Selecting graphic symbols for an initial request lexicon: integrative review

Environmental factors contributing to using spelling in communication: Perceptions of literate aided communicators

The aim of this interpretive qualitative study was to explore how environmental factors influence the transition from relying solely on graphic symbols to using spelling in face-to-face communicative interactions, from the perspective of literate adults with speech and motor impairments who use augmentative and alternative communication (AAC). Fourteen adults either chose to submit a written story with weekly email follow-up, took part in interviews conducted via Zoom1, or chose to communicate solely by email. Researchers analyzed data using Charmaz's (2014) constructivist grounded theory approach. The analysis yielded three themes explaining environmental factors relevant to the transition from using graphic symbols to spelling in communication: (a) access to AAC systems and services; (b) knowledgeable and supportive communication partners who have high expectations; and (c) opportunities to learn reading, writing, and spelling. Supportive factors included providing sufficient time for spelling in communicative interactions, structured learning opportunities for practice and independence, opportunities to learn through socially meaningful interactions and having print-rich and language-rich activity settings. Slow speed in navigating graphic symbols and lack of ability to express an exact message were motivational reasons for participants to use spelling in communicative interactions. The interaction among environmental factors and person-related characteristics warrants further investigation.

The Effects of Symbol Format and Psycholinguistic Features on Receptive Syntax Outcomes of Children Without Disability

PURPOSE

The graphic symbol is the foundation of augmentative and alternative communication (AAC) for many preliterate individuals; however, research has focused primarily on static graphic symbol sequences despite mainstream commercial technologies such as animation. The goal of this study was to compare static and animated symbol sequences across receptive communication outcome measures and psycholinguistic features (e.g., word frequency).

METHOD

A counterbalanced, 2 × 2 × 2 mixed design was used to investigate the effects of symbol format (animated and static), first condition (animated or static), and first experimental task (identification or labeling) on identification accuracy and labeling accuracy of graphic symbol sequences (five symbols) in 24 children with typical development ages 7 and 8 years old. Additionally, three 2 × 2 repeated-measures analyses of variance were conducted using symbol format (animated and static) and (a) word frequency (low, high), (b) imageability (low, high), and (c) concreteness (low, high).

RESULTS

In addition to superior identification and labeling accuracy of animated sequences, a significant interaction between symbol format and the first condition was observed for both experimental tasks. When the animation format was the first condition, then the children's performance improved in the subsequent static condition. Finally, word frequency, imageability, and concreteness ratings for all verbs and prepositions had significant effects on labeling accuracy of verbs and prepositions. Significant interactions between symbol format and psycholinguistic features were also found. For example, highly imageable, animated verbs were labeled with greater accuracy when compared with all other variables.

CONCLUSIONS

Animation technology appears to alleviate some of the burden associated with word- and sentence-level outcomes in children with typical development. Moreover, animation appears to reduce the effects of psycholinguistic features such as word frequency and imageability by increasing the transparency of the symbol. Given the increase in research in this area, speech-language pathologists may consider adopting animated graphic symbols on a case-by-case basis as a tool to augment the learning of word classes in which movement is integral to comprehension.

Effects of a Systematic Augmentative and Alternative Communication Intervention Using a Speech-Generating Device on Multistep Requesting and Generic Small Talk for Children With Severe Autism Spectrum Disorder

Purpose The purpose of this study was to determine the effects of augmentative and alternative communication (AAC) intervention using a speech-generating device (SGD) on acquisition, maintenance, and generalization of multistep requesting and generic small talk in three children with severe autism spectrum disorder (ASD) between the ages of 7 and 13 years. Method A multiple-baseline design across participants combined with a posttreatment multiple-generalization-probe design was used to assess acquisition, generalization, and maintenance of target communicative behaviors with the experimenter and the participants' familiar communication partners (FCPs). Intervention was composed of systematic instruction in the use of an SGD using least-to-most prompting, constant time delay, error correction, and reinforcement. Results Visual analysis established a strong functional relationship between the independent variable and the two dependent variables (i.e., requesting preferred activities, engaging in generic small talk) for all three participants. Effect size indicator analyses corroborated these findings, indicating strong effects for performing multistep requesting and medium effects for engaging in generic small talk. All participants were able to generalize the acquired communicative behaviors to request new and untrained snacks and activities and engage in generic small talk with FCPs who were not part of the training. Maintenance of acquired communicative behaviors was demonstrated 3 weeks post completion of intervention. Conclusion This study provides preliminary evidence that AAC intervention using an SGD and incorporating least-to-most prompting, constant time delay, error correction, and reinforcement is effective in terms of multistep requesting and generic small talk behaviors in children with severe ASD. Supplemental Material https://doi.org/10.23641/asha.16663630.

A parent-implemented embedded AAC intervention for teaching navigational requests and other communicative functions to children with Autism spectrum disorder

This study evaluated the effectiveness of an embedded naturalistic intervention for teaching augmentative and alternative communication (AAC) application responses to three preschool-aged males with autism spectrum disorder (ASD). Parents were taught to embed opportunities for their child to communicate with a grid-based AAC application during every-day routines such as play or mealtime. Communication targets included requesting objects using two-step taxonomic navigational responses, and requesting assistance, rejecting items, or making social comments/responses using a two-step message-strip response. During intervention, parents used strategies such as time delay, prompting, reinforcement, and device proximity (faded over time) to encourage target responses. Display formats and intervention targets were selected in consideration of prior dynamic assessment results. Effects of intervention were evaluated using a multiple probe across participants design. For functional navigational AAC item requesting, all three participants showed an immediate increase in responding that maintained at high levels. Functional AAC responding for other communicative purposes also increased, but at a more gradual pace. All three participants showed generalized responding when new items were added to displays, and when display pages with a larger array of folders and vocabulary items were introduced. Generalization to labeling tasks was mixed.

The effect of cue type on directive-following in children with moderate to severe autism spectrum disorder

For this study, 11 children with moderate to severe autism spectrum disorder (ASD) were given directives containing prepositions in three cue conditions: (a) spoken alone, (b) a short video clip along with spoken cues, and (c) a sequence of three graphic symbols accompanied by spoken cues. Participants followed directives significantly more accurately with the video clip than with spoken cues only, and significantly more accurately with spoken cues only relative to the sequence of graphic symbols. Results suggest that the short video clip along with spoken cues may be an optimal mode for enhancing learners' ability to follow directives containing prepositions. In addition, results reveal three statistically significant correlations between participants' preexisting skills and directive-following accuracy: a positive correlation between spoken preposition preassessment total score and accuracy in the spoken-alone condition; a positive correlation between spoken noun preassessment total score and accuracy in the video-clip condition; and a positive correlation between ASD severity and the need for repetition in the video-clip condition. Results also suggested that, for children with more severe ASD symptoms, the video clips require repetitions so that the relationships illustrated within it can gain more semantic salience. Implications for clinical practice and future research are discussed.

Naturalistic teaching approach to develop spontaneous vocalizations and augmented communication in children with autism spectrum disorder

Naturalistic developmental behavioral interventions (NDBI) have been shown to facilitate the development of spontaneous language in individuals with speech and language impairment. Several meta-analyses have reported a small number of studies that utilized naturalistic teaching approaches combined with augmentative and alternative communication (AAC) interventions to develop requesting skills in individuals with autism spectrum disorder (ASD). Therefore, the main purpose of this study was to determine whether a natural language paradigm (NLP) and time delay is effective in expanding vocal and augmented requesting skills in three children with ASD between the ages of 4 and 6 years. A concurrent multiple baseline design across participants was used to evaluate the effectiveness of the intervention. The results of the study demonstrated that the participants were successful in emitting vocal requests when both modalities were available and NLP combined with time delay was effective in increasing spontaneous vocal requests in all participants.

A Dental Communication Board as an Oral Care Tool for Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) sometimes display an inability for information sharing through functional verbal communication. This may interfere with professional oral care. These children tend to process visual information more efficiently than auditory information. Picture schedules can briefly suffice as visual cues serving a vital function in helping children with ASD to function in a particular setting such as an oral care environment. A visual communication implement such as a dental communication board was developed in this study to allow for a facilitated communication process between the patient with ASD and the oral care professional. This study entailed two main phases, namely the selection of symbols for the construction of a dental communication board and the small scale testing of the board in a clinical setting. This study incorporated a combination of a quantitative non-experimental descriptive survey combined with a concurrent mixed method survey design which retrieved data for both close-ended and open-ended questions from the same respondent. A quantitative survey questionnaire at a structured dental seminar presentation was employed for the first phase, and a combination of a quantitative and qualitative questionnaire was employed for the second phase of this study. Documented responses were collated and analyzed using frequency and thematic analysis. The most frequently selected symbols were retrieved after a frequency analysis and displayed on a color coded background to distinguish the various categories on the dental communication board. The thematic analysis resulted in the emergence of three main themes, namely the strengths of the board; weakness of the board and suggestions. This study anticipates the incorporation of a dental communication board as a visual mode using graphic symbols to augment expressive and receptive language in an oral care environment to facilitate professional oral care for children with ASD.

Exploring AAC graphic symbol choices: a preliminary study

Purpose

Graphic symbols have been used widely in the field of augmentative and alternative communication (AAC). The advancement of technology in recent years has stimulated their development even further, thereby providing speech-language pathologists (SLPs) a wide range of options to choose for the individuals they support. However, existing literature on graphic symbols is scant and clinicians must base their decisions almost solely on clinical judgment. This paper aims to investigate the factors SLPs consider when choosing corpuses of graphic symbols for their clients.

Design/methodology/approach

An online survey was used that allowed multiple-choice responses. Data were analyzed and presented primarily as percentages.

Findings

Most respondents used graphic symbols with people having developmental disorders, and the corpuses of symbols they drew upon were based predominantly on availability, characteristics of the individual’s impairment or disability and intelligibility to the user and his or her communication partners. Existing policies related to graphic symbols also influence clinicians’ choices. SLPs search for support mainly from professional associations and training providers. In terms of use with technology, ready-made symbol packages for clinicians to use were found to be attractive.

Practical implications

Professional associations and institutions that focus on AAC need to provide adequate support to clinicians with a foundation based on evidence-based practice.

Originality/value

To the best of the authors’ knowledge, this is the first research that focuses on current practices concerning the factors SLPs take into consideration when choosing the optimum graphic symbol corpus(es) for their clients.

Tracking Early Sentence-Building Progress in Graphic Symbol Communication

Purpose As is the case with children who rely on spoken language, speech-language pathologists must support and track the expressive language development of children with complex communication needs who use graphic symbols to communicate. This research note presents a framework of the progression of expressive English sentence development using graphic symbols and introduces possible approaches for measuring and analyzing graphic symbol use. Method Current issues in measuring graphic symbol utterances are explored, and a range of measures designed to analyze individual graphic symbol utterances as well as larger samples of utterances are presented. Results Both the Graphic Symbol Utterance and Sentence Development Framework and suggested measures are based on years of graphic symbol intervention research, including two large ongoing research studies of preschoolers with severe speech impairments. Our framework adapts the work of Hadley (2014) to depict expressive language progression from early symbol combinations to childlike and adultlike sentences and highlights developmental patterns unique to graphic symbol productions. Adaptations of existing measures (such as mean length of utterance) as well as measures unique to graphic symbol analyses are presented and discussed. Conclusion To accurately track changes in early graphic symbol utterance growth and complexity, a multidimensional approach, which includes analyses such as symbol relevance, word class diversity, and lexical diversity, is recommended.

Framework for Selecting Vocabulary for Preliterate Children Who Use Augmentative and Alternative Communication

Purpose Nearly 50% of school-based speech-language pathologists (SLPs) provide services to school-age children who use augmentative and alternative communication (AAC). However, many SLPs report having insufficient knowledge in the area of AAC implementation. The objective of this tutorial is to provide clinicians with a framework for supporting 1 area of AAC implementation: vocabulary selection for preliterate children who use AAC. Method This tutorial focuses on 4 variables that clinicians should consider when selecting vocabulary: (a) contexts/environments where the vocabulary can be used, (b) time span during which the vocabulary will be relevant, (c) whether the vocabulary can elicit and maintain interactions with other people, and (d) whether the vocabulary will facilitate developmentally appropriate grammatical structures. This tutorial focuses on the role that these variables play in language development in verbal children with typical development, verbal children with language impairment, and nonverbal children who use AAC. Results Use of the 4 variables highlighted above may help practicing SLPs select vocabulary that will best facilitate language acquisition in preliterate children who use AAC.

Identification and Expression of Themes Depicted in Visual Scene and Grid Displays by Adults With Traumatic Brain Injury

Purpose The study purpose was to compare the speed and accuracy with which people with traumatic brain injury (TBI) identified themes depicted in visual scene and grid displays. Additionally, we compared the verbal responses associated with the 2 display types to determine whether adults with TBI tended to produce more action or naming messages. Method Thirteen adults with and 13 without TBI viewed grid and visual scene displays matched for content and theme. They then provided verbal responses stating the theme or central idea of each image. Results Although no significant differences were noted between groups for theme identification accuracy, adults with TBI required significantly more time than adults without TBI to process both display types. Both participant groups more rapidly and accurately identified visual scenes than grid displays. Additionally, participants with and without TBI produced more action messages in response to visual scenes and naming messages in response to grid displays. Conclusions This investigation provides preliminary evidence that themes that depicted visual scenes maybe more rapidly and accurately identified than those depicted in grid displays. Additionally, visual scenes may more effectively represent action messages, and grids may more effectively represent naming messages for people with TBI.

Does Animation Facilitate Understanding of Graphic Symbols Representing Verbs in Children With Autism Spectrum Disorder?

Purpose The effects of animation on identification of graphic symbols for verbs were studied using the Autism Language Program Graphic Symbols Set in children diagnosed with mild-to-severe autism spectrum disorder between the ages of 3 and 7 years. Method The participants were randomly assigned to an animated symbol condition or a static symbol condition. Static symbols were spliced from the animated symbols to ensure that the symbols differed only in terms of the absence or presence of movement. The participants were asked to identify a target symbol among foils given the spoken label. Results There were no significant differences between the groups with respect to chronological age, autism severity, and receptive target verb knowledge. An independent t test revealed that animated symbols were more readily identified than static symbols. Conclusions Animation enhances the identification of verbs in children with autism spectrum disorder. Clinicians are encouraged to take advantage of animation when introducing graphic symbols representing verbs. Limitations and implications for future research are discussed.

Visual-graphic symbol acquisition in school age children with developmental and language delays

Augmented language systems have become both an integral component of communication intervention programs for children with severe communicative impairments and spurred research on their language and communication development. This study examined intrinsic and extrinsic factors that may influence the language development process for children with developmental disabilities, by exploring the relationship between varying degrees of symbol arbitrariness and extant speech comprehension skills in the discrimination, learning, and use of symbols for communication. For the study, 13 school-aged participants (M = 8.24 [years; months]), with both developmental and language delays, were provided experience with iconic Blissymbols and an arbitrary symbol set of lexigrams via observational computerized experience sessions. There was a modest difference in their ability to learn arbitrary versus iconic symbols. There were no differences if the vocabulary item was unknown prior to the symbol learning experience. These findings suggest that iconicity of a symbol may not be a critical factor in learning a symbol-referent relationship if a target referent is not yet known in comprehension.

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.

Promoting Conditional Use of Communication Skills for Learners With Complex Communication Needs: A Tutorial

PURPOSE

Conditional use of communication skills refers to the ability of a learner to appropriately generalize and discriminate when, where, and how to communicate based on constant variation and shifts in environmental cues.

METHOD

We describe discrimination and generalization challenges encountered by learners with complex communication needs and ways in which these challenges are fostered through traditional communication intervention programming. We address arrangements in instruction that maximize the probability of learners acquiring the conditional use of new vocabulary and the modest instructional technology implemented when planning for generalization.

RESULTS

We propose establishing well-discriminated and generalized use of new vocabulary items through the application of a general case instruction framework to communication intervention programming.

CONCLUSION

We provide intervention methodology, including intervention steps for general case instruction, a plethora of functional examples, and graphic displays to assess and intervene to promote conditional use of communication skills for learners with complex communication needs.

Using Images With Individuals With Aphasia: Current Research and Clinical Trends

PURPOSE

Visuographic supports in the form of images are utilized during assessment and treatment for individuals with aphasia to supplement speech, language, and cognitive losses limiting communication. Clinicians rely on prior experience and intuition to make decisions regarding image-based support design and selection (e.g., augmentative and alternative communication strategies). Researchers have begun to focus on the relationship between the images and the benefits they provide for adults with aphasia.

METHOD

The aim of this review-resulting from a roundtable discussion at the 2016 Clinical Aphasiology Conference-was to disseminate summaries of current and past researches regarding image use by individuals with aphasia and to highlight areas of need within research and practice.

RESULTS

Review of the literature illuminated 4 major themes: (a) image creation, capture, and sharing; (b) image characteristics; (c) image use across linguistic domains and contexts; and (d) implications for clinical and research practices.

CONCLUSIONS

Reviewing current knowledge and practice regarding the use of visual supports for individuals with aphasia is essential to advancing therapeutic practices and providing evidence-based protocols for creating, selecting, and implementing images within augmentative and alternative communication strategies. Several gaps in knowledge were identified as future research needs (e.g., caregiver training and enhanced image feature investigation).

Exploring professionals’ experiences when choosing graphic symbol sets

Purpose

The ongoing development of new graphic symbol sets in conjunction with a lack of literature supporting professionals in choosing the optimum set(s) for their users was the driving force behind this research project. The purpose of this paper is to explore the factors that professionals take into consideration when they choose one graphic symbol set instead of another.

Design/methodology/approach

Based on the phenomenology of pedagogy, semi-structured interviews were used with three speech and language therapists (SLTs), three special education teachers, one teacher for pupils with hearing loss, one foundation year teacher and one SENCo/deputy head teacher. Thematic analysis was used to process the data.

Findings

The results have shown that when professionals choose a graphic symbol set for their user(s), they focus on the iconicity, the software availability and its features. They are also influenced by any existing graphic symbol policies in the area they work. Training and follow-up support also influence professionals’ experiences when choosing graphic symbol sets for their users.

Practical implications

Given the limited literature pertaining to the topic of this paper, it is proposed that further research is conducted in order to build the theoretical and practical frameworks upon which professionals (such as SLTs and teachers), symbols developers and academics can base their future work.

Originality/value

This research aims to contribute to the scant literature regarding the factors that SLTs take into consideration when choosing a graphic symbol set for their user(s).

Effect of Message Type on the Visual Attention of Adults With Traumatic Brain Injury

PURPOSE

The purpose of this investigation was to measure the effect of message type (i.e., action, naming) on the visual attention patterns of individuals with and without traumatic brain injury (TBI) when viewing grids composed of 3 types of images (i.e., icons, decontextualized photographs, and contextualized photographs).

METHOD

Fourteen adults with TBI and 14 without TBI-assigned either to an action or naming message condition-viewed grids composed of 3 different image types. Participants' task was to select/sustain visual fixation on the image they felt best represented a stated message (i.e., action or naming).

RESULTS

With final fixation location serving as a proxy for selection, participants in the naming message condition selected decontextualized photographs significantly more often than the other 2 image types. Participants in the action message condition selected contextualized photographs significantly more frequently than the other 2 image types. Minimal differences were noted between participant groups.

CONCLUSIONS

This investigation provides preliminary evidence of the relationship between image and message type. Clinicians involved in the selection of images used for message representation should consider the message being represented when designing supports for people with TBI. Further research is necessary to fully understand the relationship between images and message type.

Effects of animation on naming and identification across two graphic symbol sets representing verbs and prepositions

PURPOSE

The effects of animation on naming and identification of graphic symbols for verbs and prepositions were studied in 2 graphic symbol sets in preschoolers.

METHOD

Using a 2 × 2 × 2 × 3 completely randomized block design, preschoolers across three age groups were randomly assigned to combinations of symbol set (Autism Language Program [ALP] Animated Graphics or Picture Communication Symbols [PCS]), symbol format (animated or static), and word class (verbs or prepositions). Children were asked to name symbols and to identify a target symbol from an array given the spoken label.

RESULTS

Animated symbols were more readily named than static symbols, although this was more pronounced for verbs than for prepositions. ALP symbols were named more accurately than PCS in particular with prepositions. Animation did not facilitate identification. ALP symbols for prepositions were identified better than PCS, but there was no difference for verbs. Finally, older children guessed and identified symbols more effectively than younger children.

CONCLUSIONS

Animation improves the naming of graphic symbols for verbs. For prepositions, ALP symbols are named more accurately and are more readily identifiable than PCS. Naming and identifying symbols are learned skills that develop over time. Limitations and future research directions are discussed.

Adults' preferences between Picture Communication Symbols (PCSs) and Gus Communication Symbols (GCSs) used in AAC

The purpose of the study was to determine whether significantly different preference exists in typical adults between Picture Communication Symbols (PCSs) and Gus Communication Symbols (GCSs) frequently displayed on their AAC. A total of 56 participants participated in the study, including 15 participants in ages 20-35; 14 participants in ages 36-50; 13 participants in ages 51-60; and 14 participants in ages 66-80. Two tasks, an identification task and a preference task, were administered sequentially and individually. The results of this study suggest: (1) typical adults' preference between PCSs and GCSs did not show any significant difference; (2) the effect of age groups of typical adults did not have any significant effect on their preference between PCSs and GCSs. However, except the group of ages 51-65, the other three groups did consciously show their preferences for PCSs. Limitations and clinical implications of the current study have been concluded.

Animation of graphic symbols representing verbs and prepositions: effects on transparency, name agreement, and identification

PURPOSE

The effects of animation on transparency, name agreement, and identification of graphic symbols for verbs and prepositions were evaluated in preschoolers of 3 age groups. Methods A mixed-group design was used; in each age group, half of the children were randomly allocated to 1 of 2 orders of symbol formats. The 52 children were asked to guess the meaning of symbols and to identify a target symbol among foils given the spoken label.

RESULTS

Animated symbols were more transparent than static symbols, although this was more pronounced for verbs. Animated verbs were named more accurately than static verbs, but there was no difference between animated and static prepositions. Verbs were identified more accurately compared with prepositions, but there was no difference between symbol formats. Older children guessed, named, and identified symbols more effectively than younger children.

CONCLUSION

Animation enhances transparency and name agreement, especially for verbs, which reduces the instructional burden that comes with nontransparent symbols. Animation does not enhance identification accuracy. Verbs are easier to identify than prepositions. A developmental effect was observed for each measure. Limitations and implications for future research are discussed.

Effect of translucency on transparency and symbol learning for children with and without cerebral palsy

Based on the concept of iconicity, the iconicity hypothesis was emphasized for decades. The aims of this study were to explore the effect of translucency on transparency and symbol learning for children with and without cerebral palsy. Twenty children with cerebral palsy and forty typical peers participated in the study. Ten symbols with high translucency and ten with low translucency were used as experimental material. The results of transparency testing demonstrated the positive relationship between translucency and transparency. The effect of translucency on symbol learning was supported partially, all children with and without CP could learn the low translucent symbols only after two teaching sessions, or three sessions at most. The authors also provided some suggestions for further study based the results of this study.

Use of a Visual Graphic Language System to Support Communication for Persons on the Autism Spectrum

This paper addresses use of visual graphic language to promote learning and communication for individuals on the autism spectrum via a comprehensive framework. Specifically, visuals are used expressively (Visual Expressive Mode), receptively (Visual Instructional Mode), and to provide organization and structure (Visual Organizational Mode). Seven key communicative functions are defined and discussed, including protesting and refusal, organization and transitions, requests, directives, comments, questions, and social pragmatics. The nature of visual supports for each communicative function is described in detail.

Effects of it takes two to talk--the hanen program for parents of preschool children with cerebral palsy: findings from an exploratory study

PURPOSE

To investigate whether It Takes Two to Talk-The Hanen Program for Parents of Preschool Children With Cerebral Palsy is associated with change in interaction between children who have motor disorders and their parents.

METHOD

Eleven children aged 19-36 months who had nonprogressive motor disorders that affected their communication, and their mothers, were observed 4 months and 1 month before mothers attended It Takes Two to Talk training, and 1 month and 4 months after its completion.

RESULTS

Interaction patterns were stable prior to training. After training, mothers initiated less and produced more responses and fewer requests. Children produced more initiations, as well as more requests and provisions of information, after training. Mothers' linguistic input did not change in amount or complexity. Changes were maintained 4 months later. Mothers' views of parenting did not change.

CONCLUSIONS

It Takes Two to Talk may be associated with positive communication change for this group. Further investigation of its clinical effectiveness is warranted.

Concomitant use of the matrix strategy and the mand-model procedure in teaching graphic symbol combinations

Matrix strategies employing parts of speech arranged in systematic language matrices and milieu language teaching strategies have been successfully used to teach word combining skills to children who have cognitive disabilities and some functional speech. The present study investigated the acquisition and generalized production of two-term semantic relationships in a new population using new types of symbols. Three children with cognitive disabilities and little or no functional speech were taught to combine graphic symbols. The matrix strategy and the mand-model procedure were used concomitantly as intervention procedures. A multiple probe design across sets of action-object combinations with generalization probes of untrained combinations was used to teach the production of graphic symbol combinations. Results indicated that two of the three children learned the early syntactic-semantic rule of combining action-object symbols and demonstrated generalization to untrained action-object combinations and generalization across trainers. The results and future directions for research 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.

Augmentative and alternative communication interventions for persons with developmental disabilities: narrative review of comparative single-subject experimental studies

Augmentative and alternative communication (AAC) as an area of clinical and educational practice involves a myriad of decisions related to the symbols, devices, and strategies from which each client must choose. These decision-making points can be productively informed through evidence from comparative intervention studies. The purpose of this review was to synthesize comparative AAC intervention studies using single-subject experimental designs involving participants with developmental disabilities. Following a systematic search, each qualifying study was reviewed in terms of a priori determined appraisal criteria, and summarized in tabular format. Studies were divided into three groups according to their study of aided approaches, unaided approaches, or a combination of both. Results are discussed in terms of methodological adequacy of the studies and their implications for future research and practice.

Meaning matters: a clinician's/student's guide to general sign theory and its applicability in clinical settings

The pragmatic mapping process and its variants have proven effective in second language learning and teaching. The goal of this paper is to show that the same process applies in teaching and intervention with disordered populations. A secondary goal, ultimately more important, is to give clinicians, teachers, and other educators a tool-kit, or a framework, from which they can evaluate and implement interventions. What is offered is an introduction to a general theory of signs and some examples of how it can be applied in treating communication disorders.

LEARNING OUTCOMES

(1) Readers will be able to relate the three theoretical consistency requirements to language teaching and intervention. (2) Readers will be introduced to a general theory of signs that provides a basis for evaluating and implementing interventions.

The impact of aided language stimulation on symbol comprehension and production in children with moderate cognitive disabilities

Over the past decade, aided language stimulation has emerged as a strategy to promote both symbol comprehension and symbol production among individuals who use graphic mode communication systems. During aided language stimulation, an interventionist points to a graphic symbol while simultaneously producing the corresponding spoken word during natural communicative exchanges. The purpose of this study was to determine the impact of aided language stimulation on children with moderate cognitive disabilities. Three preschool children with moderate cognitive disabilities who were functionally nonspeaking participated in the investigation. The investigator implemented a multiple-probe design across symbol sets/activities. Elicited probes were used to determine whether the children increased their comprehension and production of graphic symbols. Results indicated that all 3 children displayed increased symbol comprehension and production following the implementation of aided language stimulation.

Toward Functional Augmentative and Alternative Communication for Students With Autism

Many individuals with autism are candidates for augmentative and alternative communication (AAC) systems, either to supplement (i.e., augment) their existing speech or to act as their primary (i.e., alternative) method of expressive communication. The purpose of this article is to summarize research and directions for future research with regard to two questions related to the delivery of AAC supports to these individuals: (a) What AAC modality is preferable to use? and (b) What do we know about the use of voice output communication aids with people with autism?