Design and Analysis of Interoperable Data Logs for Augmentative Communication Practice

Access to Justice: An SLP’s Guide to Helping Persons with Complex Communication Needs Voice Their Case

Supporting Families of Children Who Use AAC

Augmentative and alternative communication (AAC) is the study of the compensatory strategies for augmenting, supporting, or replacing communication via speech, e.g. speech generating devices (SGDs) and communication books. Because provision of AAC services (such as evaluation, treatment, and AAC system or device determination) is part of the scope of practice for speech and language pathologists (SLPs), it is important that students entering this field feel competent in their AAC knowledge. The purpose of this study was to examine the impact of additional components of AAC education (i.e., workshops and clinical practica) on SLP students’ preservice confidence levels in providing these services. An online survey was distributed via email to 49 SLP graduate students attending a large metropolitan university. The survey included questions in which students were asked to identify their education experiences, and then rate their levels of confidence in providing AAC services for individuals with complex communication needs (CCN). The results show trends indicating that additional clinical practica in AAC impacted student’s confidence levels in treating individuals with CCN and in determining appropriate AAC systems for the student. In conclusion, it is likely that required pre-service education in AAC needs to be more robust, especially in the area of device/system determination.

Augmentative and alternative communication (AAC) in pediatric cochlear implant recipients with complex needs: A scoping review.

With recent data reporting approximately 40–50% of Deaf or hard of hearing (DHH) individuals as having a diability, complex communication needs are not uncommon within this population and can present unique communicative challenges. Implementing augmentative and alternative communication (AAC) systems can provide this population with an effective means of communication, assist them in developing specific language skills, and support them in effectively accessing their social environment. The purpose of this scoping review was to (a) identify the facilitators and barriers to AAC provision for this group of individuals, (b) discuss observable trends throughout studies, and (c) highlight areas for further research in AAC for this group of learners. This review compiles the results from seven studies within the last 10 years and focuses on the facilitators and barriers when implementing AAC systems for DHH individuals with a disability (DWD) and complex communication needs. The facilitators and barriers are categorised as interpersonal, intervention and assessment related. The trends that were identified included (a) the overall success of AAC, (b) the prevalence of speech-generating devices (SGD) use, (c) the lack of communication within interdisciplinary teams, (d) the lack of DHH-specific research, and (e) the lack of standardised methods for AAC selection.

PurposeThis naturalistic study adapted exploratory school practice in order to support empirically‐informed decision making in the provision of augmentative and alternative communication (AAC) technologies for children with autism.Design/methodology/approachResearch was conducted with three boys with autism and little speech, as part of a curricular literacy lesson. A mixed method approach, involving observational coding and staff diaries, identified how the boys used computer‐based voice output communication aids (VOCAs), also called speech generating devices (SGDs) and how the technology impacted on their communication and language. The boys were observed in initial lessons (“baseline” sessions), without the VOCA present and in sessions in which the VOCA was available (“intervention” sessions).FindingsVOCAs were used for two main communicative purposes; naming and giving information, with aids being used primarily to support curricular, task‐related communication. Existing modes of communication continued to be used when access to the VOCA was available. In addition, all three boys showed an increase in Mean Length of Utterance (MLU) after the VOCA was introduced. The findings suggest that computer‐based VOCA technology can augment children's communicative participation in lesson activities. Specific patterns of change were also recorded in the boys' communication, suggesting individualised responses to this technology.Originality/valueThis paper extends the empirical base for clinical decision making by reporting the use of high tech VOCAs by school age children with autism for additional forms of communication, beyond those described elsewhere. It adds to the evidence that interventions which include access to a computer VOCA can have a positive impact on the language complexity of children with autism. It describes the potential of VOCAs to provide an enabling and inclusive technology in a classroom setting.

Despite evidence for the usefulness of augmentative and alternative communication (AAC) for young children with complex communication needs (CCN), several barriers prevent children from accessing AAC intervention. This qualitative study is focused on understanding the lived experiences of parents accessing and learning how to use speech-generating devices with their young children (3-6 years) with CCN. Findings generate insight into the similarities and differences across families’ experiences through several categories and themes: (a) foundational perspectives (determination and resilience; finding balance); (b) experiences getting access to an AAC device (initiating access; navigating barriers); (c) experiences using an AAC device (learning and navigating challenges; supporting their child’s communication at home and in the community; seeing progress); and (d) surrounding factors (family structure, informal supports, and demands; access to services and professional supports; the COVID-19 pandemic). Implications for practice and policy are discussed related to how to improve AAC access and intervention.

Using a descriptive quantitative approach, this study examined the role of caregiver self-perceived comfort level (SPCL) in the success of augmentative and alternative communication (AAC) system implementation. The role of SPCL as a mediator variable affecting the relationship between the predictor variable (caregiver training resources) and the outcome variable (AAC use) was investigated. Related factors examined as covariates include caregiver demographics (gender, education level, and setting), the primary disability of the child or youth with complex communication needs, the type of AAC system (low-technology vs high-technology), and caregiver involvement in system selection. To examine the contribution of these variables to AAC use, the innovation decision model was used as a guide to propose a new framework describing how these factors are related as well as how they directly or indirectly impact AAC use. Data from a pre-administered Caregiver Training Survey was analyzed to answer the research question. There were 291 participants who completed the original survey. An inspection of the initial data revealed that 52.86% of the overall data was missing. Following Multiple Imputation using the fully conditional specification method, the data was analyzed including test of model fit, and multiple regression to test the direct and indirect effects of the independent variables on the dependent variable. For low-technology AAC, there was no statistically significant direct or indirect effect observed between the study variables. Thus, SPCL cannot be said to mediate the relationship between training resources and low-technology AAC use. For high-technology AAC, although SPCL cannot be said to mediate the relationship between training resource and AAC use, there were statistically significant direct and total effects of training resource on AAC use. The results suggest that SPCL does not mediate the relationship between caregiver training resources and AAC use for both low-technology and high-technology AAC. However, there were a few limitations that must be considered when interpreting the results. The significant amount of missing data meant that there was a significant inability to detect the studied effects using statistical analysis. This was further compounded with the fact that the survey was pre-administered and causal relationships between the variables in the study could not be established before a mediation analysis was conducted. Conducting a mediation analysis with observational data leaves room for multiple confounding variables. These limitations notwithstanding, the role of training resources in the communicative outcomes of children and youth with complex communication needs was established. The nature of this relationship should be further investigated, including the role of SPCL as a moderator that strengthens or weakens the observed relationship between training resources and AAC use.

The current study researches the impact of voice output communication aids (VOCA) on the language acquisition of toddlers and school-aged children with developmental disabilities. There are a wide variety of augmentative and alternative communication (AAC) devices available to nonverbal individuals, making the decision of parents, teachers, and speech pathologists of which to use and implement a substantial task, one that needs the guidance of research based evidence. SPSS software was used to conduct a series of analyses with secondary data from Nancy Brady’s study Language Development of Non-verbal Children Age 3 Years through 7 Years, 2007 to 2012, looking specifically at the increase in total words rate of children using various AAC interventions over a year’s time. Total words rate scores were determined using the number of different words each child spoke, signed, or selected during observations and assessments completed by researchers. A multitude of T-tests and a multiple regression equation were run, comparing the outcomes of participants based on their use of a VOCA and presence of an autism diagnosis. Results found participants using other forms of augmentative communication to have a higher total words rate at time 2 than those using VOCA, though these findings were not significant. Gender and autism were not found to be significant predictors of language acquisition, though being male was positively correlated with total words rate scores. Analyses also concluded that participants with an autism diagnosis using VOCA had a slightly higher total words rate at time 2 than those with other developmental disabilities using VOCA, though these findings were also not significant. Future research should consider looking at a randomly selected sample with a wider quantitative range of expressive vocabulary, as well as obtaining the identification of the type and severity of a child’s diagnosis to further clarify the evidence-based benefits of VOCA with specific populations.

Purpose To examine the experiences of people with ALS (pALS) and their communication partners (cALS) regarding receiving speech-generating device (SGD) evaluation and treatment via telepractice. Method Eight pALS along with a primary cALS participated in telepractice SGD evaluation and treatment with an augmentative and alternative communication (AAC) specialist and representatives from multiple SGD vendors. Participants were interviewed postevaluation and post-SGD training to examine their experiences. Mixed methods data were collected through Likert scale responses and qualitative interviews. Results Telepractice SGD evaluation and training were feasible and resulted in all pALS receiving SGDs they were able to use to communicate. In both Likert rating items and qualitative interviews, participants rated the telepractice experience very highly in terms of giving them access to AAC services via an AAC specialist that they would not have otherwise been able to access, and doing so in a format that was possible given their limitations in mobility, endurance, and caregiver availability. Suggestions for improving the telepractice experience were provided. Conclusions Telepractice should be considered as an option to provide vital SGD services to patients who are geographically remote, mobility impaired, unable to leave their home, experience fatigue with travel, or otherwise would not have access to these specialized services. Telepractice allows patients to preserve their time and energy for the assessment and treatment sessions, resulting in perhaps deeper and more frequent engagement in evaluation and training. Telepractice could serve as an alternative to outpatient, in-person evaluations, or be utilized in conjunction with in-person appointments. Supplemental Material https://doi.org/10.23641/asha.15094257.

Augmentative and Alternative Communication (AAC) emerged as a combination of methods or strategies that constitute any device, such as Speech Generating Device (SGD), Program (mobile applications), Procedure (PECS, Picture Exchange Communication System), which enhances individual’s communication ability. Autism Spectrum Disorder (ASD) is a spectrum of comprehensive neurodevelopment disorder that leads to speech impairments, repetitive behavior, and social communication difficulties; therefore, it is imperative to underscore that at the core of all impediments are communication impairment. This article represents a systematic review of research initiatives that investigate multi-modal AAC strategies and functionality, features of mobile applications to reinforce communication and communal skills in verbally challenged ASD children because other researches are focused only on low or high-tech AAC or interventions to provide insights on ASD children respond to a particular approach. Following the PRISMA method, a total of 60 (January 2015 to October 2020) research articles were reviewed, indexed by Springer, Science Direct, Scopus, ACM, IEEE databases, and published in the AAC journal. The selected research articles are categorized into different themes where most of them focused on interactive mobile applications to improve emotional, social, learning, and overall communication skills in verbally challenged ASD children. This systematic review provides an outline of the paradigm shift in AAC modalities from PECS to Artificial Intelligence (AI), Machine Learning (ML), and Augmented Reality (AR) based applications. It opens up underline future opportunities to integrate intelligent analytics features in mobile applications to strengthen communication skills in verbally undermined ASD children.

This case study focused on skill generalization following instruction of an adolescent girl with multiple disabilities using two augmentative and alternative communication (AAC) devices: a simple pictographic display and a voice output communication aid (VOCA) with an identical display used as an overlay. An alternating treatments design was used to assess community members' response latency, focus of attention, and comprehension of requests made via the two AAC devices. Skill generalization occurred for both devices, with similar rates of efficiency. These findings underscore the importance of the use of multiple modalities and of incorporating individual preferences to enhance the communicative competence of individuals who use AAC in natural environments.

Augmentative and alternative communication (AAC) services for people with complex communication needs in New Zealand were investigated by surveying speech-language therapists. Two separate survey forms were developed and mailed to speech-language therapists who worked with either students or adults. In both survey forms, information was requested about (a) the provision of AAC intervention, (b) the professional needs of speech-language therapists providing AAC services, and (c) demographic information about students with complex communication needs. Low-tech communication options and sign language were the most commonly reported AAC strategies used by adults and students with complex communication needs. Students aged 5 – 10 years received the most AAC intervention. Cerebral palsy, intellectual disabilities and autism spectrum disorders were the most commonly reported etiologies of students who used AAC. A total of 86% of the respondents indicated a desire for further AAC information or training.

Children with autism spectrum disorder (ASD) show differences in their communication development when compared to children who are typically developing and other clinical populations. In addition, children with ASD show divergence and delays in their expressive language when compared to each other, and a reported 30% do not develop spoken language even with access to early intervention. In order to support children with ASD in their communication development, there is a critical need for (a) detailed accounts of the emergence of expressive language for children receiving early intervention, (b) investigation of factors that might explain differences in expressive language abilities, and (c) investigation of sensitive predictors of expressive language change for children receiving early intervention. Children with ASD are often recommended augmentative and alternative communication (AAC) as part of early intervention to augment existing communication abilities, thus providing a complementary communication system while supporting early language development. Augmentative and alternative communication can be introduced as a focused intervention to target communication specifically, or it can be introduced as part of a comprehensive intervention program targeting multiple domains of learning. When used as part of a comprehensive intervention program, AAC is believed to support communication development broadly, including children’s use of spoken language. Despite emerging evidence for its effectiveness as a focused intervention and potential to support spoken language development within the context of comprehensive interventions, little research exists examining the mechanisms underpinning outcomes of AAC interventions. The current project aimed to address this gap by investigating both the emergence of expressive language in children with ASD, and factors underpinning concurrent and longitudinal expressive language abilities for children receiving an AAC-infused comprehensive intervention program. This research was conducted as a series of three studies: Study 1 investigated the communication profiles of 246 children with ASD upon entry and exit to a comprehensive early intervention program; Study 2 investigated mechanisms underpinning concurrent expressive language abilities, and Study 3 investigated predictors of longitudinal expressive language abilities, in 48 children with ASD receiving an AAC-infused comprehensive intervention program. The findings from Study 1 documented that 58.7% of children who started early intervention as minimally verbal remained minimally verbal after approximately 12 months of intervention, while 41.3% went on to develop phrase speech (using two-word phrases), highlighting an as yet unmet clinical need, as well as research need to understand these differences. The findings from Study 2 challenged previously held beliefs regarding word learning abilities in children with ASD, and extended on previous research by investigating the relationship between symbolic word learning and expressive language level. By focusing on processes that might be relevant to children’s development within interventions incorporating AAC, the findings from Study 3 provided preliminary data on the characteristics of children who might experience the largest gains in spoken language within AAC-infused comprehensive interventions. This research demonstrated a novel approach to investigating variability in expressive language development in children with ASD. The findings from this research demonstrate potential to explain some of the variability through analysis of social-cognitive learning processes that might help predict change within intervention. Finally, the findings of this research have potential to inform how researchers and clinicians approach individual differences in all children who present with complex developmental profiles.

Adolescents with complex communication needs require interventions based on community communication skills for effective communication within the expanding scope of their lives. This study aimed to compare two augmentative and alternative communication (AAC) interventions by using script for their effectiveness in helping four adolescents with complex communication needs to express themselves in the community. The devices used in the study were a location-based and a category-based high-tech AAC device used in an alternative treatment design. The two intervention methods were alternated during the intervention phase of the study to determine the more effective one. The effect size was calculated using an improvement rate difference (IRD) analysis. Then, the more effective method was applied instead of the less effective one in the replication phase, within the setting where the less effective method had previously been employed, to assess its effectiveness. and effective AAC communication methods were employed within the community during the generalization phase. As a result of the interventions, all four participants showed increased accuracy of expression in the local community compared with the baseline, and the location-based tool showed greater treatment effects than the category-based tool. Additionally, the location-based device also showed generalization effects in the local community. The findings confirmed the efficacy of the two different AAC tools to improve the accuracy of expression among adolescents with complex communication needs, facilitating their integration into the community.