to look into:

Huntington's Disease

Talking Mats

Talking Mats in a discussion group for people with Huntington’s disease

The use of Talking Mats to support people with dementia and their carers to make decisions together

Added to site May 2015


Using different methods to communicate: how adults with severe acquired communication difficulties make decisions about the communication methods they use and how they experience them (short summary)

The researchers interviewed several men with acquired neurological disorders about their choice of augmentative and alternative communication (AAC) methods. They found that the choice of method used to communicate is individual and professionals need to take this into consideration when working with clients with acquired neurological conditions. Often different methods will be chosen for different situations and communication partners.

The findings of the study indicate the benefits of social media, digital communication and mainstream technologies as communication methods for people who use AAC. Participants were generally positive about the benefits of high tech communication systems, with some reservations.

Mainstream, multi-functional mobile technologies were preferred where these were physically accessible.

In order to best support a person-centred approach to making decisions about communication systems speech and language therapists need to be well-informed about developments in these areas.

More research is required into the use of social media by people with communication difficulties.


Things you may want to look into:

Real-Life Challenges in Using Augmentative and Alternative Communication by Persons With Amyotrophic Lateral Sclerosis

Promoting acceptance of augmentative and alternative communication by adults with acquired communication disorders

Added to site Dec 2015


Using different methods to communicate: how adults with severe acquired communication difficulties make decisions about the communication methods they use and how they experience them (summary)

Background

It is recognised that assistive technologies, including augmentative and alternative communication (AAC) can be beneficial in helping improve the quality of life for adults with complex needs. People with acquired communication difficulties have to make many decisions about new technologies and also learn how to use them.

Involving communication aid users in decision making about which systems to use and in what situations is known to be beneficial but does not always happen.

Adults with acquired communication difficulties often use more than one communication method, which might include newer mobile technologies as well as traditional AAC systems. Communication systems used might include social media, Skype and e-mail.

What did they do?

The study aimed to explore how adults with severe, acquired communication difficulties experience and make decisions about the communication methods they use. The researchers wanted to look at user's perceptions of different communication methods and how they chose which method to use in different situations and with different people.

Seven men with acquired neurological disorders took part in the study. They had all used AAC for at least six months. Participants were interviewed face-to-face using the communication method of their choice. Further information was gathered from five of the participants via e-mail interviews. Two of the men did not have access to e-mail.

What did they find?

Analysis of the information gathered led to four main themes developing; communicating in the digital age, encountering frustrations, role and identity changes and seeking a functional communication interaction.

Participants who used e-mail said it was their preferred method for some interactions as it gave extra time to construct messages, resolved the issues of timing and reduced speed of communication present in face-to-face interactions, gave opportunity to correct errors and stopped people making judgements based on physical appearance.

The ability to easily access the internet using a communication system, and appropriate methods of accessing the system were considered important.

The slow rate of communication using AAC was the most common frustration together with issues around physical access, the effort required to use a device and lack of reliability.

Becoming non-verbal and using AAC affected both participant's sense of self-identity and the way they felt they were viewed by other people.

Communication aids were generally felt to be essential, but their effective use was often dependent on them being made available by others and on other people understanding how they are used.

Participants also considered how the choice of communication method can limit or support 'good' communication, based on a number of factors including speed of communication and voice quality. These things contributed to changes in the way participants communicated before needing AAC.

Participants were keen to be on-line and found that use of the internet increased their social interactions, potentially reducing loneliness and supporting the development and maintenance of friendships.

Mainstream devices such as iPads that enabled the integration of a range of features including internet access, music etc., in portable devices were generally the preferred option, provided they could be physically accessed.

Conclusions:

The choice of method used to communicate is individual and professionals need to take this into consideration when working with clients with acquired neurological conditions.

The findings of the study indicate the benefits of social media, digital communication and mainstream technologies as communication methods for people who use AAC. In order to best support a person-centred approach to making decisions about communication systems speech and language therapists need to be well-informed about developments in these areas.

More research is required into the use of social media by people with communication difficulties.

Cautions:

The study involved only a small number of people, all male, from one hospital, so the results cannot be widely generalised and further research is needed.


Things you may want to look into:

Real-Life Challenges in Using Augmentative and Alternative Communication by Persons With Amyotrophic Lateral Sclerosis

Promoting acceptance of augmentative and alternative communication by adults with acquired communication disorders

Added to site Dec 2015


Visual support for language in ASD (short summary)

Researchers at Children's Hospital Boston have developed an approach to AAC for children with ASD. The Visual Immersion Program builds on strengths that many children with ASD already have in order to teach them about language, communication and other skills. The program can be used on technology that is readily available on today's market; it does not require specialized, purpose-built AAC systems.


Things you may want to look into:

webcast of Visual Immersion Program

high-tech

Added to site August 2013


Visual support for language in ASD (summary)

What was the aim of the study? This paper described an approach to AAC called the Visual Immersion Program, which helps children with autism spectrum disorders learn language and communicate.

Why was the paper written? The use of AAC for people with ASD started to be investigated in the 1980s and 1990s. The first strategies were no-tech or low-tech, such as simple pointing techniques or exchange systems such as PECS. More recently, high-tech AAC with many different hardware and software options has become available. Now, the technology to create and use AAC resources is readily available so that users do not necessarily have to buy expensive, specialized equipment. For example, digital cameras and camcorders can be used to make resources for use on tablet computers, laptops or smartphones. However, instructional approaches to using such tools are very important if AAC is to be effective and successful.

What did the authors do? Children's Hospital Boston created an approach to AAC for children with ASD that can be used on the high-tech platforms that are readily available today. It helps its users learn language and communicate and is called the Visual Immersion Programme (VIP).

The VIP uses visual scenes to portray information that is usually explained with complex language that can be difficult for children with ASD to process. When first introduced, these scenes are dynamic moving pictures to aid children's comprehension. The dynamic scenes can later be replaced by static, or still, images. Graphic representations are then used as elements of language, and the VIP includes instructions on combining these elements to form messages. The VIP includes a programme that allows users to experience word forms in many different environments and contexts, so learners can build up their knowledge of the meaning of word forms and how they can be used in language. The VIP also includes video modelling that aids in developing pragmatic skills, behaviour and daily living skills.

Conclusions: The Visual Immersion Programme is a new way of teaching children with ASD about language. It capitalizes on the technology readily available today and does not require expensive, specialist AAC devices or software.


Things you may want to look into:

webcast of Visual Immersion Program

high-tech

Added to site August 2013


Working memory in children’s language comprehension (short summary)

In this study, researchers performed an experiment to investigate whether children can use a visual context to support auditory processing, whether children can do this when the language they hear is very complex and whether the memory abilities of children influence this skill. It was found that children with both high and low memory spans made use of a visual picture in speech comprehension and that they did this for even very complex language structures. However, children with a high-span memory integrated contextual information more fully than the other children.


Things you may want to look into:

working memory

relative clause

Added to site August 2013


Working memory in children’s language comprehension (summary)

What was the aim of the study? The authors wanted to find out whether children can incorporate a visual context into auditory processing, and whether they can do this when the language they hear is very complex. The researchers also wanted to see whether children's working memory abilities influenced their comprehension of complex patterns of speech.

Why was the paper written? Listeners must be able to make sense of complex pieces of incoming language, and this skill is called parsing. There is a debate about how children accomplish this. Some researchers believe that children, unlike adults, rely on just the words they hear to work out their meaning and do not use other clues like how a speaker is talking or the context in which the speech occurs. Other researchers think that children process language in much the same way as adults, but their competence is limited by their developing cognitive abilities, such as memory.

What did the authors do? The authors of this study performed an experiment to investigate their aims. They used a language construction called a relative clause to vary the complexity of the language that children heard in the experiment. A relative clause adds extra information to a sentence and includes a missing word that is referred to elsewhere in the sentence but is not repeated in the clause. Examples of the types of sentences used in the experiment are given below (taken from Weighall & Altmann, 2011). The relative clause is italicised in each example, and the position of the words that are not repeated in the clauses is marked with an X.

(a) The pig bumps into the horse that X jumps over the giraffe.

(b) The dog that X jumps over the pig bumps into the lion.

(c) The dog stands on the horse that the giraffe jumps over X.

(d) The lion that the horse bumps into X jumps over the giraffe.

In examples (a) and (c), the relative clauses occur at the end of the sentences, and in examples (b) and (d) the clauses occur in the middle of the sentences. The relative clauses in examples (a) and (b) have unrepeated words (X) that are the subjects of phrases in the clauses, and the clauses in examples (c) and (d) have unrepeated words (X) that are objects of the phrases in the clauses. There is evidence that adults and children find it more difficult to process clauses that are included in the middle of a sentence and whose unrepeated words are the objects of the phrase; so, example (d) is the most difficult kind of sentence with a relative clause to process.

In the experiment, children saw two different pictures and then heard one of these four kinds of sentences. The first picture showed the characters involved in the relative clause. There were two types of the first picture, which were used to give visual context to the sentence that the children later heard. In the first type of picture, the characters performed the action that they did in the relative clause. For example, if a child were to hear example (a) above, this first picture would depict a horse jumping over a giraffe. In the second type, the characters were represented on their own, without performing any action; so, for example (a) above, the picture showed a horse and a giraffe side by side.

Children saw one of these two types pictures, and then they saw another picture of different characters, including all the characters of the sentence they were about to hear. While they looked at this last picture, the children heard one sentence of the types explained above. They were then asked a question about the sentence that required them to understand either the relative clause or the main part of the sentence.

The children in the experiment were divided into a group with a high-span verbal memory and a group with low-span verbal memory. The test that the researchers used for this is reliable and used in many other studies.

What did they find? Children with high-span memory performed better than children with low-span memory. Both groups of children showed poorest performance when answering questions about the main part of a sentence with a relative clause included in its middle. Children also performed better when the first picture they saw showed the characters that were in the relative clause performing an action.

The results also showed that children with a high-span memory were able to use more information about the context to improve their comprehension.

Conclusions: The authors concluded that both groups of children in their study were able to make use of the visual picture context in speech comprehension and that children could do this even for speech that had very complex structures. Children with both high and low memory spans showed this skill, but children with higher-span memory integrated the visual context more fully than the other children. This is in keeping with the idea that children process language in an adult-like way that develops with their increasing cognitive skills.


Things you may want to look into:

working memory

relative clause

Added to site August 2013


iPads, Mobile Technologies, and Communication Applications: A Survey of Family Wants, Needs, and Preferences (summary)

Background

The rapid development of iPads and other mobile technology in recent years is affecting both the study and practice of augmentative and alternative communication (AAC) and impacting on service delivery, the work of speech and language therapists (SLTs) and families of people who use AAC.

It has been found that most parents of children who use AAC had positive views of their benefits and family involvement is crucial in achieving good AAC outcomes. Therefore families need to be involved throughout the AAC assessment and teaching process.

Parents generally want close relationships with professionals in training and information sharing regarding AAC devices and implementation.

The relatively low price of mobile technology has made the use of these as AAC systems a possibility through self-funding rather than seeking external or third party funding which is often needed for dedicated high-tech communication aids.

The proliferation of mobile technology is also increasing public awareness of this as a form of AAC so the development of communication apps is increasing rapidly.

Another effect of the emergence of mobile technology is the change in service delivery in AAC from being clinician led following detailed assessment of the clients' needs, to being led by families making purchases independently then requiring support to help people use the system.

This leads to SLTs needing to change their models of working to be more collaborative, respecting families' wants and needs, and matching features of apps to individuals appropriately. It is therefore important that SLTs have a good knowledge and understanding of mobile technology and apps in order to best support families to develop AAC users communication and avoid abandonment of devices.

What did they do?

The researchers used an online survey to investigate what the families of children who use augmentative and alternative communication (AAC) wanted from technology and the support services around this.

The majority of participants had children who had either autism spectrum disorder or some form of intellectual disability. All had 50 or fewer spoken words.

What did they find?

The majority of participants who already had an iDevice had not had an assessment prior to making the purchase and in most cases it was to be used by other family members in addition to the AAC user, not as a dedicated communication system.

Chief reasons for choosing a particular device were ease of use, affordability and the multiple functions e.g. social, entertainment and information, available. Ease of use and affordability were the primary reasons for selecting apps too.

Participants said they wanted more information and support from professionals about how their child could use the app for communication. They also wanted help with customisation of and technical support for the device and apps, and help with navigation of the system.

When asked about the amount of support they wanted most felt that between one and four hour long sessions with a professional would be needed.

Conclusions:

The researchers conclude that the development of mobile technology presents challenges to established forms of service provision.

There is a danger that the lack of detailed assessment might lead to devices being purchased that are not the 'best fit' for individuals.

There are implications for speech and language therapists particularly, in needing to change their ways of working to support individual families in the choices of systems they have made. It is also important for professionals to maintain up-to-date knowledge of communication apps as they develop in order to offer appropriate support.

Cautions:

The survey was piloted with only one family and the on-line distribution method means it was likely to be completed by families who regularly use technology and who were active advocates for their children. It might not be representative of a wider cross-section of families. A larger number of participants would have been beneficial.

As most of the families had children with autism or intellectual disabilities the results might not generalise to all families of children who use iDevices and communication apps.


Things you may want to look into:

The iPad and Mobile Technology Revolution: Benefits and Challenges for Individuals who require Augmentative and Alternative Communication

The right communication aid?

A Comparison of Communication Using the Apple iPad and a Picture-based System


Added to site August 2015

iPads, Mobile Technologies, and Communication Applications: A Survey of Family Wants, Needs, and Preferences (short summary)

As the availability of mobile technology and apps increases, and the cost reduces, the researchers used an online survey to investigate what the families of children who use augmentative and alternative communication (AAC) wanted from technology and the support services around this.

They found that many families had bought, or were considering buying, the AAC system themselves without detailed assessment. Main reasons for purchasing the mobile devices and apps were ease of use and affordability. The families generally wanted more information from professionals about how their children could use apps for communication. Most respondents wanted help to support the child's use of the device for communication purposes, others wanted help with customisation and technical support for the device or app.

The families also wanted devices to have multiple functions e.g. information social and entertainment, in addition to communication.

The researchers conclude that the development of mobile technology presents challenges to established forms of service provision.

There is a danger that the lack of detailed assessment might lead to devices being purchased that are not the 'best fit' for individuals.

There are implications for speech and language therapists particularly, in needing to change their ways of working to support individual families in the choices of systems they have made. It is also important for professionals to maintain up-to-date knowledge of communication apps as they develop in order to offer appropriate support.


Things you may want to look into:

The iPad and Mobile Technology Revolution: Benefits and Challenges for Individuals who require Augmentative and Alternative Communication

The right communication aid?

A Comparison of Communication Using the Apple iPad and a Picture-based System


Added to site August 2015

‘‘It’s got to be more than that’’. Parents and speech-language pathologists discuss training content for families with a new speech generating device (short summary)

Parents have a central role in supporting children who use augmentative and alternative communication (AAC) to become competent and effective communicators. High-tech speech generating devices (SGDs) are complex systems that require a great deal of learning by new users in terms of understanding the technology and how to use it as well as maintaining it.

If parents lack confidence in using the device or are not adequately supported this can contribute to a lack of success or abandonment of the system.

It has been found that families often feel that there is insufficient training offered when a new SGD is recommended. The importance of this increases as systems become increasingly complex.

There has been limited research into which areas parents and professionals regard as priorities for training for families with a new SGD.

This study investigated the views of parents of children who used SGDs and speech and language pathologists (SLPs) working with people who use AAC about the training needs of families.

Parents and SLPs identified a range of training needs relevant to families of children with a new SGD. Each family is different and a family-led approach to training is suggested as likely to be most beneficial. Whilst some generic training can be useful there will always be a need for individual support.

There was an overlap between the SLPs perceptions of training needs and those of the families there were also differences, indicating the importance of consulting all stakeholders when planning support.

 


Things you may want to look into:

Alternative service delivery models for families with a new speech generating device: Perspectives of parents and therapists

Speech-language pathologists' views on mentoring by people who use speech generating devices

iPads, Mobile Technologies, and Communication Applications: A Survey of Family Wants, Needs, and Preferences

Professionals’ and parents’ shared learning in blended learning networks related to communication and augmentative and alternative communication for people with severe disabilities 

Added to site July 2016


 

 

‘‘It’s got to be more than that’’. Parents and speech-language pathologists discuss training content for families with a new speech generating device (summary)

Background

Parents have a central role in supporting children who use augmentative and alternative communication (AAC) to become competent and effective communicators. They are often the main teacher, programmer and advocate for the user and device in a variety of settings. High-tech speech generating devices (SGDs) are complex systems that require a great deal of learning by new users in terms of understanding the technology and how to use it as well as maintaining it.

If parents lack confidence in using the device or are not adequately supported this can contribute to a lack of success or abandonment of the system.

It has been found that families often feel that there is insufficient training offered when a new SGD is recommended. The importance of this increases as systems become increasingly complex.

Families also often require training in how best to teach and model language on the device and how to change their own communication style when interacting with the SGD user.

The views of parents and professionals about what training is needed for families are not always the same. Whilst broadly similar the emphasis given to different areas varies and parents have been found to want training in areas professionals might not have considered, or additional focus on areas such as organisation of vocabulary and programming.

There has been limited research into which areas parents and professionals regard as priorities for training for families with a new SGD.

 

What did they do?

This study investigated the views of parents of children who used SGDs and experienced and novice (less than 2 years’ experience in AAC) speech and language pathologists (SLPs) working with people who use AAC. Seven parents took part, six mothers and one father. They each took part in a single, private semi-structured interview.

Ten experienced and three novice SLPs were involved in the study. The experienced professionals took part in focus groups and the novices were interviewed individually using a similar, semi-structured format to that used with the parents.

The data gathered was analysed into themes which were then organised into three primary focus areas. This study considers just one of those areas; SGD training for families.

What did they find?

A wide range of training needs were described, including an initial process to support understanding about and acceptance and uptake of SGDs, home practice strategies and advice about language teaching and goal-setting as well as support around the technology, programming etc.

All participating groups felt that it is important to overcome reluctance to accept the device by giving clear information at an early stage, making the system appropriate to the user and increasing confidence and competence in its use.

Some parents found the technology intimidating and needed hands-on time and support to feel comfortable with its use. Several parents thought that introducing additional features of the devices such as music player, camera and simple environmental controls as well as communication would help with acceptance of the system.

SLPs felt that information should be given about the impact an AAC system might have, that it will not stop a child from developing speech but that it will not solve all difficulties. The importance of being clear about the time and workload needed to develop competence in AAC use was stressed by the SLPS.

Several participants suggested that parents should be given advice about advocating for and negotiating the use of SGDs in different settings and with different people.

A second area identified as needing training was around communication development and aided language. Families needed an understanding of the language system and representation on their device, particularly to enable the parents to model aided language to their child. They also required support in setting communication goals and targets.

The importance of developing parental skills in teaching language through AAC was identified by all participants and the need for ideas to help maintain children’s motivation to use the system was also stressed.

 

Conclusions:

Parents and SLPs identified a range of training needs relevant to families of children with a new SGD.

It is acknowledged that each family is different and a family-led approach to training is likely to be most beneficial. Whilst some generic training can be useful there will always be a need for individual support.

There was an overlap between the SLPs perceptions of training needs and those of the families there were also differences, indicating the importance of consulting all stakeholders when planning support.

 

Cautions:

The small number of families involved in this research means that the findings cannot be generalised to all families with an SGD. The inclusion of only one father in the parent group is significant as the training and support needs of mothers and fathers have been reported to be different.

The children involved in this work mainly had diagnoses of cerebral palsy or autism so the training needs of families of children with other diagnoses might not have been identified.


Things you may want to look into:

Alternative service delivery models for families with a new speech generating device: Perspectives of parents and therapists

Speech-language pathologists' views on mentoring by people who use speech generating devices

iPads, Mobile Technologies, and Communication Applications: A Survey of Family Wants, Needs, and Preferences

Professionals’ and parents’ shared learning in blended learning networks related to communication and augmentative and alternative communication for people with severe disabilities

Added to site July 2016