Interacting with peers through conversation turntaking with a communication book adaptation

Supporting Peer Interactions for Students with Complex Communication Needs in Inclusive Settings: Paraeducator Roles

PURPOSE

This clinical focus article presents a review of literature supporting the importance of fostering positive peer interactions for students with complex communication needs. A resulting template is included to help guide educational teams, including speech-language pathologists (SLPs), in planning for paraeducator training specific to supporting peer interactions for children with CCN. This article summarizes the current literature available on inclusion and peer relationships for students with CCN in general education classrooms, and paraeducator roles and training. The World Health Organization (WHO) International Classification for Functioning, Disability and Health Children and Youth (ICF-CY) framework was consulted to help establish considerations relevant to paraeducator training. With many demands on the time of SLPs throughout the school day, paraeducators may offer an often untapped resource to help support positive peer relationships for students with CCN.

CONCLUSIONS

This article provides an overview of challenges that may impede positive peer relationships from developing in inclusive classroom settings, including ones related to: (1) the student with CCN, (2) the peers, (3) the AAC systems, or (4) the environment. The readers will be provided with a template to guide educational teams and SLPs in collaborating with paraeducators to foster positive peer interactions, including the following steps: (1) define goals for the student with CCN and determine supports required from paraeducators; (2) determine content of training for paraeducators; (3) choose an effective instructional approach; (4) establish a feasible training format; (5) implement the paraeducator training and evaluate outcomes to ensure benefits for students with CCN and their peers.

Interactions of Communication Partners and Students who are Deaf-Blind: A Model

This article examines various forms of communication systems for their “partner friendliness” and presents a model of different types of communication partners and their communication needs. Case samples illustrate how the forms of communication of two students who are deaf-blind were expanded to promote greater communication with a variety of partners in different settings.

Connections: Facilitating Social Supports for Students with Deaf-Blindness in General Education Classrooms

This article describes a three-component package to facilitate social supports for students who were deaf-blind in general education classes and discusses the rationale for and importance of its use. It also presents case examples of the application of social support strategies to four students with deaf-blindness who were served in general education or deaf education classes.

A Scoping Review of the Involvement of Children's Communication Partners in Aided Augmentative and Alternative Communication Modeling Interventions

Purpose The purpose of this study was to inform practice and research by identifying and synthesizing research on interventions in which natural communication partners implemented aided augmentative and alternative communication (AAC) modeling strategies. Method A scoping review yielded 29 studies. Data were charted related to participant characteristics, intervention characteristics, partner instruction and assessment, and partner perspectives of social validity. Results More than 157 peer and 100 adult communication partners (e.g., parents, special educators, paraprofessionals) implemented aided AAC modeling strategies within included studies. To teach communication partners intervention strategies, researchers frequently reported using (a) oral instruction, (b) modeling, and (c) practice or application opportunities with performance feedback. Partner instruction frequently involved both training and concurrent support (e.g., coaching, facilitation, consultation, follow-up support). Conclusion Findings from this review inform the design and delivery of aided AAC modeling interventions by children's natural communication partners. Findings also highlight important avenues for enhancing the rigor of future research on interventions involving aided AAC modeling, including the quality of reporting and application of principles from implementation science. Supplemental Material https://doi.org/10.23641/asha.8038505.

Systematic Review of Interventions Involving Aided AAC Modeling for Children With Complex Communication Needs

Building the communicative competence of individuals who use augmentative and alternative communication (AAC) requires intervention and support. This systematic review examined experimental studies involving aided AAC modeling to promote the expressive communication of children and youth (i.e., birth to age 21) with complex communication needs. A search yielded 48 studies involving 267 participants. Interventions were categorized according to three different approaches to aided AAC modeling-augmented input, models as prompts, and models within instructional demonstrations. Although the procedures varied, interventions were generally effective at improving diverse measures of expressive communication. This review provides insight for both researchers and practitioners by describing interventions involving three distinct approaches to aided AAC modeling, highlighting areas needing future research, and offering implications for practice.

Creating Socially Supportive Environments for Fully Included Students who Experience Multiple Disabilities

This investigation analyzed the effectiveness of an intervention designed to facilitate the social inclusion of three students who experienced significant physical and intellectual challenges and, for two students, dual sensory impairments. The children were full-time members of two first-grade and one fourth-grade classrooms. The individualized intervention package included three major components: (a) provision of ongoing information to classmates about the communication system, adaptive equipment, and educational activities of the students with disabilities in the context of naturally occurring interactions between the students and their classmates or during “club” meetings; (b) identification and utilization of various media that could serve as the basis for interactive exchanges between the focus students and others; and (c) ongoing facilitation by educational staff of social exchanges between students and their classmates through the establishment of a “buddy” system, arrangement of interactive activities across the day, and prompting and interpreting communicative exchanges when necessary. All aspects of intervention were implemented by educational staff including general education and inclusion support teachers, paraprofessionals, and related service personnel. An analysis of the interactive patterns between the focus students and others indicated that when the intervention was fully implemented, there were increases in (a) reciprocal interactions with peers, (b) focus student-initiated interactions, and (c) focus student-initiated interactions that were comments (with no increase in requests or protests). In addition, there were decreases in assistive interactions with paraprofessionals. The social validity of changes in interactive patterns between the focus students and their classmates was established through interviews with the students' friends and their teachers.

Elements of a Theoretical Structure that Will Support Best Practices in Communication Facilitation

Communication programming for individuals with severe disabilities often does not meet the requirements of best practices. One reason for this is that a dominant psycholinguistic model, the Dictionary + Rules model (pronounced “Dictionary plus Rules model”) provides a theoretical base that is inconsistent with best practices. In fact, the model's perspective on language and communication may be sufficiently inadequate and misleading to warrant not using this model as an approach to understanding the fundamental mechanisms underlying communicative behavior. An alternative model, the Context × Memory model (pronounced “Context times Memory model”) is described. This model is shown to support a view of communication and language that is consistent with emerging best practices and has new implications for language instruction. Adoption of this second model represents a paradigm shift, because this model's perspective on the relationship between cognition and language differs from that of the dominant model.

Promoting Interactive Partnerships in Inclusive Educational Settings

An analysis was conducted of the effectiveness of a multicomponent intervention designed to increase the social inclusion of three elementary-aged students with disabilities who were full-time members of general education classrooms. The intervention package included: (a) provision of information to classmates about the communication system and adapted curriculum and materials of the student with disabilities during natural opportunities, and regularly scheduled class meetings; (b) identification and utilization of various media (including “conversation books”) that could serve as the basis for interactive exchanges between the focus students and others; and (c) facilitation by educational staff of social exchanges between students and their classmates through the establishment of “partner systems,” arrangement of interactive activities across the day, and prompting and interpreting communicative exchanges when necessary. All aspects of the intervention, with the exception of the weekly class meetings, were implemented by educational staff including the general education teachers, inclusion support teachers, and instructional assistants. Analyses of the interaction patterns between the focus students and others suggsted that implementation of the social support package facilitated increased exchanges with peers that were more “balanced,” with the focus students more often initiating the interactions and providing information, rather than receiving communication or assistance. In addition comparisons of the interactions between the focus students and their peers with those of selected classmates revealed closer approximations to typical student-student exchanges during the intervention versus baseline condition. Finally, the social validity of changes in interaction patterns between the focus students and their classmates was evaluated.

What We Write about When We Write About AAC: The Past 30 Years of Research and Future Directions

For the past 30 years, the Augmentative and Alternative Communication (AAC) journal has both documented and instigated change in the field of AAC. We reviewed the papers published in the AAC journal from 1985-2014 in order to identify trends in research and publication activities. Intervention research made up the largest proportion of the four types of research (i.e., intervention, descriptive, experimental, and instrument and measurement development) reported in the journal. Intervention research has most commonly focused on the individual with complex communication needs, and most frequently on younger individuals (aged 17 and younger) with developmental disabilities. While much has been learned in the past 30 years, there continues to be a need for high quality research in a large number of areas. There is a special need for reports of interventions with older individuals with complex communication needs as a result of acquired disabilities, and for information on effective interventions for the communication partners of persons with complex communication needs.

Participation and Enjoyment in Play with a Robot between Children with Cerebral Palsy who use AAC and their Peers

This study explores children with complex communication needs, their peers and adult support persons in play with the talking and moving robot LekBot. Two triads were filmed playing with LekBot at pre-school. LekBot was developed to facilitate independent and enjoyable play on equal terms for children with significant communication disabilities and their peers. Using Conversation Analysis, participatory symmetry and enjoyment were investigated in relation to spoken and gestural communication, embodied stance, gaze, and affective display. Data originated from three video-recorded sessions that were approximately 2 hours long. Four different interaction situations were identified and explored: Participatory Asymmetry, Adult Facilitation, Greater Participatory Symmetry and Creativity, and Turn-taking and Enjoyable Play with LekBot. Neither participatory symmetry nor enjoyment were easily achieved in the play sessions and may require considerable effort, including adult involvement, but creative, spontaneous and highly enjoyable play, correlating with participatory symmetry to various degrees, was observed in a few instances. The findings are discussed with regard to play, AAC and the future development of robots to facilitate play.

Teaching Children and Young Adults with Mental Retardation in School Programs: Current Research

This paper reviews the recent behavioural research on instruction of children and young adults with mental retardation in schools settings and community-based school programs. Instructional research in 12 skill areas (motor, self-care, communication, social skills, choice making, school behaviours, health and safety skills, home management, leisure skills, community use, vocational skills, and academics) meeting specified criteria on population (age and disability), location of instruction, functionality of skill, and research integrity was identified in 11 journals from 1990 through 1996. The pool of identified research is discussed by skill category and by intervention method, with critical comments made regarding strengths and weaknesses. Conclusions are drawn for practitioners and future researchers.

Social interactions of students with disabilities who use augmentative and alternative communication in inclusive classrooms

The purpose of this study was to explore the naturally occurring social interactions for students with disabilities who use augmentative and alternative communication (AAC) in general education classrooms. We observed 16 students who used AAC and received services under the categories of autism or intellectual disability. Participants primarily interacted with their support personnel and infrequently conversed with peers despite often being in close proximity. Few interaction episodes were initiated by students who used AAC, and initiations to peers and adults appeared to serve somewhat different functions. Students with disabilities relied more heavily on facial expressions and gestures than on the use of their AAC devices. Recommendations for promoting interaction opportunities among students are offered, and future research directions are suggested.

Using blended and guided technologies in a university course for scientist-practitioners: teaching applied behaviour analysis to autism professionals

Although the incidence of autism spectrum disorders is increasing worldwide, there is a shortage of professionals trained to provide effective interventions. The article describes an advanced university course in Applied Behaviour Analysis (ABA) and autism tailored to meet the needs of Swedish professionals from multiple disciplines. The course implemented both blended-learning technologies (web, telecommunication, and in vivo) and guided-design (problem-solving) exercises to promote the scientist-practitioner model. Overall, students advanced their skills related to identifying extant scientific literature, choosing appropriate single-subject design evaluation methods, and critically analysing the effects of attempted interventions. Students rated the course as having high social validity and predicted the course content would positively affect their professional practice. The relevance of the course and future directions are discussed in the context of meeting the global need for effective autism intervention professionals.

The World Health Organization's International Classification of Functioning, Disability and Health: implications for clinical and research practice in the field of augmentative and alternative communication

In 2001, the World Health Organization (WHO) ratified and published a new classification system, the International Classification of Functioning, Disability and Health (ICF). There has been a varying amount of discussion and debate across the health and disability fields about what the ICF means and what it has to offer. However, there has been little discussion of its use and value in the field of augmentative and alternative communication (AAC). This article describes the earlier International Classification of Impairments, Disabilities, and Handicaps (ICIDH), upon which the current ICF was based; and outlines the ICF and the preliminary, derived Child and Youth version of the ICF (ICF-CY). The article also proposes what the ICF has to offer the AAC field, from both a clinical and research perspective; and concludes with a discussion of the advantages and challenges of using the ICF.

Responsiveness of male adolescents with mental retardation to input from nondisabled peers: the summoning power of comments, questions, and directive prompts

The expressive communication of individuals with cognitive impairments may be directly influenced by a partner's input, because such individuals often have limited conversational skills. Sequential analyses of dyadic interactions examined the effects of input by 32 normally developing adolescents on responses by male subjects with mental retardation whose communication modes included augmented communication. Results suggested that (a) verbal prompts in the form of questions were significantly more likely to receive responses from subjects with mental retardation than directive prompts, (b) comments were significantly more likely to receive responses from subjects with retardation than were directive prompts, when the nondisabled peer was male, and (c) male subjects with mental retardation were more likely to respond to input from male peers than from females. These data suggest that questions facilitate naturally occurring conversations but underscore the importance of evaluating gender-related effects on interaction involving persons with severe cognitive and communication impairments.