Professional judgments of the intentionality of communicative acts

A new intervention to prevent social isolation in people with complex communication needs

While implementing communication interventions, practitioners follow diverse theoretical models. Different conceptual orientations influence the way professionals embrace the subject of communication and its disorders. This research project explores the co-creation and validation of a new model and intervention program to analyze and improve communication between persons with Complex Communication Needs and their caregivers. The methodology incorporated a comprehensive narrative review, as foundation for the new model and intervention proposal. Succeeding this stage, the team implemented an online Delphi Panel to improve and validate these results, involving 17 international renowned experts. Following the Appropriateness Method, 25 indications were subject to scrutiny and rated as appropriate with minimal values of disagreement among the evaluators. Qualitative feedback was used to improve the research products. Quality assurance measures were taken to ensure quality and transparency of the results. A new conceptual framework of atypical interpersonal communication and intervention program result from the investigation. The new model is inspired by the Transactional model and principles of Dialogism. The intervention consists of consultations with caregivers, using video analysis and a dialogical methodology to enhance communication. The next research phase is to pilot-test the intervention program with clinicians supporting persons with disability at risk of social isolation.

Effects of Interaction Approaches and Added High-Tech Augmentative and Alternative Communication on Prelinguistic and Linguistic Communication from School-Age Beginning Communicators

INTRODUCTION

Augmentative and alternative communication (AAC) intervention research is rarely focused on school-age beginning communicators, despite the urgent need to ensure individuals in this population have access to the fundamental human right of communication.

METHODS

Four school-age children with multiple disabilities who were primarily prelinguistic communicators participated in the current study. The study used a single-subject research design to explore the effects of two interaction approaches - a social routine approach and a directive approach - on prelinguistic communication, compared to independent play and to one another. This study then evaluated the added effects of high-tech AAC within the most effective interaction approach for each participant.

RESULTS

All participants demonstrated prelinguistic communication indicating positive affect most frequently when interacting within a social routine. Furthermore, all participants increased linguistic communication while either maintaining or increasing prelinguistic communication when high-tech AAC was added to the social routine interaction.

CONCLUSIONS

Clinicians should consider building accessible, predictable, engaging, and age-respectful social routines into leisure contexts to promote prelinguistic communication from school-age beginning communicators. Clinicians should also provide access to linguistic communication through high-tech AAC while continuing to honor and promote prelinguistic communication.

The identification of exceptional skills in school-age autistic children: Prevalence, misconceptions and the alignment of informant perspectives

BACKGROUND

Although autism is commonly described in terms of deficits, many autistic individuals have been found to demonstrate exceptional skills. The shift to a strengths-based approach in the field of autism necessitates increased understanding of these skills.

AIMS

This study examined (1) rates of exceptional skills in autistic school-age children as reported by parents and teachers, (2) associations between exceptional skills, autism severity and intellectual disability and (3) correlations between parent and teacher reports of exceptional skills.

METHOD

Parents and teachers of 76 children attending autism-specific schools in Australia completed online questionnaires. Thereafter, 35 parents and teachers who identified their child as having one or more exceptional skills were interviewed by a clinical psychologist.

RESULTS

Forty parents (53%) and 16 (21%) teachers reported that their child had at least one exceptional skill (agreement between the parent and teacher reports was low; κ = .03, p = .74). In comparison, clinical psychologist assessments identified 22 children (29%) as having at least one such skill. No statistically significant relationships were identified between exceptional skills, autism severity and intellectual disability.

CONCLUSION

While different exceptional skills were identified, regardless of children's intellectual functioning or autism severity, parents and teachers varied substantially in their evaluations of these skills. Furthermore, the identified prevalence rates of exceptional skills did not always align with the rates identified in previous studies. The study findings highlight the need for definitional consensus on different types of exceptional skills, and the importance of multiple criteria/multi-instrument approaches in the identification of exceptional skills in autistic children.

A Comparison of Maternal and Clinician Perception of Communication in Autistic Toddlers

PURPOSE

Parent instruction in communication facilitation strategies for autistic toddlers relies on assumptions that parents interpret child behaviors in alignment with clinician definitions of communication. The purpose of this study was to identify features of child behaviors that are predictive of alignment in identification of child communication between clinical researchers and mothers of young autistic children.

METHOD

Participants were 33 mothers and their autistic children between 18 and 48 months of age. Mothers' and clinical researchers' perceptions of child communication were assessed using a procedure in which mothers and clinical researchers each independently identified child communication in the same ten 1-min video clips of each mother's child. Endorsed communicative acts were coded for the presence of conventional forms (e.g., vocalization) and potentially communicative forms (e.g., body movement). Multilevel binomial regressions, fit with Bayesian inference, were conducted to predict classification of maternal endorsements of child communication based on the presence of conventional and potentially communicative forms as either an aligned act (i.e., act endorsed by mother and clinical researcher as communicative) or a unique maternal endorsement (i.e., act endorsed by mother but not clinical researcher).

RESULTS

The presence of vocalization, verbalization, and gesture each significantly predicted increased likelihood of alignment; the presence of eye contact did not. Although repetitive and sensory behaviors significantly increased the likelihood of unique maternal endorsement, affect shifts and body movements each significantly reduced the likelihood of unique maternal endorsement, and hand activity was not significantly predictive of unique maternal endorsement.

CONCLUSIONS

Misalignment in mothers' and clinical researchers' identification of communication may be in part due to mothers' endorsement of behavioral forms that are not traditionally classified as part of a child's communication repertoire. Findings emphasize the need to work toward designing communication interventions that consider the ways in which clinicians and parents of autistic children each bring their own interpretive frameworks to the early intervention experience.

Changes in the early communicative behaviors of young children with significant cognitive and motor developmental delays in a two-year span

INTRODUCTION

This study examines longitudinal changes in communicative behavior of young children with significant cognitive and motor developmental delays (SDD) and determines their individual communicative trajectories. A second focus of this study is the relation of changes in communicative behavior with motor skills.

METHODS

Data consists of codes resulting from a self-developed coding scheme used on observations of 23 children in three different settings and responses on a questionnaire. First, group trends were determined to find out whether communication-related variables tend to significantly change over the course of two years. Furthermore, these findings were contrasted with the individual trajectories of the children. Next, the association of initial communicative skills and (the acquisition of) specific motor skills with the change in their communicative functioning was studied. Wilcoxon Signed Ranks and correlational analyses were used to answer the research questions.

RESULTS

Out of sixteen different variables related to communicative behavior, ten changed significantly over the course of two years. Children with more focus on prompt on the first datapoint showed a significantly larger increase of signs of functionality. Still, all children showed highly individual trajectories. Children with better motor skills on the first datapoint showed a significantly larger increase in communication rate.

CONCLUSIONS

Results show that if a myriad of detailed variables are taken into account children with significant cognitive and motor developmental disabilities do change regarding their communicative functioning, but that they tend to all show unique developmental trajectories. Children with stronger skills in some aspects of communication and motor functioning, can be considered advantaged regarding their communicative development.

Effect of Low-Tech Augmentative and Alternative Communication Intervention on Intentional Triadic Gaze as Alternative Access by School-Age Children With Multiple Disabilities

PURPOSE

Students with multiple disabilities who are beginning communicators require augmentative and alternative communication (AAC) to communicate during school and participate in its academic and social aspects. Triadic gaze is a method for accessing low-tech AAC that minimizes physical demands on access for students with limited mobility, such as students with multiple disabilities. Thus, this study evaluated an instructional protocol for teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities.

METHOD

Three students with multiple disabilities who were beginning communicators participated in a multiple baseline across participants design with three phases: baseline, treatment, and generalization and maintenance. Participants engaged in instruction around using triadic gaze to communicate by making selections on an eye gaze board.

RESULTS

Visual analysis showed that all three participants acquired the use of triadic gaze as a method of accessing low-tech AAC in response to instruction. Effect size estimations suggested instruction was effective. The participants also demonstrated that the newly acquired skill generalized to interactions with familiar communication partners after instruction ended.

CONCLUSIONS

These findings show that instruction can be effective in teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities. Future research should explore the effects of using this access method on communicating across school contexts.

The effects of AAC video visual scene display technology on the communicative turns of preschoolers with autism spectrum disorder

Over 40% of children with autism spectrum disorder (ASD) experience difficulty in using speech to meet their daily communication needs. Although augmentative and alternative communication (AAC) can be of benefit, the AAC intervention must support beginning communicators in the early social interactions that provide the foundation for more sophisticated communication skills. An AAC video visual scene display approach uses an AAC app (provided on a tablet computer), including videos based on the interests of the child and infused with AAC supports, to provide opportunities for social interaction and communication between the child and the communication partner. The purpose of this study was to investigate the impact of video visual scene display technology on the communicative turns taken by three preschoolers with ASD and complex communication needs during a high-interest, shared activity (i.e., watching videos). All three participants demonstrated a large increase in the number of communicative turns taken with their partner (Tau-U of 1.00) following the introduction of the video VSD app. The results provide evidence that a video VSD approach may be a promising intervention to increase participation in communication opportunities for young children with ASD.

Preliminary investigation of the effects of a prelinguistic AAC intervention on social gaze behaviors from school-age children with multiple disabilities

Some school-age children with multiple disabilities communicate predominately through the display of prelinguistic behaviors such as gestures, vocalizations, facial expressions, and eye gaze. Increasing the frequency and complexity of these behaviors may be one approach to building communication and transitioning toward linguistic communication (i.e., symbolic language). The current preliminary study used a single-subject ABB'B" design nested within a multiple baseline across participants design with randomization to evaluate a multi-phase intervention aimed at increasing social gaze behaviors. The participants were 5 school-age children with multiple disabilities. Participants appeared to demonstrate increases in both the frequency and complexity of their social gaze behavior during the intervention according to Improvement Rate Difference calculations that largely maintained four months after intervention ended. More research is needed, but the intervention shows promise as one aspect of AAC intervention for children who are prelinguistic communicators. Future research is critical to evaluating this or related interventions with a larger number of individuals and across a larger range of profiles and ages.

Providing Supportive Hospital Environments to Promote the Language Development of Infants and Children Born Prematurely: Insights From Neuroscience

INTRODUCTION

Rapid neural development occurs beginning in utero and extending throughout a child's first years of life, shaped by environmental input, which is essential for language learning. If this development is disrupted by premature birth and/or related repeated hospitalizations, atypical language development may result even in the absence of severe neurologic damage.

METHOD

This narrative review describes typical neurodevelopment associated with language and the atypical neurodevelopment often experienced by children born prematurely that can adversely affect their language development.

RESULTS

We describe evidence-based intervention strategies applicable in the hospital setting that can support the language development of young children who are born prematurely.

DISCUSSION

To promote neurodevelopmental growth that will support language learning, children born prematurely need to engage in supportive interactions with others. Awareness of evidence-based strategies can equip health care staff to provide a supportive hospital environment to promote the language development of children born premature.

Effect of AAC partner training using video on peers' interpretation of the behaviors of presymbolic middle-schoolers with multiple disabilities

Children require consistent responses from partners to their presymbolic behaviors in order to increase the frequency and variety of these behaviors and eventually build symbolic language. This study served as an initial attempt to evaluate the effect of AAC training on typically-developing peers' interpretation of the behavior of three students with multiple disabilities whose communication was presymbolic and idiosyncratic in nature. The study used a pretest-posttest control group design with 12 peers in each condition (i.e., experimental and control). During the pretest, peers in both groups were inaccurate in their interpretations of the behaviors of the students with multiple disabilities. During the posttest, peers who completed the training interpreted the behaviors of the students with multiple disabilities with statistically significantly higher accuracy than participants who did not complete the training. The training may be an effective intervention approach to increase the accuracy and consistency with which communication partners interpret the idiosyncratic behaviors of children with multiple disabilities. Future research should evaluate the efficacy of using such training to increase communication partners' identification of and responsivity to idiosyncratic behaviors within the context of real-world interactions.

An ecological method for the sampling of nonverbal signalling behaviours of young children with profound and multiple learning disabilities (PMLD)

BACKGROUND

Profound and multiple learning disabilities (PMLD) are a complex range of disabilities that affect the general health and well-being of the individual and their capacity to interact and learn.

METHOD

We developed a new methodology to capture the non-symbolic signalling behaviours of children with PMLD within the context of a face-to-face interaction with a caregiver to provide analysis at a micro-level of descriptive detail incorporating the use of the ELAN digital video software.

CONCLUSION

The signalling behaviours of participants in a natural, everyday interaction can be better understood with the use of this innovation in methodology, which is predicated on the ecology of communication. Recognition of the developmental ability of the participants is an integral factor within that ecology. The method presented establishes an advanced account of the modalities through which a child affected by PMLD is able to communicate.

Music Therapy in Special Education: Do We Need More Evidence?

The evidence-based framework underpins the field of special education research. Many educational researchers and administrators accept this model, and expectations of research are rapidly changing as it gains prominence. This dialogue explores the impact of the evidence-based model through a debate between two researchers in the field – a special education academic with a positivist agenda and a music therapy researcher with qualitative inclinations. Through a series of questions designed to illustrate their complementary perspectives, the authors provide opinions on what constitutes evidence in special education and consider the music therapy literature from these perspectives. Ultimately, they propose a research study that pragmatically accepts the evidence-based framework as one valid approach to research. This research project is seen as one step in a series of studies that have international collaborations as their basis.

Interaction with a person with profound intellectual and multiple disabilities: a case study in dialogue with an experienced staff member

BACKGROUND

The aim of this descriptive single case study was to describe a unique interaction with a person with profound intellectual and multiple disabilities (PIMD) in a holistic way-focusing on the client, the staff member, and the interacting dyad-and to include the experiential knowledge of the interaction partner.

METHOD

A videotaped interaction of the staff-client dyad was analysed by triangulating data from video analysis, documents, observational rating scales, and an interview with the staff member.

RESULTS

The interactional pattern revealed in this study is that of a staff member who offers an activity that is considered to be stimulating for the client, by using a variety of initiatives and structuring strategies, and a client who is alert and responsive, but has limited chances to take own initiatives. Rather low scores were obtained on observations from a dialogical perspective.

CONCLUSIONS

This study highlights the value of video analysis for practitioners, demonstrates the usefulness of describing an interaction episode supported by an integrative theoretical framework, and confirms the importance of combining observations by an independent researcher with experiential staff knowledge.

Use of eye-pointing by children with cerebral palsy: what are we looking at?

BACKGROUND

Children with cerebral palsy often show significant communication impairment due to limited or absent speech. Further, motor impairment can restrict the use of movement, including pointing, to signal interest and intent. For some children, controlled gaze can be an effective 'point-substitute': such 'eye-pointing' can be used to request items, establish mutual interest in an event, or select vocabulary within an alternative or augmentative communication (ACC) system. However, in clinical practice there is a lack of clarity about how the term 'eye-pointing' is used, how 'eye-pointing' is recognized or how it relates to social development.

AIMS

To present a clinical description of the term 'eye-pointing' with reference to children with severe cerebral palsy who cannot speak or finger-point. To consider this description within a wider discussion of the importance of gaze in communication development.

METHODS & PROCEDURES

Cumulative clinical observations during assessment of children referred to a specialist multidisciplinary communication clinic have provoked discussion between the authors on what factors precipitate use of the term 'eye-pointing' in young children with severe cerebral palsy. In particular, discussion has centred on whether use of the term is appropriate in individual cases and whether guidance is available about how gaze should be observed in this developmentally vulnerable group of children. A literature search was also conducted in order to explore whether the use and meaning of the term is established.

CONCLUSIONS & IMPLICATIONS

In interactions with non-speaking children, determining whether a child is using eye-gaze communicatively requires observation and interpretation of several factors. These processes will be informed by reflection on what is known about other aspects of the child's communication and interaction skills. Within the literature, the term 'eye-pointing' is sometimes used when describing the communication functions of individuals using augmentative and alternative communication (AAC) systems, and is occasionally qualified by a definition. No papers have been found that set out a clinical description universally applicable to children with severe motor impairment. Moreover, guidance is lacking on how possible episodes of 'eye-pointing' might be confidently distinguished from other episodes of directed gaze in young, developing communicators. The discussion of the term makes reference to the importance of gaze in early communication development, and explores factors that might influence gaze and its interpretation in young children with cerebral palsy. A description of eye-pointing for this group is offered. The authors suggest that this will bring practical benefits to those supporting the communication development of children with severe cerebral palsy.

Examination of the communication interface between students with severe to profound and multiple intellectual disability and educational staff during structured teaching sessions

BACKGROUND

Individuals with severe to profound and multiple intellectual disability (S-PMID) tend to function at the earlier stages of communication development. Variable and highly individual means of communicating may present challenges to the adults providing support in everyday life. The current study aimed to examine the communication interface between students with S-PMID and educational staff.

METHOD

An in-depth, observational study of dyadic interaction in a class within the secondary part of a special school was conducted. The designated educational level was Key Stage 3 under the National Curriculum of England, which is typically for children from age 11 to 14 years attending a state school. There were four student-teacher dyads in the class. The students had multiple impairments with severely limited communication skills. Video capture of dyadic interaction was conducted during five English lessons and sampled to 2.5 min per dyad per lesson. The video footage was transcribed into standard orthography, detailing the vocal and non-vocal aspects. A coding framework guided by the principles of structural-functional linguistics was used to determine the nature of dyadic interaction, comprising linguistic moves, functions and communicative modalities. The relative contributions of student and teacher to the interaction were examined.

RESULTS

Significant differences were found between the students and educational staff on the majority of the measures. The teachers dominated the interaction, occupying significantly more turns than the students. Teacher turns contained significantly more initiations and follow-up moves than the students, who used more response moves. Teacher communication mainly served the functions of requesting and information giving. Feedback and scripted functions were also significantly greater among teacher turns, with only limited occurrence among the students. Self- or shared-expression was greatest among the students. The modalities of speech, touch, singing and objects were used by the teachers for the purpose of communication, whereas vocalisation and gesture were used by the students.

CONCLUSIONS

Despite differences in the availability of communication skills, both student and teacher were able to make their respective contributions to the interaction during classroom activity. Features of the student-teacher interface retained critical features seen in studies of more able individuals with intellectual disability. Scaffolding provided by teachers appears to be relevant to the communicative contributions of individuals functioning at the earliest stages of communication. The coding framework based on structural-functional linguistics provides some new potential for examining and enhancing the communication interface between individuals with S-PMID and the people who support them.

Assessing the communication skills of carers working with multiple learning disabilities: a case study

BACKGROUND

Speech and language therapists (SLTs) working with adults who have multiple learning disabilities and complex communication needs often deliver their care via indirect therapy where SLTs train carers to communicate with their clients. Yet, very little is known about how SLTs assess the carers' communication skills prior to the training even though the assessment should be the basis of this indirect therapy.

AIMS

To explore the level of agreement between Finnish SLTs' assessments of carers as skilful communication partners for adults who have multiple learning disabilities and complex communication needs. To investigate which interaction strategies affect the SLTs' assessments.

METHODS & PROCEDURES

Six SLTs with more than 15 years of experience in working with individuals with complex communication needs saw together ten video clips of interaction situations between a carer and an adult who had multiple learning disabilities (aged 17-50 years). The SLTs assessed the carers on a scale from one to ten. The SLTs discussed their selections before giving their final ratings. The data were analysed both quantitatively and qualitatively. The unanimity of SLTs' assessment was analysed with a test of Kendall's W. Furthermore, the frequencies of the carers' different communication acts were counted and these counts were compared with the mean of the carers' assessments. These results were further explored with the SLTs' justifications about their assessments.

OUTCOMES & RESULTS

SLTs did not fully agree on which of the carers were the most skilful interaction partners. Furthermore, the six SLTs were not unanimous about which carers' interaction strategies resulted in skilful communication. However, SLTs assessed those carers higher who used facilitative verbal acts. The carers used these verbal acts to involve themselves in the interests of the client.

CONCLUSIONS & IMPLICATIONS

This case study showed that Finnish SLTs seem to have different criteria about what is considered skilful communication between carers and clients who have multiple learning disabilities. Even though there might not be a single way of being a skilful interaction partner, this variable can be confusing to carers if they work with several SLTs and each of them offers different professional advice. Therefore, the results suggest a need for an assessment tool for evaluating the carers' interaction skills. In addition to this tool, it appears that SLTs also need further training to be able to perform this multifaceted task.

The effectiveness of the Talking Mats framework in helping people with dementia to express their views on well-being

Deteriorating communication is one of the most distressing aspects of dementia and it becomes increasingly difficult to ensure that the person’s views are heard. This study involved 31 people at different stages of dementia who were each interviewed about their well-being using Talking Mats, a low-tech communication framework, and usual communication methods. The communication effectiveness of each method was compared. This study found that the Talking Mats framework was associated with better communication at all stages of dementia compared to usual communication methods. Better communication effectiveness was evident in the participants’ understanding, engagement, keeping on-track and ability to make their views understood. There was also less repetitive behaviour and less distractibility when using the Talking Mats framework. The findings suggest that the Talking Mats framework can play an important role in improving communication by providing an accessible, low cost tool which family and staff can use with people with dementia to help them express their views.

Reliability and validity of the revised Triple C: Checklist of Communicative Competencies for adults with severe and multiple disabilities

AIMS

Few tools are available to assess the communication skills of adults with severe and multiple disabilities functioning at unintentional to early symbolic levels. An exception is the Triple C: Checklist of Communicative Competencies. In this study, aspects of support worker and clinician agreement, internal consistency and construct validity of a revised version of the Triple C were explored.

METHOD

Triple C checklists were completed for 72 adults with severe intellectual disabilities (ID) by 118 support workers and stages were assigned by the researchers. Two support workers completed checklists for each of 68 adults with ID. Three researchers also conducted direct observations of 20 adults with ID.

RESULTS

The average support worker agreement for items across the five stages of the Triple C ranged from 81% to 87%; agreement for stage assignment based on first and second support worker checklists was moderate to high (k = 0.63). Internal consistency was high (KR20 = 0.97); the stages were found to tap one factor (accounting for approximately 74% of variance), interpreted to be unintentional to early symbolic communication. Agreements between stages based on researcher observations and support worker-completed checklists were 35% and 71% across first and second support workers.

CONCLUSION

The revised Triple C provides a reliable means of gathering data on which to determine the communication skills of adults with severe and multiple disabilities. The results support a collaborative use of the Triple C, such that a speech-language pathologist or other communication specialist works with a support worker to ensure understanding of the skills observed and development of appropriate intervention strategies.

Increasing Communication in Children With Concurrent Vision and Hearing Loss

Nine children with complex communication needs and concurrent vision and hearing losses participated in an intervention program aimed at increasing intentional prelinguistic communication. The intervention constituted a pilot, descriptive study of an adapted version of prelinguistic milieu teaching, hence referred to as A-PMT. In A-PMT, natural gestures and vocalizations were targeted in child-focused, one-on-one activities conducted by a member of the project staff. Adaptations included using more physical prompts than in other forms of PMT and using means other than directed eye gaze to determine directionality of gestures. All nine participants increased their rates of initiated, intentional communication substantially during the course of intervention; in addition, each participant acquired new forms of natural gestures. Results were limited primarily to requests (as opposed to other communication functions). Discussion centers on how to promote more generalized communication developments in future implementations of the program.