Increasing Reciprocal Social Interactions Between Children Who Use Augmentative and Alternative Communication and Peers Using a Collaborative Learning Framework

PURPOSE

Children with complex communication needs who rely on augmentative and alternative communication (AAC) strategies to express themselves face significant difficulties interaction with peers. This study sought to design, implement, and evaluate a collaborative photography intervention designed to increase reciprocal social interaction between children who use AAC and their same-age peers.

METHOD

A single-subject, withdrawal design (ABAB) was used to explore the functional relationship between engagement in a collaborative photography intervention and the frequency of reciprocal social interactions between children who use AAC and their same-age peers. Partial-interval time sampling was used to code the number of reciprocal social interactions across four dyads.

RESULTS

Increased frequencies of reciprocal social interactions were observed in intervention phases across all four dyads. Very large levels of effect and 100% nonoverlapping data were noted for Dyads 1 and 4. Moderate levels of effect and 70% of nonoverlapping data were noted for Dyads 2 and 3.

CONCLUSIONS

Collaborative learning frameworks may be used to increase reciprocal social interactions between children who use AAC and their peers. Speech-language pathologists should consider utilizing collaborative learning elements in activities with children who use AAC. Future research is needed to further explore collaborative learning frameworks for interventions for children who use AAC.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25464064.

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.

Evaluating the Effects of Placement of Students with Severe Disabilities in General Education versus Special Classes

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This investigation examined the effects of self-prompted communication book training provided by peers on the conversational initiations of four high school students with extensive support needs. The intervention was associated with increases in participants' appropriate initiations and general education conversational partners' corresponding responses. The self-prompting strategy also was associated with increases in conversational topics discussed and decreases in inappropriate initiations by participants. In addition, interviews conducted postintervention generally indicated that participants believed they had (a) met their social goals to increase their interactions with their general education peers and (b) made more friends at school. Implications of findings are discussed and suggestions made for future programmatic efforts.

Enhancing Communication with Persons Labeled Severely Disabled

Among the most important philosophical shifts in our perspective on persons labeled severely disabled has been a change from an exclusive emphasis on remediation of deficit behavior to a positon of empowering and enabling persons with disabilities to participate in all aspects of everyday living. Fundamental to that shift is the reconsideration of the role of persons without obvious disabilities. In this paper introducing a special issue on communication, we examine the role of communication partners in enhancing communication with persons labeled severely disabled. Three fundamental assumptions about the nature of communication are discussed. The papers contained in the volume are reviewed briefly and recommendations for future research are considered.

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.

Supporting High School Students to Engage in Recreational Activities with Peers

The authors investigated the effects of an intervention package to support five high school students with extensive support-needs to initiate and engage in recreational activities with general-education peers in their physical education classes. The intervention components were (a) assessing participants’ recreational activity goals, (b) teaching self-prompting using a picture book, (c) programming common stimuli, and (d) asking participants to assess daily performance and evaluate daily goal achievement. The intervention was associated with increases in participants’ initiation of and engagement in recreational activities with general-education peers, as well as increases in ratings of quality of interaction. In addition, participants typically assessed with accuracy their performance of recreational activities and whether they had achieved their recreational goals. Findings are discussed with respect to future research and practice.

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.

Effects of augmentative and alternative communication on challenging behavior: a meta-analysis

The purposes of this review were to (a) use meta-analytic procedures to examine the effectiveness of single-case AAC intervention research on challenging behaviors exhibited by individuals with disabilities, (b) identify study characteristics that moderate intervention effects, and (c) evaluate the quality of research. The authors provided inferential and descriptive analyses of 54 studies representing 111 participants and estimated effect sizes using the Nonoverlap of All Pairs (NAP) method. Overall, AAC interventions were found to be equally effective across a broad spectrum of participants and interventions. AAC interventions were more effective with younger children than with adults. Interventions in which functional behavior assessments (FBA) were used had significantly larger effect sizes than those that did not use FBAs. Further, functional communication training interventions resulted in larger effect sizes than Picture Exchange Communication System interventions. Descriptive analysis revealed that (a) interventions often occurred in atypical environments (e.g., therapy room, experimental room) and with atypical interventionists (e.g., therapists, researchers), and (b) numerous studies did not exhibit quality characteristics of single-case research.

Social and Communicative Interventions and Transition Outcomes for Youth with Disabilities

The relationship between social and communicative interventions and transition-related outcomes for secondary-aged youth with disabilities is explored in this systematic review. In all, 30 studies intervening with 316 youth with a broad range of disability labels (both high- and low-incidence disabilities) were reviewed. Subgroup analyses were conducted on original research in these areas: augmentative and alternative communication (AAC), conversation skills, decreasing aberrant behavior, and social skills training (SST). Little support was found for AAC and modest support for interventions designed to increase conversation skill acquisition and for SST, and the research in decreasing aberrant behavior was unable to be synthesized because of effect size calculation formula problems. Results are discussed in terms of alignment with extant literature reviews, methodological issues in meta-analysis, recommendations for further research, and practical implications.

Functional communication training using assistive devices: recruiting natural communities of reinforcement

We evaluated the effectiveness of functional communication training (FCT) as an intervention for the problem behavior exhibited by 5 students with severe disabilities both in school and in the community. Following an assessment of the function of their problem behavior, the students were taught to use assistive communication devices in school to request the objects and activities that presumably were maintaining their behavior. Multiple baseline data collected across the students indicated that not only did the students use their devices successfully, but the intervention also reduced their problem behavior. In addition, data from community settings showed generalization to untrained community members. These results replicate other successful efforts to use FCT with individuals having limited communication skills, and demonstrate the value of teaching skills to recruit natural communities of reinforcement in order to generalize intervention effects to meaningful nontraining environments.

The Ability of Children With Language Impairment to Manipulate Topic in a Structured Task

This study investigated the way in which 10 children with specific language impairment (SLI), 10 typical children of similar chronological ages (CA), and 10 typical children at similar levels of language functioning (LS) maintained topics that were introduced to them by an adult investigator. Two different types of topics were introduced in interaction with each child. One topic type involved verbal introduction of an object, the other involved verbal introduction of an event. Although most subject in all groups contributed appropriate utterances in response to the examiner’s topics, subjects with SLI contributed more inappropriate utterances than subject in either of the other groups. Children with SLI demonstrated particular difficulty with verbal topics when compared with their CA and LS peers.

Teaching choice making during social interactions to students with profound multiple disabilities

We taught 4 students with profound multiple disabilities to use a microswitch communication system to request a change in recreational stimuli during social interactions with nondisabled peers. In Study 1, we conducted a preference assessment across a range of stimuli for each student. The most and least preferred stimuli were incorporated into microswitch communication system training in Study 2. During the second study, 3 of the 4 students (a) learned to use the microswitch communication system to control stimulus presentation, (b) more clearly differentiated their time among stimuli, and (c) increased their level of general alertness. Study 3 extended the use of the microswitch communication system to social interactions with nondisabled peers. Two students were more engaged in interactions when they chose when to change stimuli; 1 student was more alert when a peer chose when to change activities; a 4th student showed an undifferentiated pattern. The outcomes of the investigation are discussed in terms of the effects of controlling stimulus presentation on the behavior of students with profound multiple disabilities and the stability of preference hierarchies over time.

An analysis of maintenance following functional communication training

The multiple and long-term effects of functional communication training relative to a common reductive procedure (time-out from positive reinforcement) were evaluated. Twelve children participated in a functional analysis of their challenging behaviors (Study 1), which implicated adult attention as a maintaining variable. The children were then matched for chronological age, mental age, and language age and assigned to two groups. One group received functional communication training as an intervention for their challenging behavior, and the second group received time-out as a contrast. Both interventions were initially successful (Study 2), but durable results were achieved only with the group that received functional communication training across different stimulus conditions (Study 3). Students whose challenging behaviors were previously reduced with time-out resumed these behaviors in the presence of naive teachers unaware of the children's intervention history. The value of teaching communicative responses to promote maintenance is discussed as it relates to the concept of functional equivalence.

Improving social skills and disruptive behavior in children with autism through self-management

The literature suggests that children with autism typically are unresponsive to verbal initiations from others in community settings, and that such unresponsiveness can lead to problematic social interactions and severely disruptive behavior. The present study assessed whether self-management could be used as a technique to produce extended improvements in responsiveness to verbal initiations from others in community, home, and school settings without the presence of a treatment provider. The results showed that children with autism who displayed severe deficits in social skills could learn to self-manage responsivity to others in multiple community settings, and that such improvements were associated with concomitant reductions in disruptive behavior without the need for special intervention. The results are discussed in terms of their significance for improved development of social skills in children with autism.