An Applied Model of Interprofessional Collaboration-Assessment (AMIC-A): A Process-Based Approach to Augmentative and Alternative Communication.

Speech-language pathologists and board-certified behavior analysts both provide important support services to children who are candidates for augmentative and alternative communication. Current assessment practices neglect critical socioecological factors that are necessary to inform communication-based interventions. By leveraging the unique knowledge, research, and expertise of both disciplines, an interprofessional approach to assessment may help realize individualized or precision interventions and personalized supports that address the unique communication needs of each person. The purpose of this article is to introduce a process-based approach to assessment called the "Applied Model of Interprofessional Collaboration-Assessment (AMIC-A)." The AMIC-A will be defined and detailed including the rationale for development, a description of the approach, and recommendations for implementation. A case study example is provided to illustrate implementation of the AMIC-A.

An Interprofessional Graduate Student and Family Coaching Program in Naturalistic Communication Techniques.

Researchers implemented a short-term cascading coaching model focusing on naturalistic developmental behavioral intervention with three participant triads. Triads consisted of a graduate student clinician, a minimally verbal child with autism spectrum disorder, and the child's parent. Coaching and intervention occurred during an interprofessional summer clinic that included graduate student clinicians from special education and speech and hearing sciences departments. The efficacy of short-term instruction, researcher coaching for student clinicians, and student clinician coaching of parents was evaluated using a multiple baseline across participants' design. The dependent variables were student clinician's and parent's use of elicitation techniques (creating communication temptations, waiting, and prompting) and response techniques (naturally reinforcing children's communication and providing spoken language models). Following coaching, parents and student clinicians from all triads increased their use of elicitation and response techniques, with very large effect sizes across all variables. Visual analysis findings suggest individualized differences and variability across triads. Implications for graduate education and parent coaching programs are discussed.

Dynamic Assessment of AAC Action Verb Symbols for Children with ASD.

Objectives: The purpose of this study was to determine whether children with autism spectrum disorder (ASD) make progress in learning to use action verb symbols on augmentative and alternative communication (AAC) applications across different communicative functions (requesting, labeling) and instructional formats (embedded instruction, discrete trial teaching). Methods: Four preschool-aged children completed graduated prompting dynamic assessment sessions in which they were provided with varying levels of support (e.g., models, gestures) across three instructional conditions: (a) requesting actions embedded in play, (b) labeling actions embedded in play, and (c) labeling actions presented via video during discrete trial teaching. An adapted multielement single-case design was used to compare participants' abilities to use symbols with different levels of support across the instructional conditions and a control. Results: Differences between instructional and control conditions were established for three participants. Three participants also reduced the levels of support they needed to use symbols in at least two instructional conditions. Although participants initially required lower levels of support (i.e., less restrictive prompts) in the requesting condition compared to labeling conditions, these differences only maintained for one participant. Across participants, differences between labeling conditions were minimal. Conclusions: Although children with ASD can use verb symbols with low levels of support during DA, additional intervention may be needed to increase independent responding. Individual characteristics may influence success across communicative functions.

Aided Language Measures: Establishing Observer Agreement for Communicators in Early Language Phases.

PURPOSE: Although many valid, reliable, and developmentally sensitive measures exist to monitor the language gains of children who rely on spoken language to communicate, the same is not true for graphic symbol communicators. This study is a first step in developing such measures by examining the interobserver agreement (IOA) and within-observer agreement of 13 measures designed to monitor the language progress of children who use aided augmentative and alternative communication (AAC). These measures are based on the Graphic Symbol Utterance and Sentence Development Framework (Binger et al., 2020) and are hypothesized to capture various phases of graphic symbol communication. METHOD: Four graduate student observers coded 13 measures across 57 different play-based sessions of children with Down syndrome ages 3;0-5;11 (years;months). For IOA, sessions were coded by two different observers. For within-observer agreement, all sessions were recoded by the same coders. Corpus-level analyses were completed to characterize the nature of the samples (e.g., average mean length of utterance for the samples). IOA and within-observer agreement were examined for each utterance. RESULTS: Across all observers and measures, acceptable levels of IOA and within-observer agreement were achieved, with most measures yielding relatively high levels of agreement. Some differences were noted across measures, with the less experienced coders demonstrating less agreement on select measures. CONCLUSIONS: Results provide initial evidence that many measures based on the Graphic Symbol Utterance and Sentence Development Framework can be reliably coded. These findings are a first step in developing psychometrically sound measures to monitor the expressive language progress of children who use AAC. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19601551.

Naturalistic Communication Training for Early Intervention Providers and Latinx Parents of Children with Signs of Autism.

In this study, researchers implemented a brief training plus coaching program in naturalistic developmental behavioral intervention with three participant triads. Each triad consisted of an early intervention provider, an English-speaking Latinx parent, and that parent's young child with autism spectrum disorder (ASD) or early signs of ASD who had limited vocal speech. The effects a single training session, plus two researcher coaching sessions were evaluated using a nonconcurrent multiple probes across participants design. Primary dependent variables included (a) the number of completed targeted communication turns between the parent and child and (b) the number of child independent target communication responses (gestures and manual signs) during family-selected routines. Additional measures examined whether parents used strategies taught to them during training, and whether early intervention providers addressed strategies taught via coaching. A social validity measure was used to determine parent and provider views of the training. Due to COVID-19 restrictions, training and post-training sessions were delivered via telehealth for two triads. While data trends and variability differed across triads, following training, all three families increased the number of completed target communication turns and all three children showed higher rates of independent communication responses. Parents and providers implemented strategies taught and reported positive effects of the program. Implications regarding the use of naturalistic intervention methods for Latinx families, the utility of brief training models to meet the needs of under-resourced early intervention programs, and potential uses of telehealth are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s10882-021-09794-w.

A parent-implemented embedded AAC intervention for teaching navigational requests and other communicative functions to children with Autism spectrum disorder.

This study evaluated the effectiveness of an embedded naturalistic intervention for teaching augmentative and alternative communication (AAC) application responses to three preschool-aged males with autism spectrum disorder (ASD). Parents were taught to embed opportunities for their child to communicate with a grid-based AAC application during every-day routines such as play or mealtime. Communication targets included requesting objects using two-step taxonomic navigational responses, and requesting assistance, rejecting items, or making social comments/responses using a two-step message-strip response. During intervention, parents used strategies such as time delay, prompting, reinforcement, and device proximity (faded over time) to encourage target responses. Display formats and intervention targets were selected in consideration of prior dynamic assessment results. Effects of intervention were evaluated using a multiple probe across participants design. For functional navigational AAC item requesting, all three participants showed an immediate increase in responding that maintained at high levels. Functional AAC responding for other communicative purposes also increased, but at a more gradual pace. All three participants showed generalized responding when new items were added to displays, and when display pages with a larger array of folders and vocabulary items were introduced. Generalization to labeling tasks was mixed.

Dynamic assessment of augmentative and alternative communication application grid formats and communicative targets for children with autism spectrum disorder.

Six children with autism spectrum disorder (ASD) participated in dynamic assessment to determine whether the complexity of grid-based augmentative and alternative communication (AAC) application displays impacted the level of instructional supports needed for responding across different communicative functions/parts of speech. Dynamic assessment was integrated into a single-case multi-element design. The researchers examined the effects of three different display formats that varied in (a) array size, and (b) the number of steps needed to make a response, on the average levels of support needed to make item requests and action/social word responses. Three participants demonstrated high levels of independence when requesting items with displays that utilized small arrays and did not require navigation. These participants also showed rapid increases in their ability to make item requests with displays that required two-step navigation, and began to use action and social words across displays with decreasing levels of support. In comparison, the three remaining participants did not demonstrate consistent independence with any display or communicative function, but did show differences in levels of supports (e.g., overall less support needed for less complex displays and for item requests in comparison to action and social words). Implications for individualized AAC assessment and display selection for children with ASD are discussed.

Teaching Preschoolers With Autism to Use Different Speech-Generating Device Display Formats During Play: Intervention and Secondary Factors.

Purpose Children with autism spectrum disorder (ASD) and complex communication needs are increasingly taught to use tablet-based speech-generating devices (SGDs). An important issue in designing such interventions is the selection of an appropriate format for displaying vocabulary. The purpose of this study was to determine (a) whether young children with ASD can be taught to use different SGD vocabulary display formats and (b) whether there are differences across the formats on a range of secondary measures (e.g., preference and generalization). Method Five preschoolers with ASD (and prior experience with simpler aided augmentative and alternative communication) were taught to use grid and visual scene display SGDs during a play-based intervention. Acquisition of functional responding was assessed using a single-case experimental design. Secondary variables included error types, antecedents for communication, preference, and generalization. Results All participants increased their use of functional target vocabulary using both the grid and the simple visual scene display. Of the five participants, three showed similar performance with both formats, whereas two had slightly higher rates of functional responding with the grid. Individualized differences across participants and formats were apparent across secondary variables (e.g., preference, error types, generalization). Conclusions Both simple grid and visual scene displays may be viable options when teaching functional use of SGDs to children with ASD who have prior aided augmentative and alternative communication experience. Analyzing secondary variables beyond device acquisition (e.g., generalization, preference) may have implications for individualizing intervention.

Introduction to the Special Issue: Communication Intervention for Individuals with Complex Communication Needs.

Individuals with complex communication needs are likely to experience considerable difficulties and challenges with everyday communication interactions due to limited use and understanding of natural speech. In this editorial, we review the nature of complex communication needs, describe the wide range of individuals who may experience such needs, and provide a brief history of behavioral approaches to addressing these needs. We also highlight the six papers in this special issue that contribute to the further understanding of the use of behavioral intervention approaches for addressing complex communication needs. These papers include one conceptual overview of aided augmentative and alternative communication (AAC) interventions for individuals with complex communication needs, four intervention studies addressing a range of communicative topographies (i.e., vocal speech, AAC, and a social messaging app), and one systematic review examining interventions that promote communicative response variability. These six papers highlight the diversity of complex communication needs and emphasize the importance of examining the efficacy of a wide range of individualized behavioral approaches that are matched to specific needs and goals.

Naturalistic Speech-Generating Device Interventions for Children With Complex Communication Needs: A Systematic Review of Single-Subject Studies.

Purpose: This article presents a systematic review that aimed to synthesize single-subject-design studies that have examined naturalistic interventions for teaching the expressive use of speech-generating devices (SGDs) to children with complex communication needs. Specifically, this review describes what intervention strategies are most commonly applied in studies with positive effects and minimal methodological flaws and examines the populations and outcomes for which these strategies have been effective. Method: A systematic approach was used to qualitatively code variables of interest to this review. Results were summarized via both visual analysis and effect size methods, and a certainty of evidence methodology was adopted to describe the quality of the evidence. Results: Thirty-two unique studies met inclusion criteria, with 19 having consistent positive results and meeting minimum requirements for certainty of evidence. Although studies used a variety of titles to describe intervention packages (e.g., milieu teaching, interaction strategies), certain strategies were common across studies. These included (a) creating and capturing communication opportunities via methods such as time delay and questioning; (b) providing feedback via methods such as reinforcement of requests, praise, or expansions; (c) prompting (verbal, physical, gestural); (d) modeling; and (e) training communication partners. Conclusions: Findings regarding these intervention components help to provide practical guidelines for naturalistic SGD intervention. Limitations of the current body of research (e.g., need to include more home-based studies and more intermediate to advanced SGDs, need to critically analyze the most critical intervention components) provide suggestions for future research. Supplemental Material: https://doi.org/10.23641/asha.6615332.

Assessing the acquisition of requesting a variety of preferred items using different speech generating device formats for children with autism spectrum disorder.

Five children with autism spectrum disorder (ASD) were taught to request preferred items using four different augmentative and alternative communication (AAC) displays on an iPad®-based speech-generating device (SGD). Acquisition was compared using multi-element designs. Displays included a symbol-based grid, a photo image with embedded hotspots, a hybrid (photo image with embedded hotspots and symbols), and a pop-up symbol grid. Three participants mastered requesting items from a field of four with at least three displays, and one mastered requesting items in a field of two. The fifth participant did not acquire requests in a field of preferred items. Individualized display effects were present, and the photo image appeared to have provided the most consistent advantages for three participants. Some errors were more or less common with specific displays and/or participants. The results have important implications for AAC assessment and implementation protocols.

Evidence-Based Social Communication Interventions for Children with Autism Spectrum Disorder.

Impairments in social communication skills are a core feature of autism spectrum disorder (ASD) and include deficits in social-emotional reciprocity, non-verbal communicative behaviors used for social interaction, and developing, maintaining, and understanding relationships. In order to improve outcomes for children with ASD, much research has been focused on developing effective interventions to treat these social communication deficits. The purpose of this paper is to highlight the evidence-based practices found within the intervention literature that specifically targets social communication impairments and provide an overview of these strategies. Four relevant themes regarding evidence-based social communication interventions are considered and discussed: (a) social communication outcomes and practices relevant to different stages of development, (b) practices that both reduce interfering behaviors and improve social communication skills,

Increasing the vocalizations of individuals with autism during intervention with a speech-generating device.

This study aimed to teach individuals with autism spectrum disorder (ASD) and limited vocal speech to emit target vocalizations while using a speech-generating device (SGD). Of the 4 participants, 3 began emitting vocal word approximations with SGD responses after vocal instructional methods (delays, differential reinforcement, prompting) were introduced. Two participants met mastery criterion with a reinforcer delay and differential reinforcement, and 1 met criterion after fading an echoic model and prompt delay. For these participants, vocalizations initiated before speech outputs were shown to increase, and vocalizations generalized to a context in which the SGD was absent. The 4th participant showed high vocalization rates only when prompted. The results suggest that adding vocal instruction to an SGD-based intervention can increase vocalizations emitted along with SGD responses for some individuals with ASD.

A review of peer-mediated social interaction interventions for students with autism in inclusive settings.

This review addresses the use of peer-mediated interventions (PMI) to improve the social interaction skills of students with autism spectrum disorder (ASD) in inclusive settings. The purpose of this review is to (a) identify the characteristics and components of peer-mediated social interaction interventions, (b) evaluate the effectiveness of PMI by offering an analysis of intervention results and research design, and (c) suggest directions for future research. Overall, results suggest that PMI is a promising treatment for increasing social interaction in children, adolescents, and young adults with ASD in inclusive settings, with positive generalization, maintenance, and social validity outcomes. Findings also suggest that participant characteristics and the type of social deficit an individual exhibits are important considerations when choosing the optimal configuration of PMI strategies.

Comparing acquisition of AAC-based mands in three young children with autism spectrum disorder using iPad® applications with different display and design elements.

Augmentative and alternative communication (AAC) applications may differ in their use of display and design elements. Using a multielement design, this study compared mand acquisition in three preschool-aged males with autism spectrum disorder, across three different displays in two iPad(®) AAC applications. Displays included a Widgit symbol button (GoTalk), a photographical hotspot (Scene and Heard), and a Widgit symbol button along with a photograph (Scene and Heard). Applications had additional design differences. Two participants showed more rapid and consistent acquisition with the photographical hotspot than with the symbol button format, but did not master the combined format. The third participant mastered all three conditions at comparable rates. Results suggest that AAC display and design elements may influence mand acquisition.

Comparing communication systems for individuals with developmental disabilities: a review of single-case research studies.

Studies that have compared different communication systems for individuals with developmental disabilities were systematically reviewed in an effort to provide information useful for clinical decision making and directions for future research. Specifically, 28 studies that compared (a) non-electronic picture systems to speech generating devices, (b) aided AAC (e.g. picture exchange systems and SGDs) to unaided AAC systems (manual sign), or (c) AAC to speech-language interventions were included in this review. Dependent variables forming the basis for comparison included: (a) effectiveness (e.g. acquisition of systems and/or rate of use), (b) efficiency or rate of skill acquisition (c) participants' preference for systems, (d) occurrence of vocalizations and problem behavior, and (e) generalization across communication partners, settings, and time (i.e. maintenance). Results suggest that clear and consistent differences between communication systems are rare, precluding definitive statements regarding a universal best approach for all people with developmental disabilities. Instead, findings of this review support the consideration of an individual's existing skills, goals and preferences as part of the process of selecting an approach to communication.

Comparisons of intervention components within augmentative and alternative communication systems for individuals with developmental disabilities: a review of the literature.

Decisions regarding augmentative and alternative communication (AAC) for individuals with developmental disabilities (e.g. what AAC to use and how to teach a person to use a specific AAC modality) should involve consideration of different intervention component options. In an effort to elucidate such decisions and options, this review synthesized 14 studies, published between 2004 and 2012, comparing different AAC intervention components including different symbol sets, instructional strategies, or speech output within aided AAC systems, and different verbal operants within unaided AAC. Evidence supported the following: (a) different instructional strategies such as building motivation, using errorless learning, or adding video models to picture exchange interventions may improve the acquisition or rate of acquisition of picture exchange mands, (b) limited data supports training mimetic (imitated) or mand signs over tacts and (c) differences in symbol sets and speech output levels appeared to have little effect on AAC-based mand acquisition, but listener-based differences should be considered. These findings have implications for future research and clinical practice.