Self-Determination for Individuals with the Most Severe Disabilities: Moving beyond Chimera

Individuals with the most severe disabilities may be unsuccessful in effecting changes in their environment for various reasons. Because of limitations in cognitive and expressive language skills, their attempts at communicating may be overlooked or misunderstood, or may be knowingly or inadvertently obstructed. Consequently, self-determination is often dependent on our interpretation of what people with the most severe disabilities are communicating. This article explores the implications of making interpretations, the need for such interpretations, and the dangers. Current progress in supporting and promoting self-determination are acknowledged. It is suggested that although these procedures may be intended to increase self-determination, they do not automatically do so. In fact, they may function to limit self-determination. Strategies and methodologies must be critically evaluated to ensure that such efforts reflect the tenets and spirit of self-determination.

Communication interventions for minimally verbal children with autism: a sequential multiple assignment randomized trial

OBJECTIVE

This study tested the effect of beginning treatment with a speech-generating device (SGD) in the context of a blended, adaptive treatment design for improving spontaneous, communicative utterances in school-aged, minimally verbal children with autism.

METHOD

A total of 61 minimally verbal children with autism, aged 5 to 8 years, were randomized to a blended developmental/behavioral intervention (JASP+EMT) with or without the augmentation of a SGD for 6 months with a 3-month follow-up. The intervention consisted of 2 stages. In stage 1, all children received 2 sessions per week for 3 months. Stage 2 intervention was adapted (by increased sessions or adding the SGD) based on the child's early response. The primary outcome was the total number of spontaneous communicative utterances; secondary measures were the total number of novel words and total comments from a natural language sample.

RESULTS

Primary aim results found improvements in spontaneous communicative utterances, novel words, and comments that all favored the blended behavioral intervention that began by including an SGD (JASP+EMT+SGD) as opposed to spoken words alone (JASP+EMT). Secondary aim results suggest that the adaptive intervention beginning with JASP+EMT+SGD and intensifying JASP+EMT+SGD for children who were slow responders led to better posttreatment outcomes.

CONCLUSION

Minimally verbal school-aged children can make significant and rapid gains in spoken spontaneous language with a novel, blended intervention that focuses on joint engagement and play skills and incorporates an SGD. Future studies should further explore the tailoring design used in this study to better understand children's response to treatment. Clinical trial registration information-Developmental and Augmented Intervention for Facilitating Expressive Language (CCNIA); http://clinicaltrials.gov/; NCT01013545.

Supporting communication in young children with developmental disabilities

The behavior of parents, adult caregivers, and peers comprises the critical features of community support for the development of communication in young children with developmental disabilities. In a bio-ecological model of development, communication development is the result of the interactions of individuals with specific characteristics, in particular contexts over time. From the perspective of this model, foundational findings of intervention research to current views of communication development in children with developmental disabilities are summarized. The contributions of individual child characteristics to child-caregiver interactions that support language development are illustrated based on research with children who have autism, Williams syndrome, Down syndrome, and children who use augmentative communication systems. Parent-child interaction and the quality and quantity of parent talk are discussed as factors in children's language development. The effects of young children's delayed language on their interactions with peers, the contributions of peers to children's language learning and use, and the critical features of classroom settings that support child language development are reviewed. MRDD Research Reviews 7:143-150, 2001.