A mHealth application for the training of caregivers of children with developmental disorders in South Africa: rationale and initial piloting.

Background: Evidence-based mobile health (mHealth) interventions have been successful for an array of physical and mental health conditions. Children with developmental disorders (DD) often have secondary speech and language disorders. The lack of high-quality medical and educational services in low- and middle-income countries limits the opportunities for children with DD to succeed in life. South Africa currently offers limited access to education, social, and health services. Methods: Twelve caregivers of twelve children with DD between the ages of 3 and 6 years who already received monthly early childhood therapy participated in this study. A mHealth app, called Nna'Le'wena, a Setswana phrase meaning "Me and You", was designed, developed, installed, and tested on tablets. The app provided a systematic framework and guidance to the caregivers in order to use evidence-based communication interaction strategies with the children over a twelve-week period. The app could be used offline and provided audio instructions in English and Setswana, two dominant languages in South Africa. The app automatically generated log files and collected answers to weekly surveys. At the end of the study, caregivers were asked to evaluate the app by using relevant portions of the Mobile App Rating Scale (MARS). Results: Caregivers were able to successfully interact and use the app. The app was well-received and liked by the caregivers. Caregivers listened to the instructional audios in English and Setswana during the 12-week period. They were able to provide communication opportunities to their children during daily living activities, especially during play- and mealtime activities. Conclusions: The Nna'Le'wena app was successfully deployed and used by caregivers of children with DD. mHealth solutions can be effective and are relatively affordable solutions that can enhance health care and educational delivery in different settings, including in low-and middle-income countries with limited Internet capabilities.

Parent-implemented augmented communication intervention and young children with Down syndrome: an exploratory report.

Introduction: Young children with Down syndrome (DS) present with speech and language impairments very early in childhood. Historically, early language intervention for children with DS included manual signs, though recently there has been an interest in the use of speech-generating devices (SGDs). This paper examines the language and communication performance of young children with DS who participated in parent-implemented communication interventions that included SGDs. Specifically, we compared the functional vocabulary usage and communication interaction skills of children with DS who received augmented communication interventions (AC) that included an SGD with those children with DS who received spoken communication intervention (SC). Methods: Twenty-nine children with DS participated in this secondary data analysis. These children were part of one of two longitudinal RCT studies investigating the effectiveness of parent-implemented augmented communication interventions in a larger sample of 109 children with severe communication and language impairments. Results: There were significant differences between children with DS in the AC and SC groups in terms of the number and proportion of functional vocabulary targets used and the total vocabulary targets provided during the intervention at sessions 18 (lab)and 24 (home). Discussion: Overall, the AC interventions provided the children with a way to communicate via an SGD with visual-graphic symbols and speech output, while the children in the SC intervention were focused on producing spoken words. The AC interventions did not hinder the children's spoken vocabulary development. Augmented communication intervention can facilitate the communication abilities of young children with DS as they are emerging spoken communicators.

Augmentative and Alternative Communication Services for Emergent Bilinguals: Perspectives, Practices, and Confidence of Speech-Language Pathologists.

PURPOSE: The purpose of this project was to examine the perspectives, practices, and confidence of speech-language pathologists (SLPs) regarding service provision for emergent bilinguals who use augmentative and alternative communication (AAC) through a nationwide survey. METHOD: Licensed SLPs (N = 179) completed an online survey, which included Likert-type and multiple-choice questions. RESULTS: Findings from the survey revealed a discrepancy between SLPs' perceptions and practices regarding service provision for emergent bilinguals who use AAC. Furthermore, most SLPs surveyed reported varying levels of confidence in serving this population and indicated that they frequently lacked training and resources to serve bilingual clients who use AAC. CONCLUSION: This research highlighted the need for increased resources, research, and education to support service provision for emergent bilinguals who use AAC.

Supporting Emergent Bilinguals Who Use Augmentative and Alternative Communication and Their Families: Lessons in Telepractice From the COVID-19 Pandemic.

PURPOSE: The purpose of this project was to examine the effect of the COVID-19 pandemic on speech-language pathologist (SLP) service provision for emergent bilinguals who use augmentative and alternative communication (AAC). One prominent issue in AAC service delivery is the efficacy and feasibility of providing AAC services via telepractice. The COVID-19 pandemic intensified this issue as most providers, clients, and families adjusted to remote service delivery models. While emerging evidence supports telepractice in AAC, little is known about the potential benefits and challenges of telepractice for emergent bilinguals who use AAC and their families. METHOD: Data were collected via a nationwide survey. Licensed SLPs (N = 160) completed an online questionnaire with Likert-type, multiple-choice, and open-ended questions, analyzed using mixed methods. RESULTS: Findings illustrated a shift in service delivery from in-person to telepractice and hybrid (both telepractice and in-person) models. Overall, child intervention outcomes declined for emergent bilinguals who used AAC during the COVID-19 pandemic, regardless of service delivery format. However, collaboration increased for many providers and families. Qualitative analyses highlighted barriers to AAC service provision for emergent bilinguals who use AAC that were exacerbated by the COVID-19 pandemic, as well as factors that facilitated collaboration and family engagement. CONCLUSION: These findings suggest that, despite challenges, telepractice or hybrid services may be a promising approach to provide more culturally responsive, family-centered care for emergent bilinguals who use AAC. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20405673.

Code-switching using aided AAC: toward an integrated theoretical framework.

Multilingual individuals who use augmentative and alternative communication (AAC) often shift between language environments and speakers of different languages; thus, code-switching (or alternating between languages or dialects within or across contexts) becomes necessary for effective communication. Recently, AAC product developers have responded to this need by building multilingual AAC systems; however, research in multilingualism and AAC is lacking. In this paper, we discuss theoretical and practical implications for research related to code-switching using aided AAC. We use available literature investigating the sociolinguistic, psycholinguistic, and usage-based aspects of code-switching in spoken or signed modalities as a starting point for considering code-switching using aided AAC. We present examples illustrating the varied expression of codeswitching across aided AAC modalities and discuss directions for future research.

Psychometric Properties of the English-Spanish Vocabulary Inventory in Toddlers With and Without Early Language Delay.

PURPOSE: Despite the increasing population of dual language learners (DLLs) in the United States, vocabulary measures for young DLLs have largely relied on instruments developed for monolinguals. The multistudy project reports on the psychometric properties of the English-Spanish Vocabulary Inventory (ESVI), which was designed to capture unique cross-language measures of lexical knowledge that are critical for assessing DLLs' vocabulary, including translation equivalents (whether the child knows the words for the same concept in each language), total vocabulary (the number of words known across both languages), and conceptual vocabulary (the number of words known that represent unique concepts in either language). METHOD: Three studies included 87 Spanish-English DLLs (M age = 26.58 months, SD = 2.86 months) with and without language delay from two geographic regions. Multiple measures (e.g., caregiver report, observation, behavioral tasks, and standardized assessments) determined content validity, construct validity, social validity, and criterion validity of the ESVI. RESULTS: Monolingual instruments used in bilingual contexts significantly undercounted lexical knowledge as measured on the ESVI. Scores on the ESVI were related to performance on other measures of communication, indicating acceptable content, construct, and criterion validity. Social validity ratings were similarly positive. ESVI scores were also associated with suspected language delay. CONCLUSIONS: These studies provide initial evidence of the adequacy of the ESVI for use in research and clinical contexts with young children learning English and Spanish (with or without a language delay). Developing tools such as the ESVI promotes culturally and linguistically responsive practices that support accurate assessment of DLLs' lexical development. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.17704391.

Language Differentiation Using Augmentative and Alternative Communication: An Investigation of Spanish-English Bilingual Children With and Without Language Impairments.

Purpose Children with severe speech and language impairments growing up in dual language environments may communicate in more than one language using augmentative and alternative communication (AAC). This study investigated predictors of bilingual children's ability to differentiate between Spanish and English using an AAC iPad app during a cued language-switching task and examined whether switching between languages using AAC incurred a cognitive cost. Method Participants were 58 Spanish-English bilingual children ages 4;0-6;11 (years;months; 23 with language impairments). Children received standardized language and cognitive assessments and completed an experimental language-switching task in which they were asked to differentiate between languages using an AAC iPad app containing English and Spanish vocabulary layouts paired with voice output. Results Results of a binary logistic regression indicated that, when controlling for age, processing speed significantly predicted whether children were classified as high or low performers on the experimental task. Nonparametric tests indicated that switching between languages did not incur a cognitive cost as evidenced by similar response times on trials where participants were required to switch between languages compared to trials where they did not switch. Conclusion This study contributes to the understanding of how young bilingual children with and without language impairments conceptualize and discriminate between languages represented in a visual-graphic modality paired with speech output. Supplemental Material https://doi.org/10.23641/asha.13289330.

Growing up with AAC in the digital age: a longitudinal profile of communication across contexts from toddler to teen.

Smart technology (e.g., smartphones, smartwatches, tablets) and the age of information have transformed our society and changed the lives of individuals who rely on assistive technology. This study provides a detailed description of an adolescent growing up in the digital age using augmentative and alternative communication (AAC). It documents the participant's development across language, cognitive, and social domains from ages 2- to 15-years-old, and explores how changes in AAC technology and contextual factors contributed to broad-based outcomes associated with AAC use. In general, results from standardized assessments show growth or stability across domains from ages 2-15. Data from a parent interview provides a narrative description of AAC device use, AAC interventions, and school and family environments. Despite communicative challenges, the participant leveraged advances in AAC technology to develop communicative competence and creatively used his smart devices and the Internet to interact with friends both online and in person.

Supporting Early Communication Skills of Children with Developmental Disorders in South Africa: Caregiver and Clinician Perspectives about Mobile Health Applications.

Using a mobile health application (i.e. app) to empower primary caregivers of young children with developmental disorders in low- and middle-income countries is opening up new avenues for early childhood intervention. Thirteen caregivers and ten speech-language pathologists participated in three focus groups to explore their perspectives about the potential benefits and suitability of a mobile health app as part of intervention, its features, the likelihood of using and recommending it, as well as potential pitfalls to be avoided. Both participant groups were generally positive, although there was little overlap between their responses. Caregivers generally focused on increased knowledge and skills (of all family members), as well as on empowerment and reduced costs. Speech-language pathologists on the other hand focused on how current service delivery would be enriched by increasing the dosage of therapy and enhancing parental cooperation. They also expected that the reach of service delivery would be expanded as more children and caregivers could potentially benefit. Although technology (i.e. mobile apps) could open up new possibilities for service delivery in this population, the perspectives of all stakeholder groups should be considered to ensure successful adoption of such technologies.

Early Sentence Productions of 3- and 4-Year-Old Children Who Use Augmentative and Alternative Communication.

Purpose: This study investigated the early rule-based sentence productions of 3- and 4-year-old children with severe speech disorders who used single-meaning graphic symbols to communicate. Method: Ten 3- and 4-year-olds requiring the use of augmentative and alternative communication, who had largely intact receptive language skills, received instruction in producing up to four different semantic-syntactic targets using an Apple iPad with a communication app. A single-case, multiple-probe, across-targets design was used to assess the progress of each participant and target. Generalization to new vocabulary was assessed, and a subgroup also was taught to produce sentences using grammatical markers. Results: Some targets (primarily possessor-entity) were mastered in the baseline phase, and the majority of the remaining targets were mastered during intervention. All four children who completed intervention for grammatical markers quickly learned to use the markers accurately. Conclusions: Expressive language potential for preschoolers using graphic symbol-based augmentative and alternative communication systems should not be underestimated. With appropriate presentation and intervention techniques, some preschoolers with profound speech disorders can readily learn to produce rule-based messages via graphic symbols.

Dynamic Assessment for 3- and 4-Year-Old Children Who Use Augmentative and Alternative Communication: Evaluating Expressive Syntax.

Purpose: The developmental readiness to produce early sentences with an iPad communication application was assessed with ten 3- and 4-year-old children with severe speech disorders using graduated prompting dynamic assessment (DA) techniques. The participants' changes in performance within the DA sessions were evaluated, and DA performance was compared with performance during a subsequent intervention. Method: Descriptive statistics were used to examine patterns of performance at various cueing levels and mean levels of cueing support. The Wilcoxon signed-ranks test was used to measure changes within the DA sessions. Correlational data were calculated to determine how well performance in DA predicted performance during a subsequent intervention. Results: Participants produced targets successfully in DA at various cueing levels, with some targets requiring less cueing than others. Performance improved significantly within the DA sessions-that is, the level of cueing required for accurate productions of the targets decreased during DA sessions. Last, moderate correlations existed between DA scores and performance during the intervention for 3 out of 4 targets, with statistically significant findings for 2 of 4 targets. Conclusion: DA offers promise for examining the developmental readiness of young children who use augmentative and alternative communication to produce early expressive language structures.

Using dynamic assessment to evaluate the expressive syntax of children who use augmentative and alternative communication.

The developmental readiness of four 5-year-old children to produce basic sentences using graphic symbols on an augmentative and alternative communication (AAC) device during a dynamic assessment (DA) task was examined. Additionally, the ability of the DA task to predict performance on a subsequent experimental task was evaluated. A graduated prompting framework was used during DA. Measures included amount of support required to produce the targets, modifiability (change in participant performance) within a DA session, and predictive validity of DA. Participants accurately produced target structures with varying amounts of support. Modifiability within DA sessions was evident for some participants, and partial support was provided for the measures of predictive validity. These initial results indicate that DA may be a viable way to measure young children's developmental readiness to learn how to sequence simple, rule-based messages via aided AAC.