Construction of graphic symbol utterances by children, teenagers, and adults: the effect of structure and task demands

Comparison of Preschooler Verbal and Graphic Symbol Production Across Different Syntactic Structures

The present study focuses on the impact of graphic symbols used in Augmentative and Alternative Communication (AAC) on clause construction. It is not yet well-understood to what extent communication produced via graphic symbols differs from verbal production. This study attempts shed light on the impact of the graphic symbol modality on message construction beyond individual differences, language knowledge, and language-specific patterns by providing a direct comparison between children's verbal and graphic symbol production. Nineteen typically developing Hebrew-speaking children aged 4-5 years were presented with 16 short videos of actions and were asked to express what they saw verbally and by choosing among graphic symbols displayed on an iPad communication board. The 570 clauses produced by the children were coded and analyzed. A significant difference was found in favor of verbal speech across different syntactic structures in terms of utilization of the target lexicon, syntactic complexity, and expected target word order. These results are consistent with the existing literature for English. Implications for AAC practices are discussed, highlighting the notion that using graphic symbols to represent spoken language may not reflect actual linguistic knowledge and that adequate, explicit instruction is necessary for graphic representation of more complex linguistic structures.

Expressive and receptive use of speech and graphic symbols by typically developing children: What skills contribute to performance on structured sentence-level tasks?

PURPOSE

To explore expressive and receptive use of speech and graphic symbols and relationships with linguistic and cognitive skills in children with typical development.

METHOD

Participants were 82 children with typical development (4 to 9 years). Measures of memory, visual analysis skills, and receptive language were used, along with five experimental tasks with speech or symbols as input (stimulus) or output (response), using single clause and compound clause stimuli. Cluster analysis grouped participants with similar performances patterns, who were then compared on linguistic and cognitive skill measures.

RESULT

The lowest performing group sometimes accurately interpreted graphic symbol utterances that were visible during responding. The mid-performing group was stronger on expressive than receptive symbol utterances when the model did not remain visible. The highest group was comparable on expressive and receptive symbol tasks, but nonetheless stronger with spoken utterances. Relationships of linguistic and cognitive skills with task performance differed across the clusters.

CONCLUSION

The findings help clarify the input-output modality asymmetry in graphic symbol communication. Spoken language proficiency does not directly transfer to sentence-level expressive and receptive graphic symbol use. Exploring potentially challenging sentence-level phenomena is important. Research is warranted to explore developmental progressions and potential clinical applications more systematically.

Language Differentiation Using Augmentative and Alternative Communication: An Investigation of Spanish-English Bilingual Children With and Without Language Impairments

Purpose Children with severe speech and language impairments growing up in dual language environments may communicate in more than one language using augmentative and alternative communication (AAC). This study investigated predictors of bilingual children's ability to differentiate between Spanish and English using an AAC iPad app during a cued language-switching task and examined whether switching between languages using AAC incurred a cognitive cost. Method Participants were 58 Spanish-English bilingual children ages 4;0-6;11 (years;months; 23 with language impairments). Children received standardized language and cognitive assessments and completed an experimental language-switching task in which they were asked to differentiate between languages using an AAC iPad app containing English and Spanish vocabulary layouts paired with voice output. Results Results of a binary logistic regression indicated that, when controlling for age, processing speed significantly predicted whether children were classified as high or low performers on the experimental task. Nonparametric tests indicated that switching between languages did not incur a cognitive cost as evidenced by similar response times on trials where participants were required to switch between languages compared to trials where they did not switch. Conclusion This study contributes to the understanding of how young bilingual children with and without language impairments conceptualize and discriminate between languages represented in a visual-graphic modality paired with speech output. Supplemental Material https://doi.org/10.23641/asha.13289330.

The emergence of clause construction in children who use speech generating devices

This study aimed to detect patterns in clause construction structural changes produced by four participants aged 9;5-13;7 (years;months) with motor speech disorders who used speech-generating devices. Sequences of adult-child interactions, drawn from the data of a larger study focused on enhancing vocabulary and grammar skills, were examined. This current study comprises a secondary analysis of a corpus of 29 conversations totalling 808.36 min, analysing clause structures by type, linguistic complexity, and intensity of adult prompts (number of turns). Results show that, over time, the participants' clause structure complexity increased through addition of phrase-internal elements such as inflections, articles, and prepositions. Use of specific grammatical elements followed the developmental stages observed in children with typical development. For all participants, the personal pronoun I (first-person singular) emerged before she, he (third-person singular), and we or they (plural). Participants with the highest number of adult-child co-constructed clauses also had the highest number of well-formed clauses. The intensity of adult prompts increased as clause structures became more complex and as participants needed more support. Implications for practice and theory are discussed.

Error patterns and revisions in the graphic symbol utterances of 3- and 4-year-old children who need augmentative and alternative communication

The purpose of this study was to explore the errors and revisions (i.e., repairs) that 3- and 4-year-old children who require augmentative and alternative communication (AAC) make as they construct 2-3-word utterances using graphic symbols. The current study involves supplemental analyses from a previously published manuscript. Various types of errors and revisions for four different semantic-syntactic structures-agent-action-object, entity-attribute, entity-locative, and possessor-entity-were analysed to explore patterns and differences across utterance types. Results indicated that the majority of errors were made during the baseline phase, and that error types varied depending on the utterance type. For example, inversions were common for agent-action-object utterances, but omissions were common for entity-attribute utterances. When the participants revised their utterances, the resulting messages were more accurate the majority of the time, regardless of utterance type. Past research has highlighted frequent word order errors within graphic symbol messages, but the current results indicate that error types are dependent upon utterance type. A more refined approach, then, is required to better our understanding of how children approach the task of learning to produce graphic symbol utterances.

Early Sentence Productions of 3- and 4-Year-Old Children Who Use Augmentative and Alternative Communication

Purpose

This study investigated the early rule-based sentence productions of 3- and 4-year-old children with severe speech disorders who used single-meaning graphic symbols to communicate.

Method

Ten 3- and 4-year-olds requiring the use of augmentative and alternative communication, who had largely intact receptive language skills, received instruction in producing up to four different semantic-syntactic targets using an Apple iPad with a communication app. A single-case, multiple-probe, across-targets design was used to assess the progress of each participant and target. Generalization to new vocabulary was assessed, and a subgroup also was taught to produce sentences using grammatical markers.

Results

Some targets (primarily possessor-entity) were mastered in the baseline phase, and the majority of the remaining targets were mastered during intervention. All four children who completed intervention for grammatical markers quickly learned to use the markers accurately.

Conclusions

Expressive language potential for preschoolers using graphic symbol-based augmentative and alternative communication systems should not be underestimated. With appropriate presentation and intervention techniques, some preschoolers with profound speech disorders can readily learn to produce rule-based messages via graphic symbols.

Exploring validation of a graphic symbol questionnaire to measure participation experiences of youth in activity settings

Participation has a subjective and private dimension, and so it is important to hear directly from youth about their experiences in various activity settings, the places where they "do things" and interact with others. To meet this need, our team developed the Self-Reported Experiences of Activity Settings (SEAS) measure, which demonstrated good-to-excellent measurement properties. To address the needs of youth who could benefit from graphic symbol support, the SEAS-PCS^TM, ¹ was created. The purpose of this paper is to describe the development of SEAS-PCS and the preliminary study that explores the equivalency of the SEAS and SEAS-PCS. The SEAS and SEAS-PCS were compared in terms of the equivalency of meaning of stimulus items by 11 professionals and five adults who used augmentative and alternative communication, were familiar with PCS, and were fluent readers. Out of 22 items, 68% were rated as highly similar on a 5-point scale (M = 4.14; SD = .70; mdn = 4; range: 2.81-5.00). Subsequently, the 32% of the SEAS-PCS items that were rated below 4 were modified based on the participants' specific comments. Further work is required to validate the SEAS-PCS. The next step could involve exploring the views of youth who use AAC.

Teaching children who use augmentative and alternative communication to ask inverted yes/no questions using aided modeling

PURPOSE

This study investigated the effects of a direct intervention program involving aided modeling and the presentation of contrastive targets on the aided production of inverted yes/no questions and possible generalization to other sentence types by children using augmentative and alternative communication (AAC).

METHOD

A single-case, multiple-probe, experimental design across participants was used to evaluate the effects of the instructional program with 3 children who had motor speech disorders and used AAC (ages 4;10 [years;months], 6;2, and 4;9). The treatment involved aided modeling of treatment and contrastive targets through concentrated modeling and interactive play activities. Direct treatment outcomes were examined by measuring the accuracy of producing inverted yes/no questions and to be declaratives through probes.

RESULTS

All 3 participants showed a direct treatment effect, producing a greater number of inverted yes/no questions and to be declaratives within the probes following treatment compared with before treatment. All 3 participants evidenced some generalization to novel sentences.

CONCLUSIONS

Results provide initial evidence that instruction involving aided modeling with contrastive targets holds promise in targeting specific linguistic rules with children using AAC. Patterns of generalization may depend on participants' specific language deficits and acquisition patterns during intervention.

Using dynamic assessment to evaluate the expressive syntax of children who use augmentative and alternative communication

The developmental readiness of four 5-year-old children to produce basic sentences using graphic symbols on an augmentative and alternative communication (AAC) device during a dynamic assessment (DA) task was examined. Additionally, the ability of the DA task to predict performance on a subsequent experimental task was evaluated. A graduated prompting framework was used during DA. Measures included amount of support required to produce the targets, modifiability (change in participant performance) within a DA session, and predictive validity of DA. Participants accurately produced target structures with varying amounts of support. Modifiability within DA sessions was evident for some participants, and partial support was provided for the measures of predictive validity. These initial results indicate that DA may be a viable way to measure young children's developmental readiness to learn how to sequence simple, rule-based messages via aided AAC.

Teaching graphic symbol combinations to children with limited speech during shared story reading

The aim of this study was to determine the effect of an intervention strategy on the production of graphic symbol combinations in children with limited speech. Four children between the ages of 6;5 and 10;8 (years;months) with limited speech participated in the study. A single-subject, multiple probe design across three different types of semantic relations was used. Generalization to untrained exemplars was also monitored. Results were mixed across the four participants: two participants learned to combine symbols across different types of relations, maintained these skills post intervention, and generalized their skills to untrained combinations; and two participants showed less consistent evidence of learning. The effects, as measured during structured probes, were strong for one participant, moderate for another, and inconclusive for the two others. Responses during shared story reading suggested that the measurement probes might have underestimated participants' ability to combine symbols.

Using aided AAC models, recasts, and contrastive targets to teach grammatical morphemes to children who use AAC

PURPOSE

The purpose of the investigation was to evaluate the effects of using aided augmentative and alternative communication (AAC) modeling and recasting on the expression of grammatical morphemes with children who used AAC.

METHOD

A single-subject, multiple-probe, across-targets design was used for the study. Three participants were each taught to use 3 grammatical structures. Intervention consisted of aided AAC models and recasts during storybook reading tasks.

RESULTS

All three children readily began using the targeted grammatical morphemes. However, none of the participants maintained use of the first morpheme. Error analyses revealed that the children either omitted the targeted morpheme or replaced it with another morpheme. To address this issue, a second intervention phase was implemented for the targets that were not maintained. During this phase, various grammatical morphemes were contrasted with each other (e.g., past tense -ed vs. possessive 's). Following the second intervention phase, participants maintained all targets.

CONCLUSIONS

Aided AAC models and recasts may be used as part of intervention packages designed to help children acquire production of grammatical morphemes; however, it is important to provide contrasts of grammatical forms to ensure acquisition. Theoretical and clinical implications are discussed.

Preschool-aged children have difficulty constructing and interpreting simple utterances composed of graphic symbols

Children who require augmentative and alternative communication (AAC) systems while they are in the process of acquiring language face unique challenges because they use graphic symbols for communication. In contrast to the situation of typically developing children, they use different modalities for comprehension (auditory) and expression (visual). This study explored the ability of three- and four-year-old children without disabilities to perform tasks involving sequences of graphic symbols. Thirty participants were asked to transpose spoken simple sentences into graphic symbols by selecting individual symbols corresponding to the spoken words, and to interpret graphic symbol utterances by selecting one of four photographs corresponding to a sequence of three graphic symbols. The results showed that these were not simple tasks for the participants, and few of them performed in the expected manner - only one in transposition, and only one-third of participants in interpretation. Individual response strategies in some cases lead to contrasting response patterns. Children at this age level have not yet developed the skills required to deal with graphic symbols even though they have mastered the corresponding spoken language structures.

Thoughts on Grammar Intervention in AAC

In this article, I propose that, for several reasons, grammar should be an early focus of communication interventions for young children using augmentative and alternative communication (AAC) systems. The basic goals for such programs should be to facilitate the child's comprehension of the language of the community, or the target language, thus leading the way to literacy, and to foster the child's use of symbol combinations that mirror the grammatical patterns of speaking children acquiring the target language, even if they cannot be fully grammatically complete. I introduce five principles that underlie most successful approaches to grammar interventions with children with specific language impairment. My initial attempts to apply these principles to interventions with children with complex communication needs indicate that they may be of considerable value to clinicians planning intervention programs. On the other hand, the challenges posed by the intellectual and physical limitations of many AAC users and their communication systems make it necessary to modify at least Principle 5 if the basic goals of intervention are to be met.