PECS and VOCAs to enable students with developmental disabilities to make requests: an overview of the literature

PsycAssist: A Web-Based Artificial Intelligence System Designed for Adaptive Neuropsychological Assessment and Training

Assessing executive functions in individuals with disorders or clinical conditions can be challenging, as they may lack the abilities needed for conventional test formats. The use of more personalized test versions, such as adaptive assessments, might be helpful in evaluating individuals with specific needs. This paper introduces PsycAssist, a web-based artificial intelligence system designed for neuropsychological adaptive assessment and training. PsycAssist is a highly flexible and scalable system based on procedural knowledge space theory and may be used potentially with many types of tests. We present the architecture and adaptive assessment engine of PsycAssist and the two currently available tests: Adap-ToL, an adaptive version of the Tower of London-like test to assess planning skills, and MatriKS, a Raven-like test to evaluate fluid intelligence. Finally, we describe the results of an investigation of the usability of Adap-ToL and MatriKS: the evaluators perceived these tools as appropriate and well-suited for their intended purposes, and the test-takers perceived the assessment as a positive experience. To sum up, PsycAssist represents an innovative and promising tool to tailor evaluation and training to the specific characteristics of the individual, useful for clinical practice.

ICT Framework for Supporting Applied Behavior Analysis in the Social Inclusion of Children with Neurodevelopmental Disorders

The applied behavior analysis (ABA) model emphasizes observable and measurable behaviors by carrying out decision making using experimental data (behavioral observation assessment strategies). In this framework, information and communication technology (ICT) becomes highly suitable for enhancing the efficiency and effectiveness of the methodology. This paper aims to delve into the potential of ICT in providing innovative solutions to support ABA applications. It focuses on how ICT can contribute to fostering social inclusion with respect to children with neurodevelopmental disorders. ICT offers advanced solutions for continuous and context-aware monitoring, as well as automatic real-time behavior assessments. Wireless sensor systems (wearable perceptual, biomedical, motion, location, and environmental sensors) facilitate real-time behavioral monitoring in various contexts, enabling the collection of behavior-related data that may not be readily evident in traditional observational studies. Moreover, the incorporation of artificial intelligence algorithms that are appropriately trained can further assist therapists throughout the different phases of ABA therapy. These algorithms can provide intervention guidelines and deliver an automatic behavioral analysis that is personalized to the child's unique profile. By leveraging the power of ICT, ABA practitioners can benefit from cutting-edge technological advancements to optimize their therapeutic interventions and outcomes for children with neurodevelopmental disorders, ultimately contributing to their social inclusion and overall wellbeing.

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

INTRODUCTION

Augmentative and alternative communication (AAC) encompasses all forms of unaided and aided modes of communication, but typically excludes codified language such as spoken words or American Sign Language (ASL). In pediatric patients with a documented additional disability (population of interest), deficits in communication may pose a barrier to language development. While forms of AAC are frequently mentioned in the literature, recent innovations have permitted the use of high-tech AAC in the rehabilitation process. Our objective was to review the implementation of AAC in pediatric cochlear implant recipients with a documented additional disability.

METHODS

A scoping review of existing literature examining the use of AAC in pediatric CI recipients was conducted in the PubMed/MEDLINE and Embase databases. Studies with pediatric cochlear implant recipients with a concomitant diagnosis requiring additional therapeutic intervention outside the scope of standard post-CI follow-up care and rehabilitation from 1985 to 2021 met inclusion criteria (population of interest). Studies limited to spoken or formal sign language (e.g., American Sign Language, ASL) as communication modalities were excluded.

RESULTS

Four hundred twenty studies were screened of which 29 were included. 13 were prospective, 10 were retrospective, 1 was cross-sectional, and 5 were case reports. Of these 29 studies, 378 patients met the inclusion criteria (age <18, CI user, additional disability, utilized AAC). Fewer studies (n = 7) utilized AAC as the primary intervention for investigation. Autism spectrum disorder, learning disorder, and cognitive delay were frequently mentioned as additional disabilities in conjunction with AAC. Unaided forms of AAC included gesture/behavior, informal sign, and signed exact English, while aided AAC included a Picture Exchange Communication System (PECS), Voice Output Communication Aids (VOCA), and touchscreen programs such as TouchChat® HD. Various audiometric and language development outcome measures were mentioned, most commonly the Peabody Picture Vocabulary Test (PPVT) (n = 4) and the Preschool Language Scale, Fourth Edition (PLS-4) (n = 4).

CONCLUSION

There is a gap in the literature regarding the use of aided and high-tech AAC in pediatric CI users with a documented additional disability. Given the use of multiple different outcome measures, additional exploration of the intervention of AAC is warranted.

Icono: a universal language that shows what it says

This article lays out the foundation of a new language for easier written communication that is inherently reader-friendly and inherently international. Words usually consist of strings of sounds or squiggles whose meanings are merely a convention. In Icono, instead, they typically are strings of icons that illustrate what they stand for. "Train," for example, is expressed with the icon of a train, "future" with the icon of a clock surrounded by a clockwise arrow, and "mammal" with the icons of a cow and a mouse-their combination's meaning given by what they have in common. Moreover, Icono reveals sentence structure graphically before, rather than linguistically after, one begins reading. On smartphones and computers, writing icons can now be faster than writing alphabetic words. And using simple pictures as words helps those who struggle with conditions like dyslexia, aphasia, cerebral palsy, and autism with speech impairment. Because learning its pronunciation or phonetic spelling is optional rather than a prerequisite, and because it shows what it says, Icono is bound to be easier to learn to read-and then easier to read-than any other language, including our own.

Ultra-Light Clay Intervention Improves Responsiveness and Initiates the Communication of Children With ASD

The barriers to responsiveness and the initiation of communication are the two key problems encountered by children with autism spectrum disorders (ASD). Prior interventions based on behavioral reinforcement have had an obvious effect on responsive communication but a weak effect on the initiation of communication. Based on psychological development theory, we designed ultra-light clay interventions involving hands-on production or multi-interaction around key concepts and themes, teaching children about basic concepts, relationships, and logic, making abstract knowledge concrete and experience. Two studies (Study 1: N = 3, one-to-one intervention; Study 2: N = 8, one-to-two intervention) showed that ultra-light clay intervention improved both the initiation of and response to communication among children with ASD, but that such improvements show a peer-generalization effect in initiation communication, not in responsive communication. These findings provide a set of ultra-light clay interventions for communication in children with ASD and suggest a relationship between endogenous interventions and the initiation of communication.

Augmentative and Alternative Communication for Children with Intellectual and Developmental Disability: A Mega-Review of the Literature

Establishing evidence- and research-based practices relies upon research synthesis of individual studies in reviews and meta analyses. Further summarizing scientific evidence about a specific topic by synthesizing reviews is an area of need to determine practices that have a strong evidence base and to identify areas of methodological weakness and gaps in the literature. A mega-review of literature reviews, systematic reviews, and meta-analyses on interventions using aided augmentative and alternative communication (AAC) interventions for children with intellectual and developmental disabilities from 2000 to mid-2020 was conducted. Participant and interventionist demographics, interventions, settings, outcomes, and recommendations of each review were reported and summarized. A MeaSurement Tool to Assess systematic Reviews Revised (AMSTAR 2; Shea et al., 2017) was used to examine the methodological rigor of 84 included reviews. Over the past 20 years, published reviews have increased slightly in methodological rigor but demonstrate a number of methodological weaknesses that detract from the strength of evidence for AAC interventions with this population. Suggestions for improving the methodological rigor of literature reviews and areas for future research specific to AAC interventions are discussed.

A Meta-analysis of Challenging Behavior Interventions for Students with Developmental Disabilities in Inclusive School Settings

Challenging behavior is a significant barrier in accessing the general education curriculum for students with developmental disabilities. This necessitates the identification of evidence-based practices for addressing challenging behavior in inclusive settings. The purpose of our meta-analysis is to (a) quantify the magnitude of effect of interventions targeting the reduction of challenging behavior in students with developmental disabilities in inclusive educational settings and (b) determine if participant and intervention characteristics moderate intervention effects. A systematic search of academic databases was conducted to identify studies, which were evaluated for methodological rigor and analyzed for effects using Tau-U. Results indicate a strong overall effect of .94 (95% CI [.87, 1]) and moderating variables associated with behavior topography, interventionist, and intervention components were identified.

Training Peer Partners to Use a Speech-Generating Device With Classmates With Autism Spectrum Disorder: Exploring Communication Outcomes Across Preschool Contexts

PURPOSE

This study examined effects of a peer-mediated intervention that provided training on the use of a speech-generating device for preschoolers with severe autism spectrum disorder (ASD) and peer partners.

METHOD

Effects were examined using a multiple probe design across 3 children with ASD and limited to no verbal skills. Three peers without disabilities were taught to Stay, Play, and Talk using a GoTalk 4+ (Attainment Company) and were then paired up with a classmate with ASD in classroom social activities. Measures included rates of communication acts, communication mode and function, reciprocity, and engagement with peers.

RESULTS

Following peer training, intervention effects were replicated across 3 peers, who all demonstrated an increased level and upward trend in communication acts to their classmates with ASD. Outcomes also revealed moderate intervention effects and increased levels of peer-directed communication for 3 children with ASD in classroom centers. Additional analyses revealed higher rates of communication in the added context of preferred toys and snack. The children with ASD also demonstrated improved communication reciprocity and peer engagement.

CONCLUSIONS

Results provide preliminary evidence on the benefits of combining peer-mediated and speech-generating device interventions to improve children's communication. Furthermore, it appears that preferred contexts are likely to facilitate greater communication and social engagement with peers.

Comparing Single Case Design Overlap-Based Effect Size Metrics From Studies Examining Speech Generating Device Interventions

Meaningfully synthesizing single case experimental data from intervention studies comprised of individuals with low incidence conditions and generating effect size estimates remains challenging. Seven effect size metrics were compared for single case design (SCD) data focused on teaching speech generating device use to individuals with intellectual and developmental disabilities (IDD) with moderate to profound levels of impairment. The effect size metrics included percent of data points exceeding the median (PEM), percent of nonoverlapping data (PND), improvement rate difference (IRD), percent of all nonoverlapping data (PAND), Phi, nonoverlap of all pairs (NAP), and Tau(novlap). Results showed that among the seven effect size metrics, PAND, Phi, IRD, and PND were more effective in quantifying intervention effects for the data sample (N = 285 phase or condition contrasts). Results are discussed with respect to issues concerning extracting and calculating effect sizes, visual analysis, and SCD intervention research in IDD.

Communication Services and Supports for Individuals With Severe Disabilities: Guidance for Assessment and Intervention

The National Joint Committee for the Communication Needs of People With Severe Disabilities (NJC) reviewed literature regarding practices for people with severe disabilities in order to update guidance provided in documents originally published in 1992. Changes in laws, definitions, and policies that affect communication attainments by persons with severe disabilities are presented, along with guidance regarding assessment and intervention practices. A revised version of the Communication Bill of Rights, a powerful document that describes the communication rights of all individuals, including those with severe disabilities is included in this article. The information contained within this article is intended to be used by professionals, family members, and individuals with severe disabilities to inform and advocate for effective communication services and opportunities.

Thematic Matching as Remedial Teaching for Symbolic Matching for Individuals with Autism Spectrum Disorder

Matching-to-sample (MTS) is often used to teach symbolic relationships between spoken or printed words and their referents to children with intellectual and developmental disabilities. However, many children have difficulty learning symbolic matching, even though they may demonstrate generalized identity matching. The current study investigated whether training on symbolic MTS tasks in which the stimuli are physically dissimilar but members of familiar categories (i.e., thematic matching) can remediate an individual's difficulty learning symbolic MTS tasks involving non-representative stimuli. Three adolescent males diagnosed with autism spectrum disorder were first trained on symbolic MTS tasks with unfamiliar, non-representative form stimuli. Thematic matching was introduced after the participants failed to learn 0, 2 or 4 symbolic MTS tasks and before additional symbolic MTS tasks were introduced. After exposure to thematic matching, accuracy on symbolic MTS tasks with novel stimuli increased to above chance for all participants. For two participants, high accuracy (> 90%) was achieved on a majority of these sessions. Thus, thematic matching may be an effective intervention for students with limited verbal repertoires and who have difficulty learning symbolic MTS tasks. Possible explanations for the facilitative effect of thematic matching are considered and warrant further investigation.

Comparing acquisition of and preference for manual signs, picture exchange, and speech-generating devices in nine children with autism spectrum disorder

OBJECTIVE

To compare how quickly children with autism spectrum disorder (ASD) acquired manual signs, picture exchange, and an iPad/iPod-based speech-generating device (SGD) and to compare if children showed a preference for one of these options.

METHOD

Nine children with ASD and limited communication skills received intervention to teach requesting preferred stimuli using manual signs, picture exchange, and a SGD. Intervention was evaluated in a non-concurrent multiple-baseline across participants and alternating treatments design.

RESULTS

Five children learned all three systems to criterion. Four children required fewer sessions to learn the SGD compared to manual signs and picture exchange. Eight children demonstrated a preference for the SGD.

CONCLUSION

The results support previous studies that demonstrate children with ASD can learn manual signs, picture exchange, and an iPad/iPod-based SGD to request preferred stimuli. Most children showed a preference for the SGD. For some children, acquisition may be quicker when learning a preferred option.

Comparing communication systems for individuals with developmental disabilities: a review of single-case research studies

Studies that have compared different communication systems for individuals with developmental disabilities were systematically reviewed in an effort to provide information useful for clinical decision making and directions for future research. Specifically, 28 studies that compared (a) non-electronic picture systems to speech generating devices, (b) aided AAC (e.g. picture exchange systems and SGDs) to unaided AAC systems (manual sign), or (c) AAC to speech-language interventions were included in this review. Dependent variables forming the basis for comparison included: (a) effectiveness (e.g. acquisition of systems and/or rate of use), (b) efficiency or rate of skill acquisition (c) participants' preference for systems, (d) occurrence of vocalizations and problem behavior, and (e) generalization across communication partners, settings, and time (i.e. maintenance). Results suggest that clear and consistent differences between communication systems are rare, precluding definitive statements regarding a universal best approach for all people with developmental disabilities. Instead, findings of this review support the consideration of an individual's existing skills, goals and preferences as part of the process of selecting an approach to communication.

Comparisons of intervention components within augmentative and alternative communication systems for individuals with developmental disabilities: a review of the literature

Decisions regarding augmentative and alternative communication (AAC) for individuals with developmental disabilities (e.g. what AAC to use and how to teach a person to use a specific AAC modality) should involve consideration of different intervention component options. In an effort to elucidate such decisions and options, this review synthesized 14 studies, published between 2004 and 2012, comparing different AAC intervention components including different symbol sets, instructional strategies, or speech output within aided AAC systems, and different verbal operants within unaided AAC. Evidence supported the following: (a) different instructional strategies such as building motivation, using errorless learning, or adding video models to picture exchange interventions may improve the acquisition or rate of acquisition of picture exchange mands, (b) limited data supports training mimetic (imitated) or mand signs over tacts and (c) differences in symbol sets and speech output levels appeared to have little effect on AAC-based mand acquisition, but listener-based differences should be considered. These findings have implications for future research and clinical practice.

Preference-Enhanced Communication Intervention and Development of Social Communicative Functions in a Child With Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) who exhibit limited speech can learn to communicate using augmentative and alternative communication (AAC) systems. We describe the case of Ian, a 10-year-old boy with ASD who had learned to use an Apple iPod®- and iPad®-based speech-generating device (SGD)Note 1, picture exchange (PE), and manual signing (MS) for functional communication (e.g., requesting), but had difficulty in using these AAC systems for spontaneous and socially oriented functions of communication. His difficulties were originally conceptualized as reflecting the social interaction and communication deficits characteristic of ASD. Alternatively, we suggest that the intervention did not allow for the development of more advanced communication. A preference-enhanced intervention was introduced with Ian’s chosen AAC system only, that is the iPad®-based SGD. Opportunities for communication were created using highly motivating activities and behavioral strategies. Results suggest that the approach facilitated development of spontaneous and socially oriented communication.

Establishing a conditional signal for assistance in teenagers with blindness

Five teenagers with severe intellectual impairments and no discernible communication skills were enrolled in training to teach a conditional request for assistance using a speech-generating device (SGD). All were either blind or severely visually impaired since birth. All learned to operate an adaptive switch to control sensory outcomes, next showed preferences among sensory outcomes, and then demonstrated the ability to use their switch to signal for assistance with an SGD when the sensory outcome was remotely disabled. During the signaling phase, or subsequent attempts to generalize its use outside the laboratory, three participants began vocalizing. Most notably, they began imitation of the word "song" or the word "help" emitted by the SGD. The potential role of cause-and-effect training with adaptive switches is discussed.

Parent-implemented picture exchange communication system (PECS) training: an analysis of YouTube videos

PURPOSE

To investigate the integrity with which parents and carers implement PECS in naturalistic settings, utilizing a sample of videos obtained from YouTube.

METHODS

Twenty-one YouTube videos meeting selection criteria were identified. The videos were reviewed for instances of seven implementer errors and, where appropriate, presence of a physical prompter.

RESULTS

Forty-three per cent of videos and 61% of PECS exchanges contained errors in parent implementation of specific teaching strategies of the PECS training protocol. Vocal prompts, incorrect error correction and the absence of timely reinforcement occurred most frequently, while gestural prompts, insistence on speech, incorrect use of the open hand prompt and not waiting for the learner to initiate occurred less frequently.

CONCLUSIONS

Results suggest that parents engage in vocal prompting and incorrect use of the 4-step error correction strategy when using PECS with their children, errors likely to result in prompt dependence.

Speech-generating devices versus manual signing for children with developmental disabilities

We compared speed of acquisition and preference for using a speech-generating device (SGD) versus manual signing (MS) as augmentative and alternative communication (AAC) options. Four children with developmental disabilities (DD), aged 5-10 years, were taught to request preferred objects using an iPod(®)-based SGD and MS. Intervention was introduced in a multiple-probe across participants design and SGD and MS conditions were compared in an alternating treatments design. A systematic choice-making paradigm was implemented to determine if the children showed a preference for using SGD or MS. All participants showed increased use of SGD when intervention was introduced, but only three learned under the MS condition. Three participants exhibited a preference for the SGD while the remaining participant demonstrated a preference for using MS. Results support previous studies showing that individuals with DD often show a preference for different AAC options and extend previous data by suggesting that acquisition and maintenance was better for the preferred option.

Social interactions of students with disabilities who use augmentative and alternative communication in inclusive classrooms

The purpose of this study was to explore the naturally occurring social interactions for students with disabilities who use augmentative and alternative communication (AAC) in general education classrooms. We observed 16 students who used AAC and received services under the categories of autism or intellectual disability. Participants primarily interacted with their support personnel and infrequently conversed with peers despite often being in close proximity. Few interaction episodes were initiated by students who used AAC, and initiations to peers and adults appeared to serve somewhat different functions. Students with disabilities relied more heavily on facial expressions and gestures than on the use of their AAC devices. Recommendations for promoting interaction opportunities among students are offered, and future research directions are suggested.

Meta-analysis of PECS with individuals with ASD: investigation of targeted versus non-targeted outcomes, participant characteristics, and implementation phase

The Picture Exchange Communication System (PECS) is a widely used picture/icon aided augmentative communication system designed for learners with autism and other developmental disorders. This meta-analysis analyzes the extant empirical literature for PECS relative to targeted (functional communication) and non-targeted concomitant outcomes (behavior, social skills, and speech) for learners with autism, learners with autism and intellectual disabilities and those with autism and multiple disabilities. Effect size analyses were done using the Improvement Rate Difference method, an advanced metric. Effect sizes were independently analyzed for targeted and non-targeted outcomes, student age, learner disability, and number of phases in the PECS protocol acquired by learners. Results supported the judgment that PECS is a promising intervention method. Analysis also revealed that functional communication outcomes associated with the PECS protocol were most impacted, that preschool children and those with autism generally showed the strongest training effects, and that in general students who advanced through the most PECS protocol phases had the best outcomes.

Picture Exchange Communication (PECS) Training for Young Children: Does Training Transfer at School and to Home?

The limited communicative abilities of young children with autism and developmental disabilities may be enhanced by augmentative communication systems such as the Picture Exchange Communication System (PECS). Both children and adults can learn to use PECS, but research is inconsistent in establishing the degree to which PECS training transfers reliably from the training setting to other settings, for example, regular classrooms, and home. Three 5–6 year-old children, diagnosed as autistic and/or developmentally disabled, were given 1:1 PECS training at school, structured to enhance generalisation and transfer. Concurrent observations were made in their regular classroom and at home to probe the extent of generalisation. All three acquired the ability to request a preferred object or activity by exchanging a picture symbol with a communicative partner. In tests of transfer and generalisation, a multiple-baseline across subjects design showed no use of PECS symbols either in the classroom or at home prior to training, with spontaneous initiations of picture exchange (transfer) occurring to a slight to moderate degree in the classroom and to a slight degree at home. Even with PECS training structured to enhance transfer, functionally significant degrees of generalisation of training may be difficult to achieve, and cannot be assumed to occur.

Assessing preferences for AAC options in communication interventions for individuals with developmental disabilities: a review of the literature

We synthesized studies that assessed preference for using different augmentative and alternative communication (AAC) options. Studies were identified via systematic searches of electronic databases, journals, and reference lists. Studies were evaluated in terms of: (a) participants, (b) setting, (c) communication options assessed, (d) design, (e) communication skill(s) taught to the participant, (f) intervention procedures, (g) outcomes of the intervention and outcome of the preference assessment, (h) follow-up and generalization, and (i) reliability of data collection and treatment integrity. Seven studies, involving 12 participants, met the inclusion criteria. In these studies, individuals were taught to use either speech-generating devices (SGD), (b) picture exchange (PE) systems, and/or (c) manual signs. Assessments to identify preferences for using each AAC option were conducted in each study. Sixty-seven percent (n=8) of participants demonstrated some degree (≥55%) of preference for using SGD compared to 33% (n=4) of participants who demonstrated some degree (≥55%) of preference for PE. The results indicate that individuals with developmental disabilities often show a preference for different AAC options. Incorporating an assessment of such preferences might therefore enable individuals to exert some degree of self-determination with respect to AAC intervention.

The use of speech generating devices in communication interventions for individuals with developmental disabilities: a review of the literature

OBJECTIVE

This review synthesizes communication interventions that involved the use of speech generating devices (SGD) for individuals with developmental disabilities.

METHODS

Systematic searches of electronic databases, journals and reference lists identified 35 studies meeting the inclusion criteria. These studies were evaluated in terms of (a) participants, (b) SGD function, (c) SGD characteristics, (d) intervention procedures, (e) intervention results and (f) certainty of evidence.

RESULTS

Across these studies, intervention was provided to a total of 86 participants aged 1-42 years. Communication skills targeted included requesting, social or conversational skills, labelling items and receptive language. Intervention approaches were categorized as using Discrete Trial Training, Milieu teaching or a combined instructional approach. Positive outcomes were reported in 86% of the studies with 54% of studies categorized as providing conclusive evidence.

CONCLUSION

This literature base is considered promising due to the large number of conclusive studies and the replication of intervention approaches.

Communication interventions involving speech-generating devices for children with autism: a review of the literature

OBJECTIVE

The current review synthesizes communication intervention studies that involved the use of speech-generating devices (SGD) for children with autism.

METHODS

Twenty-three studies were identified that met the inclusion criteria following systematic searches of electronic databases, journals and reference lists. Studies were evaluated in terms of: (a) participants, (b) setting, (c) mode of communication, (d) communication skill(s) taught to the participant, (e) intervention procedures, (f) outcomes, (g) follow-up and generalization, (h) reliability and treatment integrity and (i) design and certainty of evidence.

RESULTS

Intervention, most commonly targeting requesting skills, was provided to a total of 51 children aged 3-16 years. Intervention strategies followed two main approaches: operant/behavioural techniques and naturalistic teaching procedures. Positive outcomes were reported for 86% of the studies and 78% of the studies were categorized as providing conclusive evidence.

CONCLUSION

The literature base suggests that SGDs are viable communication options for children with autism. However, several areas warrant future research.

Behavioral Intervention Promotes Successful Use of an iPod-Based Communication Device by an Adolescent With Autism

Individuals with autism and limited speech are candidates for speech-generating devices (SGDs), but some individuals might experience difficulty in operating these devices. We describe the case of Steven, a 17-year-old adolescent with autism who used an iPod-based SGD, but had difficulty activating the speech output feature of this device. His difficulties were initially interpreted as motor control problems, suggesting the need to abandon this technology, prescribe a different SGD, or adapt his existing device. An alternative conceptualization was that the existing intervention procedures had failed to shape more effective response topographies. Along these lines, a behavioral intervention, involving differential reinforcement and delayed prompting, proved effective in shaping response topographies that enabled Steven to be more successful in activating the speech output function of his iPod-based SGD. The results suggest that behavioral intervention may provide an alternative to the more costly and involved process of replacing or modifying the person’s SGD.

Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: a meta-analysis

PURPOSE

The Picture Exchange Communication System (PECS) is a popular communication-training program for young children with autism spectrum disorders (ASD). This meta-analysis reviews the current empirical evidence for PECS in affecting communication and speech outcomes for children with ASD.

METHOD

A systematic review of the literature on PECS written between 1994 and June 2009 was conducted. Quality of scientific rigor was assessed and used as an inclusion criterion in computation of effect sizes. Effect sizes were aggregated separately for single-subject and group studies for communication and speech outcomes.

RESULTS

Eight single-subject experiments (18 participants) and 3 group studies (95 PECS participants, 65 in other intervention/control) were included. Results indicated that PECS is a promising but not yet established evidence-based intervention for facilitating communication in children with ASD ages 1-11 years. Small to moderate gains in communication were demonstrated following training. Gains in speech were small to negative.

CONCLUSIONS

This meta-analysis synthesizes gains in communication and relative lack of gains made in speech across the PECS literature for children with ASD. Concerns about maintenance and generalization are identified. Emerging evidence of potential preintervention child characteristics is discussed. Phase IV was identified as a possibly influential program characteristic for speech outcomes.

Longitudinal course of cognitive, adaptive, and behavioral characteristics in Costello syndrome

Costello syndrome is a rare rasopathy caused by germline mutations in the oncogene HRAS resulting in increased signal transduction through the Ras/mitogen-activated protein kinase pathway. In contrast to the more common rasopathies, such as neurofibromatosis type 1 and Noonan syndrome, limited information is available on standardized cognitive testing in this cohort. Past research indicated a mean average IQ in the mild mental retardation range, with strengths in fluid reasoning (FR) and weakness in expressive language, as well as static skills over time. Here we report on standardized IQ and adaptive functioning in 18 individuals with Costello syndrome, nine males and nine females, and longitudinal development for 11 who had previous testing. The overall IQ, ranging from severe mental retardation to the average range, with a mean in the mildly mentally retarded range, was again found to be stable, but an interesting pattern in the development of nonverbal FR was identified. Participants showed an improvement in nonverbal FR, followed by stable skills thereafter, suggesting a "late bloomer" effect in late childhood/early adolescence. Overall adaptive functioning fell into the range of Intellectual Disability for 70% of subjects, with Socialization as a relative strength and Daily Living Skills an area of relative difficulty. Interestingly, females were found to be higher functioning than males in all domains, including Communication, Daily Living Skills and Socialization. Caregivers reported significantly more behavioral concerns in males, including internalizing, externalizing, and other maladaptive behaviors. In contrast, no gender differences were found in cognitive or visuomotor functioning.

The token economy for children with intellectual disability and/or autism: a review

One of the most important technologies of behavior modifiers and applied behavior analysts over the last 40 years has been the token economy. These procedures are useful in that they help provide a structured therapeutic environment, and mimic other naturally occurring reinforcement systems such as the use of money. Token economies, at least from a research standpoint, appeared to have crested in popularity during the 1980's. However, for children with intellectual disability (ID) and/or autism, such methods continue to hold considerable therapeutic promise. An overview of past developments, current status, and potential future trends and applications with respect to this special population are discussed.

Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review

PURPOSE

This systematic review aimed to determine the effects of augmentative and alternative communication (AAC) intervention on speech production in children with autism or pervasive developmental disorder-not otherwise specified.

METHOD

A systematic review methodology was utilized to limit bias in searching, selecting, coding, and synthesizing relevant treatment studies. This involved a multifaceted search for studies written between 1975 and May 2007 using various bibliographic databases, dissertation databases, hand searches of selected journals and published compilations of AAC theses and dissertations, and ancestry searches. To be included, studies had to meet stringent criteria. A coding manual and form facilitated data extraction in terms of participant characteristics, treatment characteristics, design and measurement, and outcomes.

RESULTS

Nine single-subject experimental design (27 participants) and 2 group studies (98 participants) were included. Results indicated that AAC interventions do not impede speech production. In fact, most studies reported an increase in speech production. However, in-depth analyses revealed that the gains were rather modest.

CONCLUSIONS

Although AAC interventions do not appear to impede speech production and may result in increased speech production, the modest gains observed require realistic expectations among clinicians and other stakeholders. Future research should be more hypothesis driven and aim to identify predictive child characteristics, such as prior speech imitation and object exploration skills.

Three persons with multiple disabilities accessing environmental stimuli and asking for social contact through microswitch and VOCA technology

BACKGROUND

Direct access to environmental stimuli and opportunity to ask for social contact/attention may be considered highly relevant objectives for persons with multiple disabilities. We assessed the possibility of enabling three of these persons (two children and one adolescent) to combine two microswitches (for accessing environmental stimuli) and a Voice Output Communication Aid (VOCA), which allowed them to ask for caregiver's attention.

METHODS

Initially, the participants were required to use each of the two microswitches individually and then together. Thereafter, they were taught to use the VOCA. Eventually, the VOCA was available together with the microswitches, and the participants could use any of the three.

RESULTS

The results, which support preliminary data on this topic, showed that all participants (1) were able to operate the two microswitches as well as the VOCA; and (2) used all three of them consistently when they were simultaneously available.

CONCLUSIONS

Teaching persons with multiple disabilities to combine a VOCA with conventional microswitches may enrich their general input, emphasize their active social role and eventually enhance their social image.