Grammatical Morphology Acquisition by Children with Complex Communication Needs

Relationship between lexicon and grammar in children and youth who use augmentative and alternative communication

The present study investigated the relationship between lexicon and grammar in individuals who use graphic symbol-based aided augmentative and alternative communication (AAC). Data came from 60 transcripts of generalization sessions that were part of two previous intervention studies, aimed at improving the expressive vocabulary and grammar of 12 children and youth who used graphic symbol-based AAC. The specific aims of the current study were to (a) describe vocabulary composition across different levels of expressive vocabulary and (b) analyze the relationship between global measures of expressive vocabulary and the use of grammar in individuals who use aided AAC. A series of multiple linear mixed effect regression analyses showed a positive predictive association between overall vocabulary size and the use of closed-class words, and a positive relationship between the use of verbs and the use of closed-class words. Additionally, the use of verbs had a significant positive association with the use of inflectional morphology, while the use of nouns did not. Theoretical and practical implications of these findings are discussed.

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.

The decision-making process in recommending electronic communication aids for children and young people who are non-speaking: the I-ASC mixed-methods study

Background

This project [Identifying Appropriate Symbol Communication (I-ASC)] explored UK decision-making practices related to communication aid recommendations for children and young people who are non-speaking. Research evidence related to communication aid decision-making is limited. The research aims were to increase understanding of influencers on the decision-making process in recommending electronic communication aids, and to develop guidance tools to support decision-making. An additional, post hoc aim was to evaluate the public involvement contribution to the I-ASC project. The research focused on the identification of attributes and characteristics that professionals, family members and those who use communication aids considered important in the recommendation process. Findings informed the development of guidance resources. The evaluation of public involvement focused on what could be learned from a nationally funded project with involvement from public contributors typically regarded as hard to include.

Methodology

For the clinical decision-making component, the methodological investigation adopted a three-tier approach with three systematic reviews, a qualitative exploration of stakeholder perspectives through focus groups and interviews, and a quantitative investigation surveying professionals’ perspectives. The public involvement evaluation adopted a mixed-methods approach. A total of 354 participants contributed to the decision-making data set, including professionals, family members, and children, young people and adults who use communication aids; 22 participants contributed to the public involvement evaluation. The literature review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thematic analysis and framework approach supported the analysis of qualitative data. Two stated preference surveys, a best–worst scaling and a discrete choice experiment, allowed the relative importance of factors in decision-making to be determined. Analysis was grounded in random utility theory.

Public involvement

Two public involvement co-researchers, an adult using a symbol communication aid and a parent of a communication aid user, were core members of the research team. The I-ASC public involvement resulted in an additional award to evaluate the impact of public involvement across the project.

Results

Factors influencing decision-making are not always under the control of the decision-makers, for example professional knowledge, referral criteria and service structure. Findings suggest that real clinical decisions contrast with hypothetical decisions. Survey responses indicated that children’s physical characteristics are less important than their language, communication and learning abilities; however, during real-time decision-making, the opposite appeared to be true, with access needs featuring most prominently. In contrast to professionals’ decisions, users and family members prioritise differing aesthetic attributes of communication aids. Time allocated to system learning remains underspecified. The research informed the development of decision-making guidance tools (https://iasc.mmu.ac.uk/; accessed 8 June 2020). A public involvement evaluation suggests that successful public involvement of individuals with disabilities requires significant resources that include staff time, training and personal support (https://iasc.mmu.ac.uk/publicinvolvement; accessed 8 June 2020).

Future work

Further research is needed in the areas of language assessment, communication aid attributes, types of decision-making episodes and service user perspectives. These data highlight the need for mechanisms that enable public involvement co-researchers to be paid for their contributions to research bid preparation.

Limitations

Individuals who benefit from communication aids are a heterogeneous group. We cannot guarantee that this study has captured all relevant components of decision-making.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 45. See the NIHR Journals Library website for further project information.

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.

Early verbal categories and inflections in children who use speech-generating devices

The use of early verbal categories, their event types, and the emergence of verbal inflections (-ing, -s, and -ed) were analyzed in data from four participants with motor speech disorders aged 9;5-13;9 (years;months) who used speech-generating devices to converse with a familiar adult. The study was conducted through a secondary analysis of a corpus of data collected as part of another study. It documents the production of verbs and the emergence of verb inflections in natural conversations between each of the participants and a member of their educational team over a period of up to 10 months. All participants used both action and state verbs, although action verbs were dominant. The emergence of the inflections -ing, -s, and -ed varied and were distributed selectively with different verb categories and event types. The results are discussed in terms of language development and are considered in terms of the findings from research with children without disabilities, which suggest that action verbs precede state verbs, and inflections are primarily acquired based on their correspondence to the verbal category (action-state). Implications for theory, practice, and further research are discussed.

Reading acquisition, AAC and the transferability of english research to languages with more consistent or transparent orthographies

Research on reading in augmentative and alternative communication (AAC) is primarily provided for the English language, which has nontransparent orthographic depth and a complex syllable structure. While there is a great deal to learn about English reading in AAC, there is substantially more information regarding reading in AAC in English than in other languages. In this article we compare reading acquisition in English and German, drawing from the existing research regarding reading for children with complex communication needs and describing how that might apply to German and other European languages with orthography that is more consistent than English (e.g., Swedish, Spanish, Finnish; Aro & Wimmer, 2003). The goal is to support the development of cross-linguistic understandings in reading and AAC.

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.

Use of aided language stimulation to improve syntactic performance during a weeklong intervention program

This pilot study assessed the performance of nine children, aged 4;8-14;5, who used augmentative and alternative communication (AAC) systems before and after a weeklong aided language stimulation intervention program. Pre/post test data were analyzed to evaluate the participants' syntactic complexity when using (a) a manual communication board and (b) a dynamic display speech generating device (DD-SGD). Results indicate that most participants improved their syntactic performance and that these gains were more pronounced when the participants used a manual communication board as compared with a DD-SGD. There was considerable individual variation in performance.

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.

Grammatical Morpheme Intervention Issues for Students Who Use AAC

Many children who use AAC experience difficulties with acquiring grammar. At the 9th Annual Conference of ASHA's Special Interest Division 12, Augmentative and Alternative Communication, Binger presented recent research results from an intervention program designed to facilitate the bound morpheme acquisition of three school-aged children who used augmentative and alternative communication (AAC). Results indicated that the children quickly began to use the bound morphemes that were taught; however, the morphemes were not maintained until a contrastive approach to intervention was introduced. After the research results were presented, the conference participants discussed a wide variety of issues relating to grammar acquisition for children who use AAC. Some of the main topics of discussion included the following: provision of supports for grammar comprehension and expression, intervention techniques to support grammatical morpheme acquisition, and issues relating to AAC device use when teaching grammatical morpheme use.

Classroom-Based Language Goals and Intervention for Children Who Use AAC: Back to Basics

When working with a preschool or school-aged child who uses aided AAC, much of the speech-language pathologist's (SLP's) focus is commonly on the AAC tools that the child is using. SLPs will often talk with educators and parents about the technology itself, and sometimes, many of the child's IEP goals center around use of the AAC technologies. Many educators (and sometimes even SLPs), however, are often reluctant to use technologies with which they are not comfortable. In the midst of all of the complications that come with technology use, it can be helpful to remember that AAC technologies are simply tools that provide the child with access to language. Most children who use AAC experience language deficits (e.g., Binger & Light, in press), and the purpose of AAC is to provide the child with a means of overcoming these language deficits. Given these facts, the goals, objectives, and intervention techniques that SLPs use with children who use AAC should not, in many cases, be very different from the goals and techniques for children who primarily rely on speech to communicate. In other words, it is important to put the language back into speech-language pathology, when working with children who use AAC. To illustrate these points, three cases of children who use AAC and who have very different profiles are presented below, with example language goals and intervention techniques that may be used with each child.

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

PURPOSE

This study investigated the impact of syntactic complexity and task demands on construction of utterances using picture communication symbols by participants from 3 age groups with no communication disorders.

METHOD

Participants were 30 children (7;0 [years;months] to 8;11), 30 teenagers (12;0 to 13;11), and 30 adults (18 years and above). All participants constructed graphic symbol utterances to describe photographs presented with spoken French stimuli. Stimuli included simple and complex (object relative and subject relative) utterances describing the photographs, which were presented either 1 at a time (neutral condition) or in an array of 4 (contrast condition).

RESULTS

Simple utterances lead to more uniform response patterns than complex utterances. Among complex utterances, subject relative sentences appeared more difficult to convey. Increasing the need for message clarity (i.e., contrast condition) elicited changes in the production of graphic symbol sequences for complex propositions. The effects of syntactic complexity and task demands were more pronounced for children.

CONCLUSION

Graphic symbol utterance construction appears to involve more than simply transferring spoken language skills. One possible explanation is that this type of task requires higher levels of metalinguistic ability. Clinical implications and directions for further research are discussed.