Roles of Speech Output in Augmentative and Alternative Communication: Narrative Review

Effects of Interventions Involving Tablet-Based Speech-Generating Devices for Individuals with ASD: A Meta-analysis

The purpose of this review was to assess the effectiveness of tablet-based speech-generating devices (SGDs) in improving communication skills for individuals with autism spectrum disorder (ASD). A total of 31 single-case design intervention studies involving 84 individuals with ASD were reviewed and included in the analysis. We calculated Tau-U to evaluate the impact of interventions involving tablet-based SGDs on four different communication responses: specifically, mands, intraverbals, tacts, and vocalizations. To explore potential moderating variables for mand outcomes, we used the Kruskal-Wallis one-way test. The analysis revealed that interventions utilizing tablet-based SGDs led to improvements in communication responses. Specifically, large to very large changes were observed in mand and intraverbal responses, whereas moderate changes were noted in tact responses and vocalizations. The findings of this review underscore the potential of tablet-based SGDs in enhancing communication among individuals with ASD. We discuss the findings and provide implications for future research and practice.

Effects of an Augmentative and Alternative Communication Intervention Package on Socio-Communicative Behaviors Between Minimally Speaking Autistic Children and Their Peers

PURPOSE

The purpose of this study is to investigate the effectiveness of an augmentative and alternative communication (AAC) intervention package consisting of systematic instruction and aided modeling with speech-output technologies on the acquisition, maintenance, and generalization of socio-communicative behaviors-initiating a request for a turn, answering questions, and commenting-in four, minimally speaking (MS) autistic children between the ages of 6 and 9 years.

METHOD

A multiple-probe design across behaviors replicated across participants was implemented to evaluate the effects of systematic instruction and aided modeling on initiating requests for a turn, answering questions, and commenting behaviors. Additionally, a pre- and posttreatment multiple-generalization-probes design was used to assess generalization across peers.

RESULTS

Visual analyses demonstrated experimental control for two participants (i.e., Derek, Ajay) showing a functional relationship between the intervention and outcomes across all social communicative behavior. For one participant (i.e., Matthew), experimental control could not be established because he did not reach the learning criterion for commenting. The fourth participant (i.e., John) transferred to a different school after making some progress on requesting. Effect size indicator analyses corroborated these findings, indicating medium-to-strong effects for initiating requests for a turn strong effects for answering questions, and medium-to-strong effects for commenting. Generalization of socio-communicative behaviors from researcher to a typically developing peer was variable across participants. Participants maintained socio-communicative behaviors 3 weeks after the last intervention session with varying degrees of success.

CONCLUSION

The outcomes of this study suggest that aided modeling and systematic instruction using speech-output technologies may lead to gains in socio-communicative behaviors in some MS autistic children.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25799935.

Autism spectrum disorder: pathogenesis, biomarker, and intervention therapy

Autism spectrum disorder (ASD) has become a common neurodevelopmental disorder. The heterogeneity of ASD poses great challenges for its research and clinical translation. On the basis of reviewing the heterogeneity of ASD, this review systematically summarized the current status and progress of pathogenesis, diagnostic markers, and interventions for ASD. We provided an overview of the ASD molecular mechanisms identified by multi-omics studies and convergent mechanism in different genetic backgrounds. The comorbidities, mechanisms associated with important physiological and metabolic abnormalities (i.e., inflammation, immunity, oxidative stress, and mitochondrial dysfunction), and gut microbial disorder in ASD were reviewed. The non-targeted omics and targeting studies of diagnostic markers for ASD were also reviewed. Moreover, we summarized the progress and methods of behavioral and educational interventions, intervention methods related to technological devices, and research on medical interventions and potential drug targets. This review highlighted the application of high-throughput omics methods in ASD research and emphasized the importance of seeking homogeneity from heterogeneity and exploring the convergence of disease mechanisms, biomarkers, and intervention approaches, and proposes that taking into account individuality and commonality may be the key to achieve accurate diagnosis and treatment of ASD.

The effect of responsiveness to speech-generating device input on spoken language in children with autism spectrum disorder who are minimally verbal†

The use of speech-generating devices (SGD) in early interventions for children with autism spectrum disorder (ASD) can improve communication and spoken language outcomes. The purpose of this study was to describe children's responsiveness to SGD input modeled by a social partner during adult-child play interactions over a 24-week intervention trial and explore the effect of that responsiveness on spoken language growth. This secondary analysis consisted of 31 children with less than 20 functional words at study entry who received a blended behavioral intervention (JASPER + EMT) as part of a randomized controlled trial. Significant improvements were seen in rate of responsiveness to both adult SGD models and adult natural speech models; only rate of responsiveness to SGD models at entry was a significant predictor of frequency of commenting and was a more robust predictor of number of different words post-intervention. Lastly, at entry, children with more joint attention and language responded to SGD models at significantly higher rates. Attention and responsiveness to SGD output may be important mechanisms of language growth and children who have more joint attention skills may particularly benefit from use of an SGD.

Attitudes Toward and Perceived Communicative Competence of Individuals with Aphasia Using Speech-Generating Devices

The purpose of this study was to investigate the effects of interface display and respondent group on listener attitudes toward and perceived communicative competence of persons with aphasia. The Attitudes Toward Nonspeaking Persons scale and the Communicative Competence Scale was used to measure listener attitudes and communicative competence, respectively. A 2 × 3 mixed factorial design was used. Interface display videos served as the within-subjects variable (i.e., grid and scene displays), and the respondent group served as the between-subjects variable. A total of 113 respondents (i.e., undergraduate lower-division students, undergraduate upper-division students, and family caregivers of individuals with aphasia) watched an individual with aphasia using a grid display in one video and a scene display in another video. The respondents completed the two scales. Significant main effects (p < .05) were found for interface display and respondent group. The use of scene displays had a more favorable impact on competence ratings than the use of grid displays. Family caregiver ratings were significantly (p < .05) more favorable than ratings from other groups. The Communicative Competence Scale was found to be a reliable measure of perceived communicative competence. Scene displays have the potential to enhance the perceived communicative competence of this population.

A Systematic Review of Play-Based Interventions Targeting the Social Communication Skills of Children with Autism Spectrum Disorder in Educational Contexts

Children with autism spectrum disorder (ASD) experience social communication difficulties which can be compounded by increased social demands and expectations of the school environment. Play offers a unique context for social communication development in educational settings. This systematic review aimed to synthesize play-based interventions for the social communication skills of children with ASD in educational contexts and identified nine studies. Overall, studies in this review provided a promising evidence base for supporting social communication skills through play in education for children with ASD. The review also highlighted gaps in research on play-based interventions for the social communication skills of children with ASD within naturalistic educational settings.

Teaching mands for information using speech generating devices: A replication and extension

Approximately 30% of individuals diagnosed with autism spectrum disorder (ASD) fail to develop vocal communication and, therefore, use some form of augmentative or alternative communication system. The current study replicates and extends previous research on teaching "Who?" and "Which?" mands for information to 3 young children diagnosed with ASD using a speech generating device. Procedures were evaluated using a multiple baseline across participants design. All participants learned to mand for information and, subsequently, used the information to access preferred items.

Telling tales: unlocking the potential of AAC technologies

Augmentative and alternative communication (AAC) has been transformed by the social media revolution made possible by the emergence of mobile technology. The cumbersome dedicated devices of the 1970s have evolved into a burgeoning AAC app industry. However, the limited use and abandonment of AAC technologies remains high. Unlocking the untapped potential of technology requires a paradigm shift in the design of AAC technologies by building systems that minimize the cognitive load placed on users, adapting to their individual physical and language needs. Telling Tales shares insights and stories of how the combination of user-centred design, interdisciplinary research and the application of intelligent computing is providing a vision of future generations of AAC technologies.

Teaching a Child With ASD to Approach Communication Partners and Use a Speech-Generating Device Across Settings: Clinic, School, and Home

Individuals with autism spectrum disorder (ASD) often have difficulty generalizing newly acquired communication skills to different contexts. In this study, a multiple baseline across settings (clinic, school, and home) design was used to determine whether an 8-year-old boy with ASD could learn to approach communication partners to request preferred items using an iPad®-based speech-generating device (SGD). Results indicated that the participant learned to approach communication partners to request across all settings. Acquisition of this skill was fastest at school and slowest in the clinic. The participant’s learning generalized to a novel room within the same setting, and he was also able to retrieve the SGD prior to approaching the communication partner without additional teaching. Results suggest that individuals with ASD may benefit from being systematically taught to use an SGD across different settings and communication partners.

Teaching ‘Yes’ and ‘No’ Responses to Children with Multiple Disabilities through a Program Including Microswitches Linked to a Vocal Output Device

The present study introduced two children (a boy and a girl of 9.2 and 12.3 yr. of age, respectively, with multiple disabilities) to an intervention program for establishing Yes and No responses in relation to preferred and nonpreferred stimuli and assessed the acquisition and generalization of those responses. The program involved the use of microswitches, which monitored the nonverbal Yes and No responses performed by the children and ensured that these responses produced the matching verbal utterances via a vocal output device. Analysis showed children acquired Yes and No responses in relation to the stimuli used for the intervention and, to a comparable degree, to the stimuli used for generalization checks as well. An interview of 30 educational staff of a center for persons with multiple disabilities indicated that they considered the presence of Yes and No verbal utterances preferable to the absence of such utterances, and thought that the utterances could be helpful for the children's response acquisition and would be useful and pleasing for staff and parents. General implications of the findings were discussed.

Moderation of effects of AAC based on setting and types of aided AAC on outcome variables: an aggregate study of single-case research with individuals with ASD

OBJECTIVE

The purpose of this meta-analysis was to evaluate the potential moderating effects of intervention setting and type of aided augmentative and alternative communication (AAC) on outcome variables for students with autism spectrum disorders.

METHODS

Improvement rate difference, an effect size measure, was used to calculate aggregate effects across 35 single-case research studies.

RESULTS

Results indicated that the largest effects for aided AAC were observed in general education settings. With respect to communication outcomes, both speech generating devices (SGDs) and the Picture Exchange Communication System (PECS) were associated with larger effects than other picture-based systems. With respect to challenging behaviour outcomes, SGDs produced larger effects than PECS.

CONCLUSION

This aggregate study highlights the importance of considering intervention setting, choice of AAC system and target outcomes when designing and planning an aided AAC intervention.

Three children with autism spectrum disorder learn to perform a three-step communication sequence using an iPad®-based speech-generating device

BACKGROUND

Many children with autism spectrum disorder (ASD) have limited or absent speech and might therefore benefit from learning to use a speech-generating device (SGD). The purpose of this study was to evaluate a procedure aimed at teaching three children with ASD to use an iPad(®)-based SGD to make a general request for access to toys, then make a specific request for one of two toys, and then communicate a thank-you response after receiving the requested toy.

METHOD

A multiple-baseline across participants design was used to determine whether systematic instruction involving least-to-most-prompting, time delay, error correction, and reinforcement was effective in teaching the three children to engage in this requesting and social communication sequence. Generalization and follow-up probes were conducted for two of the three participants.

RESULTS

With intervention, all three children showed improvement in performing the communication sequence. This improvement was maintained with an unfamiliar communication partner and during the follow-up sessions.

CONCLUSION

With systematic instruction, children with ASD and severe communication impairment can learn to use an iPad-based SGD to complete multi-step communication sequences that involve requesting and social communication functions.

Barriers and facilitators to the use of high-technology augmentative and alternative communication devices: a systematic review and qualitative synthesis

BACKGROUND

There has been a rapid growth in recent years of available technologies for individuals with communication difficulties. Research in the area is currently underdeveloped with practitioners having a limited body of work on which to draw to guide the process of intervention. Concerns have been raised that this newly developed technology may have limited functional usage.

AIMS

This review aims to investigate the potential barriers and facilitators to high-technology AAC provision and its ongoing use. The aim of the analysis is to explore factors underpinning use rather than effectiveness, thus it synthesized data from predominantly qualitative and survey studies reporting the views and perceptions of AAC users or staff providing the devices.

MAIN CONTRIBUTION

The review highlights the range of factors that can impact on provision and use of high-technology AAC, which practitioners should consider and address as appropriate in the intervention process. These include: ease of use of the device; reliability; availability of technical support; voice/language of the device; decision-making process; time taken to generate a message; family perceptions and support; communication partner responses; service provision; and knowledge and skills of staff. The work outlines how qualitative synthesis review methods may be applied to the consideration of published material that is not reporting outcomes data, and how this may provide valuable information to inform future studies.

CONCLUSIONS

Practitioners should be aware of barriers and facilitators to successful use when making recommendations, and consider how barriers where present might be overcome. Aspects of service delivery such as ongoing technical support and staff training may require further consideration. The synthesis of evidence describing views of users and providers, and the implementation of high-technology AAC systems, can provide valuable data to inform intervention studies and functional outcome measures.

Communication interventions involving speech-generating devices for children with autism: a review of the literature

OBJECTIVE

The current review synthesizes communication intervention studies that involved the use of speech-generating devices (SGD) for children with autism.

METHODS

Twenty-three studies were identified that met the inclusion criteria following systematic searches of electronic databases, journals and reference lists. Studies were evaluated in terms of: (a) participants, (b) setting, (c) mode of communication, (d) communication skill(s) taught to the participant, (e) intervention procedures, (f) outcomes, (g) follow-up and generalization, (h) reliability and treatment integrity and (i) design and certainty of evidence.

RESULTS

Intervention, most commonly targeting requesting skills, was provided to a total of 51 children aged 3-16 years. Intervention strategies followed two main approaches: operant/behavioural techniques and naturalistic teaching procedures. Positive outcomes were reported for 86% of the studies and 78% of the studies were categorized as providing conclusive evidence.

CONCLUSION

The literature base suggests that SGDs are viable communication options for children with autism. However, several areas warrant future research.

Synthesized speech output and children: a scoping review

PURPOSE

Many computer-based augmentative and alternative communication systems in use by children have speech output. This article (a) provides a scoping review of the literature addressing the intelligibility and listener comprehension of synthesized speech output with children and (b) discusses future research directions.

METHOD

Studies investigating synthesized speech intelligibility and/or comprehension with children as listeners were systematically identified and coded according to their objectives and methodology.

RESULTS

Ten studies were identified. They were organized according to the following variables: intelligibility variables related to the stimuli (context and rate), intelligibility variables related to aspects of the listener (age of the child, the language or languages spoken by the listener, experience, and practice effects), and comprehension. Each of these factors-and the research support with child participants-was discussed.

CONCLUSIONS

Overall, there is a paucity of research investigating synthesized speech for use with children. Available evidence suggests that children produce similar trends but lower levels of intelligibility performance when compared with adults. Future areas of applied research are required to adequately define this relationship and the variables that may contribute to improving the intelligibility and comprehension of synthesized speech for children.

Evaluation of technology-assisted learning setups for undertaking assessment and providing intervention to persons with a diagnosis of vegetative state

OBJECTIVE

To evaluate the viability of technology-assisted learning setups for undertaking assessment and providing intervention to persons in vegetative state.

METHOD

Study I investigated whether three persons with a diagnosis of vegetative state could associate eye blinking or hand closure responses with contingent, positive stimulation, thus increasing their frequencies (showing signs of learning). Study II extended the learning process (introducing a new response and new stimuli) for one of the participants of Study I.

RESULTS

Two of the participants of Study I succeeded in increasing their responses, indicating signs of learning. Study II showed that the participant (one of the two succeeding in Study I) acquired a new response to access new stimuli and could alternate this response with the one acquired in Study I.

CONCLUSION

Learning might represent a basic level of knowledge and consciousness. Detecting signs of learning might help modify a previous diagnosis of vegetative state and support intervention/rehabilitation efforts.

ITHACA

As an answer to the disabled community’s odyssey to gain access to adaptable, modular, multilingual, cheap and sustainable Augmentative and Alternative Communication (AAC) products, we propose the use of the ITHACA framework. It is a software environment for building component-based AAC applications, grounded on the Design for All principles and a hybrid--- community and commercial ---Open Source development model. ITHACA addresses the developers, the vendors, as well as the people who use AAC. We introduce a new viewpoint on the AAC product design-develop-distribute lifecycle, and a novel way to search-select-modify-maintain the AAC aid. ITHACA provides programmers with a set of tools and reusable Open Source code for building AAC software components. It also facilitates AAC product vendors to put together sophisticated applications using the available on the Web, independently premanufactured, free or commercial software parts. Furthermore, it provides people who use AAC with a variety of compatible AAC software products which incorporate multimodal, user-tailored interfaces that can fulfill their changing needs. The ITHACA architecture and the proposed fusion of past and current approaches, trends and technologies are explained. ITHACA has been successfully applied by implementing a family of AAC products, based on interchangeable components. Several ready to use ITHACA-based components, including on-screen keyboards, Text-to-Speech, symbol selection sets, e-chatting, emailing, and scanning-based input, as well as four complete communication aids addressing different user cases have been developed. This demonstration showed good acceptance of the ITHACA applications and substantial improvement of the end users’ communication skills. Developers’ experience on working in ITHACA’s Open Source projects was also positively evaluated. More importantly, the potential contribution of the component-based framework and Open Source development model combination to the AAC community emerged.

A technology-assisted learning setup as assessment supplement for three persons with a diagnosis of post-coma vegetative state and pervasive motor impairment

Post-coma persons in an apparent condition of vegetative state and pervasive motor impairment pose serious problems in terms of assessment and intervention options. A technology-based learning assessment procedure might serve for them as a diagnostic supplement with possible implications for rehabilitation intervention. The learning assessment procedure adopted in this study relied on hand-closure and eye-blinking responses and on microswitch technology to detect such responses and to present stimuli. Three participants were involved in the study. The technology consisted of a touch/pressure sensor fixed on the hand or an optic sensor mounted on an eyeglasses' frame, which were combined with a control system linked to stimulus sources. The study adopted an ABABCB sequence, in which A represented baseline periods, B intervention periods with stimuli contingent on the responses, and C a control condition with stimuli presented non-contingently. Data showed that the level of responding during the B phases was significantly higher than the levels observed during the A phases as well as the C phase for two of the three participants (i.e., indicating clear signs of learning by them). Learning might be deemed to represent basic levels of knowledge/consciousness. Thus, detecting signs of learning might help one revise a previous diagnosis of vegetative state with wide implications for rehabilitation perspectives.

Persons with multiple disabilities accessing stimulation and requesting social contact via microswitch and VOCA devices: new research evaluation and social validation

The first of these two studies assessed whether 11 participants with multiple disabilities of 5.3-18.2 (M=10.7) years of age would succeed in combining a microswitch for accessing preferred environmental stimuli and a Voice Output Communication Aid (VOCA) for requesting social contact. The second study conducted a social validation assessment of the aforementioned microswitch-VOCA combination. Data showed that all participants learned to use the microswitch and the VOCA. Moreover, the 10 participants, who received a 1-month post-intervention check, largely maintained their responding. The social validation assessment indicated that the raters (i.e., 110 university psychology students) favored the combination of microswitch and VOCA over the microswitch or the VOCA alone, and hypothetical combinations of microswitches or VOCAs.

Effects of synthetic speech output in the learning of graphic symbols of varied iconicity

PURPOSE

To examine the effects of additional auditory feedback from synthetic speech on the learning of high translucent symbols versus low translucent symbols.

METHOD

Two adults with little or no functional speech and severe intellectual disabilities served as participants. A single-subject ABACA/ACABA design was used to study the relative effects of two treatments: symbol training in the presence and absence of synthetic speech output.

RESULTS

The results clearly indicated that the two treatments, rather than extraneous variables were responsible for gains in the symbol learning. Both participants learned either more low translucent symbols or reached their maximum learning of low translucent symbols in the speech output condition.

CONCLUSIONS

The results of this preliminary study replicate and extend the iconicity hypothesis to a new set of learning conditions involving speech output, and suggest that feedback from speech output may assist adults with profound intellectual disabilities in coding particularly those symbols whose association with their referent cannot be coded via their visual resemblance with the referent.

Importance of speech production for phonological awareness and word decoding: the case of children with cerebral palsy

The goal of this longitudinal study was to investigate the precursors of early reading development in 52 children with cerebral palsy at kindergarten level in comparison to 65 children without disabilities. Word Decoding was measured to investigate early reading skills, while Phonological Awareness, Phonological Short-term Memory (STM), Speech Perception, Speech Production and Nonverbal Reasoning were considered reading precursors. Children with cerebral palsy lag behind on all reading precursors at the beginning of the second year of kindergarten. For the children without disabilities, early reading skills in Grade 1 were best predicted by Phonological Awareness and Phonological STM while Speech Production was the most important predictor of early reading success for the children with cerebral palsy, followed by Phonological Awareness and Speech Perception. Furthermore, for children with cerebral palsy, Speech Production appears to dominate reading development, as Speech Production measured at the beginning of the second year of kindergarten was strongly predictive of all other reading precursors measured at the end of the second year of kindergarten. The results of this study reveal that children with cerebral palsy with additional speech impairments are at risk for limited literacy development. Clinical implications are discussed.

Peer-mediated teaching and augmentative and alternative communication for preschool-aged children with autism

BACKGROUND

The aim of this study was to assess the effectiveness of two communication interventions for preschool-aged children with autism.

METHOD

Six typically developing peers were taught to implement peer-mediated naturalistic teaching, with and without a speech generating device (SGD), during play sessions with 3 classmates with autism in three preschools. Generalisation probes were conducted during mealtimes at the preschools. A multiple baseline design was used to assess the outcomes of the two intervention conditions.

RESULTS

All 3 children with autism increased their communicative behaviours immediately following the introduction of the two interventions, and generalised these increases to mealtime interactions with their peers. However, only 1 child maintained these increases in communication.

CONCLUSION

These results provide preliminary evidence for the effectiveness of combining peer-mediated naturalistic teaching with the use of SGDs for preschool-aged children with autism. Suggestions for improving the maintenance of intervention effects are provided.

The Effect of Voice Output on the AAC-Supported Conversations of Persons with Alzheimer's Disease

The purpose of this study was to determine whether the presence or absence of digitized 1-2 word voice output on a direct selection, customized augmentative and alternative communication (AAC) device would affect the impoverished conversations of persons with dementia. Thirty adults with moderate Alzheimer's disease participated in two personally relevant conversations with an AAC device. For 12 of the participants the AAC device included voice output. The AAC device was the Flexiboard™ containing 16 messages needed to discuss a favorite autobiographical topic chosen by the participant and his/her family caregivers. Ten-minute conversations were videotaped in participants' residences and analyzed for four conversational measures related to the participants' communicative behavior. Results show that AAC devices with digitized voice output depress conversational performance and distract participants with moderate Alzheimer's disease as compared to similar devices without voice output. There were significantly more 1-word utterances and fewer total utterances when AAC devices included voice output, and the rate of topic elaborations/initiations was significantly lower when voice output was present. Discussion about the novelty of voice output for this population of elders and the need to train elders to use this technology is provided.

Three persons with multiple disabilities accessing environmental stimuli and asking for social contact through microswitch and VOCA technology

BACKGROUND

Direct access to environmental stimuli and opportunity to ask for social contact/attention may be considered highly relevant objectives for persons with multiple disabilities. We assessed the possibility of enabling three of these persons (two children and one adolescent) to combine two microswitches (for accessing environmental stimuli) and a Voice Output Communication Aid (VOCA), which allowed them to ask for caregiver's attention.

METHODS

Initially, the participants were required to use each of the two microswitches individually and then together. Thereafter, they were taught to use the VOCA. Eventually, the VOCA was available together with the microswitches, and the participants could use any of the three.

RESULTS

The results, which support preliminary data on this topic, showed that all participants (1) were able to operate the two microswitches as well as the VOCA; and (2) used all three of them consistently when they were simultaneously available.

CONCLUSIONS

Teaching persons with multiple disabilities to combine a VOCA with conventional microswitches may enrich their general input, emphasize their active social role and eventually enhance their social image.

Elation or frustration? Outcomes following the provision of equipment during the Communication Aids Project: data from one CAP partner centre

BACKGROUND

The Communication Aids Project (CAP) was a 4-year initiative by the UK Department for Education and Skills to provide communication equipment for students who were unable to speak in order to facilitate their access to education. Each child was given three goals or targets which were then evaluated after 6 months of provision of the communication aid.

METHODS

We evaluated the targets of 60 children, between the ages of 3 and 18 years. Six months after receipt of equipment, the targets were mailed to the initial referrer who was requested to record whether the child had achieved, partially achieved or not achieved each target. Evidence and explanations of these outcomes were also requested. Data were analysed using descriptive statistics, and the explanations were grouped into common themes using a keyword analysis.

RESULTS

Sixty-three per cent of targets were not achieved and 36% were achieved. We investigated any possible associations to attempt to explain some of the possible reasons for the children's non-achievement of targets. Targets were grouped into operational, linguistic, social and academic, but there were no differences between the successes because of target type. Age may be an influence on success, but neither school placement or type of communication aid influenced success. The explanations for non-achievement highlighted the misunderstanding or interpreting of the underlying skills of the communication aid user as a potential cause.

CONCLUSION

The CAP raised the profile of children with Augmentative and Alternative Communication needs within education. However, only one-third of the targets of children using the equipment were achieved. The reasons for this include inappropriate provision of equipment, demands of the equipment, lack of appropriate support and targets. The major consequence, however, is the need for detailed assessment and provision appropriate to the individual needs of each child. There is a need for research into the best methods of providing communication aids and the support needed for successful communication.

Enabling two persons with multiple disabilities to access environmental stimuli and ask for social contact through microswitches and a VOCA

This study assessed the combination of two microswitches with a voice output communication aid (VOCA) with two persons (an adolescent and a young adult) with multiple disabilities. The microswitches allowed the participants to obtain direct access to preferred environmental stimuli; the VOCA enabled them to ask for caregiver's attention. Initially, the participants were taught to use each of the two microswitches individually and then together. Next, they were taught to use the VOCA and, eventually, this was available together with the microswitches. Results showed that the participants learned to operate the microswitches and the VOCA and used all three of them consistently when they were simultaneously available. Implications of these findings and the potential role of a VOCA combined with conventional microswitches were discussed.

PECS and VOCAs to enable students with developmental disabilities to make requests: an overview of the literature

This paper provides an overview of the literature dealing with the use of the Picture Exchange Communication System (PECS) and voice output communication aids (VOCAs) for promoting the performance of requests by students with developmental disabilities. Computerized and manual searches were carried out to identify the studies published during the last 15 years (i.e., the period between 1992 and 2006 during which PECS and VOCA approaches became popular). Thirty-seven studies were identified and then divided into three groups concerning the use of the PECS or equivalents, the use of VOCAs or equivalents, and the comparison of both these approaches, respectively. Of the 173 students involved in studies using the PECS or equivalents only three could be considered failures, while a fourth one did not progress in the program due to illness. Similarly, of the 39 students who used VOCAs or equivalents only three could be considered failures, while one was partly successful. Finally, of the 11 students involved in the comparisons between PECS and VOCAs none could be classified as a failure. The results are very encouraging but methodological concerns and the relatively limited use of the systems in terms of request items and request opportunities suggest caution. Caution may also be needed in interpreting the reported similarities between the two systems in usability and effectiveness.

The state of research and practice in augmentative and alternative communication for children with developmental/intellectual disabilities

Augmentative and alternative communication is a compilation of methods and technology designed to supplement spoken communication for people with limited speech or language skills, including children with developmental and intellectual disabilities. The field of AAC has evolved rapidly within the last 10 years, due to a combination of empirical advances from research as well as rapid changes in technology. This article reviews some of the most significant aspects of this growth as it relates to children with developmental disabilities. Major issues within the field, the evidence base available to practitioners and researchers, and promising areas of future growth are identified.

Micro-switch programmes for students with multiple disabilities and minimal motor behaviour: assessing response acquisition and choice

This study assessed (a) whether three girls with multiple disabilities and minimal motor behaviour could acquire pairs of responses taught through micro-switch-based programmes and (b) how the girls would eventually choose between those responses. In relation to the choice issue, a response-choice analysis was conducted to find out whether possible differences in performance rates for the two responses were due to the stimuli linked to them and/or to potential response preferences. Results indicated that all three girls succeeded in the acquisition of the two responses programmed for them and showed clear response choices. The choices seemed to be largely motivated by the stimuli linked to the responses. Implications of these findings were discussed, including the need to assess their generality and extend the scope of the work in this area.

Extending the evaluation of a computer system used as a microswitch for word utterances of persons with multiple disabilities

BACKGROUND

Micro-switches can be vital tools to help individuals with extensive multiple disabilities acquire control of environmental stimulation. This study was aimed at extending the evaluation of a computer system used as a microswitch for word utterances with three participants with multiple disabilities.

METHOD

Sets of 7 or 12 word utterances were used for the participants. The utterances were divided into three groups, which were exposed to intervention successively. During the intervention and a 2-month post-intervention check, the participants' emission of the target utterances led the system to present favourite, matching stimuli (i.e. provided that it recognized the utterances).

RESULTS

Intervention data showed that (1) the participants increased the frequencies of the target utterances and (2) the computer system recognized approximately 80% of those utterances. These findings were maintained at the post-intervention check. An analysis of the levels of occurrence of individual utterances showed statistically significant differences among them, in line with the notions of preference and choice.

CONCLUSIONS

The computer system was useful as a microswitch to enable access to favourite stimuli. There is a need to improve the accuracy of the system with respect to its recognition of the participants' utterances.

Microswitch programs for persons with multiple disabilities: an overview of the responses adopted for microswitch activation

BACKGROUND

To introduce a person with multiple disabilities to a microswitch-aided program, one has to select a plausible response(s), that is, a response(s) that can be performed reliably and without excessive effort by the person and can successfully activate the microswitch(es) available (producing preferred stimuli). This paper provides an overview of the responses adopted for microswitch activation in research studies during the last 20 years.

METHOD

Computerized and manual searches were carried out to identify the studies published between 1986 and 2005. Forty-eight research studies were identified. They concerned the use of (1) a single (typical) response, (2) a single (non-typical) response, (3) multiple (typical and non-typical) responses, and (4) multiple (vocal) responses.

RESULTS AND DISCUSSION

The results showed that 151 of the 190 participants involved in the studies had a positive outcome (i.e., clear increases in their responding, which suggested that they had learned the association between responding and consequent preferred stimuli). Failures were largely concentrated in the first group of studies. The discussion focused on (a) the importance of selecting plausible responses for increasing the chances of success, (b) the need of non-typical responses for persons with minimal motor behavior, (c) implications of programs with multiple responses on engagement and choice, and (d) relevance of using vocal utterances. Some suggestions for future research concerning these points were also examined.

Effects of speech and print feedback on spelling by children with autism

In this systematic replication of a previous study (R. W. Schlosser, D. M. Blischak, P. J. Belfiore, C. Bartley, and N. Barnett, 1998), the effects of speech and print feedback on spelling performance were evaluated. Four children with autism and no functional speech were taught to spell words with a speech-generating device under 3 feedback conditions. In the auditory-visual condition, children received both speech and print feedback, whereas in the auditory and visual conditions, only 1 type of feedback was provided. An adapted alternating treatments design was used. All 4 children reached criterion across conditions. Although 3 children reached criterion first with print or speech-print feedback, 1 child was most efficient with speech-print followed by speech feedback. Based on the findings of both studies, 2 distinct profiles of feedback efficiency are proposed. Children that exemplify the primarily visual profile spell words most efficiently when feedback involves print. Children that fit the auditory profile spell words most efficiently when feedback involves speech. The implications for understanding the learning characteristics of children with autism, as well as those for practice and further research are derived.