The effects of color cues on typically developing preschoolers' speed of locating a target line drawing: implications for augmentative and alternative communication display design

Delivering Enhanced Milieu Teaching to Toddlers With Down Syndrome via Hybrid Telepractice: A Single-Case Experimental Design

PURPOSE

This pilot study investigated delivering enhanced milieu teaching tailored for children with Down Syndrome (EMT-DS) through hybrid telepractice.

METHOD

In this multiple-baseline design across behaviors study, a speech-language pathologist (SLP) taught EMT-DS to three caregivers and their children with DS (22-40 months) using a hybrid service delivery model. Sessions were conducted in person and via telepractice. The SLP taught caregivers EMT-DS, emphasizing the use of (a) four target EMT strategies: matched turns, expansions, time delays, and milieu teaching episodes; (b) augmentative and alternative communication (AAC; manual signs, speech-generating device); and (c) aided AAC modeling. The SLP provided caregiver instruction following the teach-model-coach-review approach. Caregiver outcomes were the accuracy (primary) and frequency (secondary) of EMT strategy use. Child outcomes were exploratory and included the rate of symbolic communication acts, weighted number of communication acts, and number of different words (NDW).

RESULTS

There was a functional relation between the intervention and the accuracy and frequency of EMT strategy use for all three caregivers. All caregivers showed an increase in the accuracy for all four target strategies. Caregivers also increased the frequency of the three EMT strategies: expansions, time delays, and milieu teaching episodes. There were no changes in the frequency of matched turns. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the rate of symbolic communication acts and NDW occurred for all three children.

CONCLUSION

Results demonstrate the preliminary efficacy of using a hybrid service delivery model to teach caregivers EMT-DS.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27115252.

Speech-Language Pathologists' Approach to Alternative Access for Augmentative and Alternative Communication for Children With Motor Impairments

PURPOSE

This study examined the processes that speech-language pathologists (SLPs) use during an augmentative and alternative communication (AAC) assessment with children with motor impairments to determine alternative access solutions. These children often are the most vulnerable to a poor fit of their AAC system, which alternative access is an integral part. Although there is an abundance of information as to what types of considerations should be made during these assessments, there is no guidance as to how the assessment is completed. The goal of this study is to build evidence about the process.

METHOD

A collective case design was used to gain detailed insights into the decision-making process. Interviews and vignette responses were two components of the data collection. Each of the five SLPs, or cases, who participated in the study transcripts was analyzed in isolation as part of a within-case analysis. Once each SLP's process was understood, a cross-case comparison was completed to ascertain similarities or differences across the five.

RESULTS

The cross-case assertions are presented in this article. Although the SLPs individually reported a lack of defined process, a clear systemization became evident when considered collectively. The SLPs all focused on the child, isolated motor access skills, and used a process of experimentation over time to build their final recommendations.

CONCLUSIONS

These results have implications for SLPs working with children with motor impairments who may benefit from AAC intervention. The shared framework can serve as a roadmap to other SLPs, especially those with less experience with these types of complex cases. The varying teaming approaches to support these cases are also discussed.

Demands Associated With an Augmentative and Alternative Communication System in Relation to Alternative Forms of Access for Individuals With Motor Impairments

PURPOSE

Successful adoption and use of aided augmentative and alternative communication (AAC) must address how to promote fluid, efficient, and organized execution of the motor behavior needed to access the AAC system. A substantial number of people who use AAC have significant motor impairments and require "alternative" access options, such as eye gaze or switch use. Such individuals may be particularly vulnerable to interference from a poorly designed system. However, the inherent demands of alternative access methods have received little direct study. The goal of this tutorial is to offer a clinically and theoretically guided framework for considerations concerning AAC access, with the hope of spurring further discussion and empirical research.

METHOD

A framework that draws upon dynamic systems theory was used to illustrate the interactions between the various elements of importance to AAC access. Information and research from the fields of motor learning, developmental dynamic systems theory, AAC, and assistive technology was integrated into this tutorial to examine their applications for alternative AAC access methods.

RESULTS

The framework illustrated that AAC access involves a complex coordination between individual skills, the demands of the communication environment, the activity being undertaken, and the supports and demands inherent in the AAC system itself.

CONCLUSIONS

Awareness of the many demands that alternative forms of access place on the person who uses them can guide clinicians during assessment and intervention decision making regarding access options for individuals with significant motor impairments. Specific directions for future research are considered.

Judicious Arrangement of Symbols on a Simulated Augmentative and Alternative Communication Display Optimizes Visual Attention by Individuals With Down Syndrome

PURPOSE

Aided augmentative and alternative communication (AAC) displays are often designed as symmetrical row-column grids, with each square in the grid containing a symbol. To maximize vocabulary on displays, symbols are often placed close to one another, and background color cuing is used to signal/differentiate symbols across different grammatical categories. However, from a visual and developmental standpoint, these display features (close-set symbols and use of background color cues) may not be optimal. In particular, placing symbols quite close together may result in visual crowding, in which individual symbols cannot be distinguished due to the presence of many neighbors, or flankers. This research sought to examine the role of display arrangement and background color cuing on the efficiency of visual attention during search.

METHOD

Ten adolescents and adults with Down syndrome underwent a visual search task while a research-based eye tracking system recorded their patterns of visual attention. Participants searched for symbol targets on displays with varying levels of visual crowding and background color cuing.

RESULTS

Spatial arrangements that reduced visual crowding and that used the spatial organization to cue the grammatical category of symbols resulted in significantly fewer fixations to nonrelevant distracters during search and reduced the likelihood of fixations away from the target once it was located. Background color was helpful in reducing the latency to find the target.

DISCUSSION

Spatial cues may offer a powerful means to maximize the efficiency of search within AAC displays. Background color cuing may facilitate speed to locate targets in these older individuals. Implications for AAC design, as well as future avenues for maximizing (growing) vocabulary, are discussed.

What's in a Photograph? The Perspectives of Composition Experts on Factors Impacting Visual Scene Display Complexity for Augmentative and Alternative Communication and Strategies for Improving Visual Communication

Purpose Visual scene displays (VSDs) can support augmentative and alternative communication (AAC) success for children and adults with complex communication needs. Static VSDs incorporate contextual photographs that include meaningful events, places, and people. Although the processing of VSDs has been studied, their power as a medium to effectively convey meaning may benefit from the perspective of individuals who regularly engage in visual storytelling. The aim of this study was to evaluate the perspectives of individuals with expertise in photographic and/or artistic composition regarding factors contributing to VSD complexity and how to limit the time and effort required to apply principles of photographic composition. Method Semistructured interviews were completed with 13 participants with expertise in photographic and/or artistic composition. Results Four main themes were noted, including (a) factors increasing photographic image complexity and decreasing cohesion, (b) how complexity impacts the viewer, (c) composition strategies to decrease photographic image complexity and increase cohesion, and (d) strategies to support the quick application of composition strategies in a just-in-time setting. Findings both support and extend existing research regarding best practice for VSD design. Conclusions Findings provide an initial framework for understanding photographic image complexity and how it differs from drawn AAC symbols. Furthermore, findings outline a toolbox of composition principles that may help limit VSD complexity, along with providing recommendations for AAC development to support the quick application of compositional principles to limit burdens associated with capturing photographic images. Supplemental Material https://doi.org/10.23641/asha.15032700.

Speech-Language pathologists' decisions when designing an aided AAC display for a compilation case study of a beginning communicator

PURPOSE

The current study sought to identify decisions speech-language pathologists (SLPs) make and their rationale for those decisions when designing an AAC display for a hypothetical school-aged child who was a beginning communicator. Augmentative and alternative communication (AAC) displays support communicative interactions for children who are unable to use spoken language to meet their communication needs. Children who are at the early stages of learning language, often termed beginning or emerging communicators, may rely heavily on the AAC display to support comprehension and expression. Thus, it is important for speech-language pathologists (SLPs) to design a display that facilitates beginning communicators' communication development.

METHODS

This paper reports on the answers related to a specific case study presented in an online survey completed by 77 SLPs with experience in AAC.

RESULTS

Data illustrated design decisions driven by child-specific characteristics and informed by research regarding type of layout, representation, and the importance of various design features.

CONCLUSIONS

Suggestions for future research are provided, including identifying goals and communicative functions best supported by different types of displays, clinicians' challenges/successes growing a system with the child, and determining the importance of symbol arrangement and organisation in communicative tasks by AAC users.Implications for RehabilitationIdentification of current practices reported by speech-language pathologists given a case study to develop and implement future research.A gap between research and practice suggests the need for better dissemination and application of research supporting the inclusion of people engaged in the event depicted in a visual scene display.Foundations for future research to provide guidance regarding best design of and communication goals supported by visual scene displays and grid-based displays.

The Effect of Symbol Background Color on the Speed of Locating Targets by Adults Without Disabilities: Implications for Augmentative and Alternative Communication Display Design

Purpose

Previous research with children with and without disabilities has demonstrated that visual–perceptual factors can influence the speech of locating a target on an array. Adults without disabilities often facilitate the learning and use of a child's augmentative and alternative communication system. The current research examined how the presence of symbol background color influenced the speed with which adults without disabilities located target line drawings in 2 studies.

Method

Both studies used a between-subjects design. In the 1st study, 30 adults (ages 18–29 years) located targets in a 16-symbol array. In the 2nd study, 30 adults (ages 18–34 years) located targets in a 60-symbol array. There were 3 conditions in each study: symbol background color, symbol background white with a black border, and symbol background white with a color border.

Results

In the 1st study, reaction times across groups were not significantly different. In the 2nd study, participants in the symbol background color condition were significantly faster than participants in the other conditions, and participants in the symbol background white with black border were significantly slower than participants in the other conditions.

Conclusion

Communication partners may benefit from the presence of background color, especially when supporting children using displays with many symbols.

Designing effective AAC displays for individuals with developmental or acquired disabilities: State of the science and future research directions

This paper reviews research on the impact of AAC display variables on visual attention and performance of children with developmental disabilities and adults with acquired conditions, and considers implications for designing effective visual scene displays (VSDs) or grids. When using VSDs with children with developmental disabilities or adults with acquired conditions, research supports the use of personalized photo VSDs that include familiar people engaged in meaningful activities, with navigation bars with thumbnail VSDs, located adjacent to the main VSD. Adults with acquired conditions seem to benefit from the inclusion of text boxes adjacent to the scene. Emerging evidence supports the use of motion to capture visual attention to VSDs (video VSDs) or to specific elements in VSDs. When using grid displays with children with developmental disabilities, research supports the use of spatial cues and clustering based on internal symbol colour to facilitate visual searching and selection. Background colour does not seem to facilitate searching for symbols on smaller displays, and may actually distract children from processing the meaningful components of symbols. Preliminary research suggests that the organization of onscreen keyboards and the number, types, and pairings of symbols in grids may impact performance of adults with acquired conditions. Directions for future research are discussed.

Consistent Symbol Location Affects Motor Learning in Preschoolers Without Disabilities: Implications for Designing Augmentative and Alternative Communication Displays

PURPOSE

Designing augmentative and alternative communication (AAC) displays that minimize operational demands is an important aspect of AAC intervention. The current study compared the effect of 2 display designs on the speed of locating target words by preschoolers without disabilities.

METHOD

Across 5 sessions, participants in the consistent condition (n = 12) were asked to locate symbols on arrays that did not change, whereas participants in the variable condition (n = 12) utilized arrays where the symbols changed locations each session.

RESULTS

No difference in response time across conditions was noted during the 1st session; however, by the 5th session, participants in the consistent condition demonstrated significantly faster response times than participants in the variable condition.

CONCLUSIONS

The current study illustrated an advantage of consistent symbol location for preschoolers without disabilities. Clinical applications for incorporating consistent symbol location into AAC display design are discussed; however, replication with children who use AAC is critical.

Putting people first: re-thinking the role of technology in augmentative and alternative communication intervention

Current technologies provide individuals with complex communication needs with a powerful array of communication, information, organization, and social networking options. However, there is the danger that the excitement over these new devices will result in a misplaced focus on the technology, to the neglect of what must be the central focus - the people with complex communication needs who require augmentative and alternative communication (AAC). In order to truly harness the power of technology, rehabilitation and educational professionals must ensure that AAC intervention is driven, not by the devices, but rather by the communication needs of the individual. Furthermore, those involved in AAC research and development activities must ensure that the design of AAC technologies is driven by an understanding of motor, sensory, cognitive, and linguistic processing, in order to minimize learning demands and maximize communication power for individuals with complex communication needs across the life span.

Manual motor-plan similarity affects lexical recall on a speech-generating device: implications for AAC users

Language production via high-tech alternative/augmentative communication (AAC) devices involves use of motor sequences that are determined by the visuo-spatial characteristics of a particular device. The current study uses traditional short-term memory tasks with device-based output to demonstrate that typical talkers show a trend toward device-specific modality interference in short-term device-based recall. The theoretical implications of these early findings with regard to models of working memory and the clinical implications are discussed.

LEARNING OUTCOMES

(1) Describe two modalities of non-phonological short-term storage, (2) List a potential effect of SGD-based output on modality of short-term word storage, (3) Describe a theoretical implication of device-based representations with regard to models of working memory, and (4) Describe a clinical application of the concept of motor memory in AAC.

Predicting language outcomes for children learning augmentative and alternative communication: child and environmental factors

PURPOSE

To investigate a model of language development for nonverbal preschool-age children learning to communicate with augmentative or alternative communication.

METHOD

Ninety-three preschool children with intellectual disabilities were assessed at Time 1, and 82 of these children were assessed 1 year later, at Time 2. The outcome variable was the number of different words the children produced (with speech, sign, or speech-generating devices). Children's intrinsic predictor for language was modeled as a latent variable consisting of cognitive development, comprehension, play, and nonverbal communication complexity. Adult input at school and home, and amount of augmentative or alternative communication instruction, were proposed mediators of vocabulary acquisition.

RESULTS

A confirmatory factor analysis revealed that measures converged as a coherent construct, and a structural equation model indicated that the intrinsic child predictor construct predicted different words children produced. The amount of input received at home, but not at school, was a significant mediator.

CONCLUSIONS

The hypothesized model accurately reflects a latent construct of Intrinsic Symbolic Factor (ISF). Children who evidenced higher initial levels of ISF and more adult input at home produced more words 1 year later. The findings support the need to assess multiple child variables and suggest interventions directed to the indicators of ISF and input.

Perceptual factors influence visual search for meaningful symbols in individuals with intellectual disabilities and Down syndrome or autism spectrum disorders

Augmentative and alternative communication (AAC) systems often supplement oral communication for individuals with intellectual and communication disabilities. Research with preschoolers without disabilities has demonstrated that two visual-perceptual factors influence speed and/or accuracy of finding a target: the internal color and spatial organization of symbols. Twelve participants with Down syndrome and 12 with autism spectrum disorders (ASDs) completed two search tasks. In one, the symbols were clustered by internal color; in the other, the identical symbols had no arrangement cue. Visual search was superior in participants with ASDs compared to those with Down syndrome. In both groups, responses were significantly faster when the symbols were clustered by internal color. Construction of aided AAC displays may benefit from attention to their physical and perceptual features.

What Are the Attention Demands of Aided AAC?

The act of communicating requires the management and use of attention. Communicating using aided Augmentative and Alternative Communication (AAC) may place unique attentional demands because of the length of time it can take to convey a message. From turning on the AAC device to activating the voice output, there are multiple tasks that call upon attention. Reducing the length of time to communicate may reduce the amount of attention required. Using the existing literature base related to display design, we offer considerations for designing the visual display that influence the speed of aided AAC.

Facilitating children's ability to distinguish symbols for emotions: the effects of background color cues and spatial arrangement of symbols on accuracy and speed of search

PURPOSE

Communication about feelings is a core element of human interaction. Aided augmentative and alternative communication systems must therefore include symbols representing these concepts. The symbols must be readily distinguishable in order for users to communicate effectively. However, emotions are represented within most systems by schematic faces in which subtle distinctions are difficult to represent. We examined whether background color cuing and spatial arrangement might help children identify symbols for different emotions.

METHOD

Thirty nondisabled children searched for symbols representing emotions within an 8-choice array. On some trials, a color cue signaled the valence of the emotion (positive vs. negative). Additionally, the symbols were either (a) organized with the negatively valenced symbols at the top and the positive symbols on the bottom of the display or (b) distributed randomly throughout. Dependent variables were accuracy and speed of responses.

RESULTS

The speed with which children could locate a target was significantly faster for displays in which symbols were clustered by valence, but only when the symbols had white backgrounds. Addition of a background color cue did not facilitate responses.

CONCLUSIONS

Rapid search was facilitated by a spatial organization cue, but not by the addition of background color. Further examination of the situations in which color cues may be useful is warranted.