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Yau SH, Choo K, Tan J, Monson O, Bovell S. Comparing and contrasting barriers in augmentative alternative communication use in nonspeaking autism and complex communication needs: multi-stakeholder perspectives. Front Psychiatry 2024; 15:1385947. [PMID: 38919639 PMCID: PMC11197385 DOI: 10.3389/fpsyt.2024.1385947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024] Open
Abstract
Augmentative alternative communication (AAC) devices or systems are often prescribed to minimally verbal or nonspeaking autistic individuals and other individuals with complex communication needs to facilitate communication or as an alternative to spoken language. AAC use can result in communication gains and improved quality of life for minimally verbal or nonspeaking individuals. Despite this, AAC abandonment is high, limiting societal participation of the individual on the autism spectrum with complex communication needs. Our study is a novel exploration of the barriers of AAC use from a multi-stakeholder perspective, and a qualitative analysis of similarities and differences between stakeholders. We conducted semi-structured interviews and focus groups with 30 parent-carers, educators and clinicians currently supporting AAC users in Western Australia and analysed the data using reflexive thematic analysis. Barriers from each stakeholder group were coded, resulting in 17 subthemes forming five main themes common to all stakeholders: Stakeholder Knowledge, Stakeholder Attitudes and Stigma, Resources, AAC User Engagement, and Device Fit. Contrasting perspectives included actual and perceived stigma associated with AAC use (parent-carers vs clinicians); different struggles with resources and knowledge (parent-carers vs clinicians and educators); and a lack of clinician communication in the processes that determined AAC-fit for school environments (educators only). Findings are discussed in the context of improving inter-stakeholder collaboration and capacity building in Australian health service and practice to better support minimally verbal or nonspeaking autistic individuals and individuals with complex communication needs. Suggestions are also offered for communication partner training.
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Affiliation(s)
- Shu H. Yau
- School of Psychology, Murdoch University, Perth, WA, Australia
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Kaylynn Choo
- School of Psychology, Murdoch University, Perth, WA, Australia
| | - Jane Tan
- School of Psychology, Murdoch University, Perth, WA, Australia
| | - Olivia Monson
- School of Psychology, Murdoch University, Perth, WA, Australia
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Logan K, Iacono T, Trembath D. Aided Enhanced milieu teaching to develop symbolic and social communication skills in children with autism spectrum disorder. Augment Altern Commun 2024; 40:125-139. [PMID: 37823798 DOI: 10.1080/07434618.2023.2263558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 09/10/2023] [Indexed: 10/13/2023] Open
Abstract
Children who lack functional spoken language are candidates for augmentative and alternative communication (AAC). Aided AAC and naturalistic interventions offer the potential to extend the communication functions demonstrated by children with autism spectrum disorder (ASD) who are nonspeaking. Related intervention research, however, has been limited, in that interventions have generally targeted a limited range of communication functions taught in highly structured, decontextualized environments. The aim of this study was to investigate the efficacy of an intervention that combined aided AAC with a naturalistic intervention - enhanced milieu teaching (AEMT) - to increase symbolic communication in children with autism spectrum disorder. Three children with autism spectrum disorder participated in a multiple probe design, in which a range of communication functions were targeted using the AEMT. Results showed increases in the use of symbolic communication from baseline to intervention phases, which were found to be statistically significant for two of the three children (phi 0.7-0.81; p < .001). Intervention outcomes were generalized to a communication partner not involved in the intervention and maintained over time for all children. The study provides preliminary evidence that communication functions beyond object requests could be taught using a systematic, multi-element approach implemented across activities.
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Affiliation(s)
- Kristy Logan
- Faculty of Health, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Teresa Iacono
- La Trobe Rural Health School and Living with Disability Research Centre, La Trobe University, Bendigo, Victoria, Australia
| | - David Trembath
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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Edgar TC, Schlosser R, Koul R. Effects of an Augmentative and Alternative Communication Intervention Package on Socio-Communicative Behaviors Between Minimally Speaking Autistic Children and Their Peers. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-20. [PMID: 38771825 DOI: 10.1044/2024_ajslp-23-00313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
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.
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Affiliation(s)
| | - Ralf Schlosser
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - Rajinder Koul
- Department of Speech, Hearing, and Language Sciences, The University of Texas at Austin
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Holyfield C, MacNeil S, Caldwell N, O'Neill Zimmerman T, Lorah E, Dragut E, Vucetic S. Leveraging Communication Partner Speech to Automate Augmented Input for Children on the Autism Spectrum Who Are Minimally Verbal: Prototype Development and Preliminary Efficacy Investigation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1174-1192. [PMID: 38290536 DOI: 10.1044/2023_ajslp-23-00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE Augmentative and alternative communication (AAC) technology innovation is urgently needed to improve outcomes for children on the autism spectrum who are minimally verbal. One potential technology innovation is applying artificial intelligence (AI) to automate strategies such as augmented input to increase language learning opportunities while mitigating communication partner time and learning barriers. Innovation in AAC research and design methodology is also needed to empirically explore this and other applications of AI to AAC. The purpose of this report was to describe (a) the development of an AAC prototype using a design methodology new to AAC research and (b) a preliminary investigation of the efficacy of this potential new AAC capability. METHOD The prototype was developed using a Wizard-of-Oz prototyping approach that allows for initial exploration of a new technology capability without the time and effort required for full-scale development. The preliminary investigation with three children on the autism spectrum who were minimally verbal used an adapted alternating treatment design to compare the effects of a Wizard-of-Oz prototype that provided automated augmented input (i.e., pairing color photos with speech) to a standard topic display (i.e., a grid display with line drawings) on visual attention, linguistic participation, and (for one participant) word learning during a circle activity. RESULTS Preliminary investigation results were variable, but overall participants increased visual attention and linguistic participation when using the prototype. CONCLUSIONS Wizard-of-Oz prototyping could be a valuable approach to spur much needed innovation in AAC. Further research into efficacy, reliability, validity, and attitudes is required to more comprehensively evaluate the use of AI to automate augmented input in AAC.
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Affiliation(s)
- Christine Holyfield
- Department of Communication Disorders and Occupational Therapy, University of Arkansas, Fayetteville
| | - Stephen MacNeil
- Department of Computer and Information Sciences, Temple University, Philadelphia, PA
| | - Nicolette Caldwell
- Department of Communication Disorders and Occupational Therapy, University of Arkansas, Fayetteville
| | - Tara O'Neill Zimmerman
- Department of Communication Disorders and Occupational Therapy, University of Arkansas, Fayetteville
| | - Elizabeth Lorah
- Department of Curriculum and Instruction, University of Arkansas, Fayetteville
| | - Eduard Dragut
- Department of Computer and Information Sciences, Temple University, Philadelphia, PA
| | - Slobodan Vucetic
- Department of Computer and Information Sciences, Temple University, Philadelphia, PA
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Forbes EJ, Morison LD, Lelik F, Howell T, Debono S, Goel H, Burger P, Mandel JL, Geneviève D, Amor DJ, Morgan AT. Speech and language in DDX3X-neurodevelopmental disorder: A call for early augmentative and alternative communication intervention. Am J Med Genet B Neuropsychiatr Genet 2024:e32971. [PMID: 38421120 DOI: 10.1002/ajmg.b.32971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/16/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
Pathogenic variants in DDX3X are associated with neurodevelopmental disorders. Communication impairments are commonly reported, yet specific speech and language diagnoses have not been delineated, preventing prognostic counseling and targeted therapies. Here, we characterized speech and language in 38 female individuals, aged 1.69-24.34 years, with pathogenic and likely pathogenic DDX3X variants (missense, n = 13; nonsense, n = 12; frameshift, n = 7; splice site, n = 3; synonymous, n = 2; deletion, n = 1). Standardized speech, language, motor, social, and adaptive behavior assessments were administered. All participants had gross motor deficits in infancy (34/34), and fine motor deficits were common throughout childhood (94%; 32/34). Intellectual disability was reported in 86% (24/28) of participants over 4 years of age. Expressive, receptive, and social communication skills were, on average, severely impaired. However, receptive language was significantly stronger than expressive language ability. Over half of the assessed participants were minimally verbal (66%; 22/33; range = 2 years 2 months-24 years 4 months; mean = 8 years; SD = 6 years) and augmented speech with sign language, gestures, or digital devices. A quarter of the cohort had childhood apraxia of speech (25%; 9/36). Despite speech and language impairments, social motivation was a relevant strength. Many participants used augmentative and alternative communication (AAC), underscoring the need for early, tailored, and comprehensive AAC intervention.
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Affiliation(s)
- Elana J Forbes
- Speech & Language, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lottie D Morison
- Speech & Language, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Fatma Lelik
- Speech & Language, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Tegan Howell
- Speech & Language, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Simone Debono
- Speech & Language, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Himanshu Goel
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Genetics, Waratah, New South Wales, Australia
| | - Pauline Burger
- Department of Neurogenetics and Translational Medicine, Institute of Genetics and Molecular and Cellular Biology (IGBMC), Université de Strasbourg, INSERM U1258, CNRS UMR7104, Illkirch, France
| | - Jean-Louis Mandel
- Department of Neurogenetics and Translational Medicine, Institute of Genetics and Molecular and Cellular Biology (IGBMC), Université de Strasbourg, INSERM U1258, CNRS UMR7104, Illkirch, France
- University of Strasbourg Institute for Advanced Studies (USIAS), Strasbourg, France
| | - David Geneviève
- Génétique Clinique, Départment de Génétique Médicale, Maladies Rares et Médecine Personnalisée, CHU Montpellier, Montpellier University, Centre de Référence Anomalies du Développement SOOR, Montpellier, France
| | - David J Amor
- Speech & Language, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Angela T Morgan
- Speech & Language, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville, Victoria, Australia
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