Effect of Low-Tech Augmentative and Alternative Communication Intervention on Intentional Triadic Gaze as Alternative Access by School-Age Children With Multiple Disabilities.

PURPOSE: Students with multiple disabilities who are beginning communicators require augmentative and alternative communication (AAC) to communicate during school and participate in its academic and social aspects. Triadic gaze is a method for accessing low-tech AAC that minimizes physical demands on access for students with limited mobility, such as students with multiple disabilities. Thus, this study evaluated an instructional protocol for teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities. METHOD: Three students with multiple disabilities who were beginning communicators participated in a multiple baseline across participants design with three phases: baseline, treatment, and generalization and maintenance. Participants engaged in instruction around using triadic gaze to communicate by making selections on an eye gaze board. RESULTS: Visual analysis showed that all three participants acquired the use of triadic gaze as a method of accessing low-tech AAC in response to instruction. Effect size estimations suggested instruction was effective. The participants also demonstrated that the newly acquired skill generalized to interactions with familiar communication partners after instruction ended. CONCLUSIONS: These findings show that instruction can be effective in teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities. Future research should explore the effects of using this access method on communicating across school contexts.

Effects of adapted Letter-Sound correspondence instruction with older learners with complex communication needs and autism spectrum disorder.

Individuals who use augmentative and alternative communication (AAC) are often excluded from learning literacy skills that use phonological approaches due to challenges with verbal production of speech sounds. This study was conducted to evaluate the effectiveness of systematic literacy instruction with materials modified to teach letter-sound correspondences (LSC) to pre-adolescent and adolescents with autism spectrum disorders (ASD) with minimal or no speech who use AAC. A single subject design across three letter-sound sets was used, with three individuals with ASD. A total of 12 LSC were targeted in the intervention. During the intervention, the participants were instructed using model, guided, and independent practice trials using low-tech letter tiles followed by two extension activities: letter sorting and initial letter-sound picture books. A functional relationship was established between the LSC intervention and the percent of correct responses on the LSC assessment probes. Very large and large effects sizes were calculated for all participants across the three LSC sets. The study adds to the very limited research base related to phonics instruction for older learners (ages 9 to 18) with ASD, demonstrating that LSC progress can still be made at an older age with systematic instruction.

Prologue: Implementation Science in CSD and Starting Where You Are.

In this prologue, we introduce readers to the Forum: Clinicians and Researchers Navigating Implementation Science in CSD. Implementation science (IS), or the study of the adoption of evidence-based practice in real-world settings, is a key area of development in communication sciences and disorders (CSD). The goal of this forum was to show by example how researchers and clinicians are collaborating to begin to apply IS in CSD. This goal culminated in a scoping review of IS in CSD, a tutorial on incorporating IS into clinical practice research, three articles on stakeholder engagement, and three examples of IS studies in CSD included in this forum. We hope this forum helps clinicians and researchers to begin wherever they are in their knowledge and understanding of IS in CSD.

Online Training to Improve Service Provider Implementation of Letter-Sound Correspondence Instruction for Individuals Who Use Augmentative and Alternative Communication.

PURPOSE: Service providers have limited training in adapting and implementing literacy instruction for individuals who use augmentative and alternative communication (AAC), and therefore, opportunities to participate in phonological-based literacy activities are minimal. An online training was developed to teach service providers how to implement a systematic lesson in letter-sound correspondence (LSC) instruction with high fidelity for individuals who use AAC. METHOD: The Active Implementation Framework was used to guide the investigation of implementation fidelity and intervention effectiveness after service provider completion of an online training in LSC instruction. Study 1 trained five speech-language pathologists, one paraeducator, and six special educators in schools (N = 12), and Study 2 trained four speech-language pathology master's students. Single case across participant methodology was used for both studies with an implementation fidelity checklist to measure changes in instructional behaviors. Additionally, social validity data from service providers were collected. Preliminary data on intervention effectiveness for individuals who use AAC were collected for three LSCs after service providers were trained. RESULTS: Prior to the online training, service providers implemented LSC instruction with low fidelity. After the training, 11 service providers in Study 1 and all four speech-pathology master's students in Study 2 demonstrated large gains in implementation fidelity. Eight of the nine individuals who use AAC demonstrated improvement in LSC. CONCLUSION: Access to the online training has the potential to change the implementation behavior of service providers and take steps toward closing the research-to-practice gap surrounding early phonological skill acquisition for individuals who use AAC. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19400741.

The effects of AAC video visual scene display technology on the communicative turns of preschoolers with autism spectrum disorder.

Over 40% of children with autism spectrum disorder (ASD) experience difficulty in using speech to meet their daily communication needs. Although augmentative and alternative communication (AAC) can be of benefit, the AAC intervention must support beginning communicators in the early social interactions that provide the foundation for more sophisticated communication skills. An AAC video visual scene display approach uses an AAC app (provided on a tablet computer), including videos based on the interests of the child and infused with AAC supports, to provide opportunities for social interaction and communication between the child and the communication partner. The purpose of this study was to investigate the impact of video visual scene display technology on the communicative turns taken by three preschoolers with ASD and complex communication needs during a high-interest, shared activity (i.e., watching videos). All three participants demonstrated a large increase in the number of communicative turns taken with their partner (Tau-U of 1.00) following the introduction of the video VSD app. The results provide evidence that a video VSD approach may be a promising intervention to increase participation in communication opportunities for young children with ASD.

"Two Friends Spending Time Together": The Impact of Video Visual Scene Displays on Peer Social Interaction for Adolescents With Autism Spectrum Disorder.

Purpose Social interaction poses many challenges for adolescents with autism spectrum disorder (ASD) and complex communication needs. The purpose of this study was to investigate the impact of video visual scene displays (video VSDs) on communication during interactions between adolescents with ASD and peer partners. Method This study used an across-participant multiple-baseline single-case experimental design. Four adolescents with ASD and complex communication needs were taught to use video VSDs, presented on a tablet-based app, during social interactions with peer partners in a high school setting. The video VSDs used during the interactions were selected (and programmed with vocabulary) based on the interests of the adolescent with ASD and their peer partner. Results Following the introduction of the video VSD intervention, all four adolescents with ASD demonstrated an increase in communicative turns compared to baseline (Tau-U= 1.0, 95% CI [0.56, 1]), and all four increased in modes of communication used. Increased use of speech also was observed for the three participants who made use of speech prior to the intervention. All participants with ASD (and their peer partners) expressed an interest in continued use of the video VSD app to support social interaction. Conclusion The use of video VSDs may be a viable option to increase the participation and communication of adolescents with ASD during social interactions with peer partners. Supplemental Material https://doi.org/10.23641/asha.16734532.

Effects of a Literacy Feature in an Augmentative and Alternative Communication App on Single Word Reading of Individuals with Severe Autism Spectrum Disorders.

The purpose of this study was to investigate the effects of an augmentative and alternative communication (AAC) app with transition to literacy (T2L) software features (i.e., dynamic text and speech output upon selection of a graphic symbol within the grid display), on the acquisition of 12 personally relevant single words for individuals with severe autism spectrum disorder (ASD) who had minimal or no speech. The study implemented a single-subject, multiple-probe, across word sets design with four participants. All four participants in this study demonstrated increased accuracy reading targeted single words and results from this study provide preliminary evidence that the T2L features can positively impact the single word learning of individuals with ASD who have minimal speech and limited literacy skills.

Using AAC video visual scene displays to increase participation and communication within a volunteer activity for adolescents with complex communication needs.

Volunteer activities can provide opportunities to learn new skills, build social networks, and contribute to enhanced self-esteem. Volunteering also provides a positive contribution to society, and an opportunity to participate in activities that may differ from those in paid employment. People with severe disabilities and complex communication needs, however, may face significant barriers in participating and communicating in volunteer activities. A multiple-probe-across-participants, single-case experimental design was used to evaluate the effectiveness of videos with integrated visual scene displays (video VSDs). The video VSDs were presented using a tablet-based augmentative and alternative communication (AAC) app, as an intervention to increase the percent of steps completed independently within a volunteer activity. Participants were four adolescents with autism spectrum disorder or Down syndrome, all of whom had complex communication needs. Each participant met the mastery criterion for the activity - completion of the volunteer work activities and communication exchanges with co-volunteers - with the use of the video VSDs. The results provide preliminary evidence that video VSDs may be an effective assistive technology for individuals with severe disabilities and complex communication needs to increase participation in volunteer activities, both as an instructional support in learning new skills, and as an AAC technique to support interaction with others.

Effects of an AAC App with Transition to Literacy Features on Single-Word Reading of Individuals with Complex Communication Needs.

The purpose of this study was to investigate the effects of Transition to Literacy (T2L) software features (i.e., dynamic text and speech output upon selection of a graphic symbol) within a grid display in an augmentative and alternative communication (AAC) app on the sight word reading skills of five individuals with severe disabilities and complex communication needs. The study implemented a single case multiple probe research design across one set of three participants. The same design was utilized with an additional set of two participants. During intervention, the T2L feature was activated for targeted sight words during a book reading activity. The dependent variable was the number of 10 target words correctly identified. With only limited exposure to the T2L feature, the five participants all demonstrated increased accuracy in identification of 10 targeted sight words. Four of the five participants generalized learning to use of a text-only display for the 10 targeted sight words. This study provides preliminary evidence that redesigning AAC apps to include the provision of dynamic text combined with speech output can positively impact the sight-word reading of participants. This adaptation in AAC system design could be used to support improved outcomes in both language and literacy.

Effect of AAC technology with dynamic text on the single-word recognition of adults with intellectual and developmental disabilities.

Purpose: Single-word recognition can support participation in life, including engagement in leisure activities, navigation through the community, and vocational opportunities. Given the limited reading skills of many adults with intellectual and developmental disabilities (IDD) and limited speech, the current study evaluated the effects of using an augmentative and alternative communication (AAC) app, featuring dynamic text and speech output embedded in visual scene displays, on the single-word recognition performance of six adults with IDD who demonstrated limited speech.Method: A multiple baseline across participants single-subject design was used. Ten target sight words for each participant were selected on an individual basis, based on participant interest. Intervention consisted solely of interactions between investigators and individual participants using the app.Result: In the absence of any formal instruction and solely through the use of the AAC app interaction, three of the six participants demonstrated increased accuracy in single-word recognition.Conclusion: Results from the study were mixed, but suggest that AAC apps which provide the dynamic display of text in conjunction with voice output can assist some adults with IDD in achieving gains in single-word reading.

Programing AAC just-in-time for beginning communicators: the process.

Individuals who have limited or no speech as a result of intellectual and developmental disabilities and who are beginning communicators (i.e., are learning early linguistic skills such as first words and early semantic relations) require augmentative and alternative communication (AAC) to build both their expressive communication and their internal language structures. Programing AAC just-in-time is a promising clinical approach to intervention for beginning communicators because of its alignment with early language development theory. Early research efforts also provide emerging evidence to support its theoretical benefits. This paper describes a six-step process for programing AAC content just-in-time for beginning communicators. It highlights clinical challenges and considerations for each step, provides case examples of using the process with beginning communicators, and highlights potential limitations and future research directions related to the just-in-time programing of AAC for beginning communicators.

New and emerging AAC technology supports for children with complex communication needs and their communication partners: State of the science and future research directions.

This paper discusses recent research and development with a specific focus on selected new and emerging research-based augmentative and alternative communication (AAC) technologies that are developmentally appropriate and responsive to the individual interests, needs, and skills of children with developmental disabilities, their families, peers, and other communication partners. Specifically, this paper reviews the state of the science and future directions related to recent research and development of AAC technologies as supports to (a) enhance language learning, (b) facilitate social interaction, (c) improve literacy skills, (d) increase participation in society, and (e) teach interaction strategies to communication partners.

Effect of mobile technology featuring visual scene displays and just-in-time programming on communication turns by preadolescent and adolescent beginning communicators.

PURPOSE: Visual scene displays (VSDs) and just-in-time programming supports are augmentative and alternative communication (AAC) technology features with theoretical benefits for beginning communicators of all ages. The goal of the current study was to evaluate the effects of a communication application (app) on mobile technology that supported the just-in-time programming of VSDs on the communication of preadolescents and adolescents who were beginning communicators. METHOD: A single-subject multiple-baseline across participant design was employed to evaluate the effect of the AAC app with VSDs programmed just-in-time by the researcher on the communication turns expressed by five preadolescents and adolescents (9-18 years old) who were beginning communicators. RESULT: All five participants demonstrated marked increases in the frequency of their communication turns after the onset intervention. CONCLUSION: Just-in-time programming support and VSDs are two features that may positively impact communication for beginning communicators in preadolescence and adolescence. Apps with these features allow partners to quickly and easily capture photos of meaningful and motivating events and provide them immediately as VSDs with relevant vocabulary to support communication in response to beginning communicators' interests.

Effect of Video Embedded with Hotspots with Dynamic Text on Single-Word Reading by Children with Multiple Disabilities.

Background: The purpose of the study was to evaluate the effects of an intervention using an AAC app programmed with video visual scene displays (VSDs) embedded with hotspots with the Transition to Literacy (T2L) feature on single-word reading. Method: Three school-aged children with multiple disabilities participated in a multiple baseline across participants design. Four names of characters in favorite movies and shows served as target words for each participant. Results: All three children demonstrated an increase in accurate identification of target words from baseline to intervention with Tau-U effect sizes for the participants of 0.69, 0.76, and 0.84, all of which were statistically significant (p<0.05). Conclusions: Clinicians can consider including the intervention evaluated in the current study as one component of literacy intervention for school-aged children with multiple disabilities. Future research should further evaluate video VSDs and the T2L feature for use with individuals with multiple disabilities.

"Augmentative and Alternative Communication (AAC) Will Give You a Voice": Key Practices in AAC Assessment and Intervention as Described by Persons with Amyotrophic Lateral Sclerosis.

The purpose of this study was to describe the perceptions of persons with amyotrophic lateral sclerosis (pALS) who use augmentative and alternative communication (AAC) with the AAC assessment and intervention process. Twenty-one pALS with complex communication needs participated in a multipart survey (and follow-up e-mails) to provide information on their experiences with AAC assessment and intervention. A majority of the participants agreed with the importance of three key AAC intervention principles: appropriate staging of the timing of assessment and intervention activities, inclusion of communication partners, and the use of multiple modalities and strategies as communication supports. Most participants reported that their assessment and intervention experiences included at least some aspect of these three key practices. The results of this study suggest that the identified best practices in AAC should be reviewed and implemented on an individualized basis for pALS with complex communication needs.

The effects of explicit instruction in academic vocabulary during shared book reading on the receptive vocabulary of children with complex communication needs.

The purpose of this study was to evaluate the effect of explicit vocabulary instruction during shared reading experiences on the acquisition of receptive academic vocabulary for children with complex communication needs. A single-subject, multiple-probe design was used. Three preschool-aged children (i.e., one with autism spectrum disorder, one with developmental delay, and one with a rare genetic disorder) were each taught two sets of vocabulary words. Intervention consisted of explicit vocabulary instruction associated with shared reading of academic texts. All three children acquired 10 targeted academic vocabulary items receptively and maintained vocabulary knowledge for at least 4 weeks. Data also suggest probable generalization to new representations. Additionally, participants became more adept at learning via this method, acquiring the second vocabulary set in significantly less time. Results indicate that explicit vocabulary instruction during shared reading experiences can be effective for teaching receptive vocabulary to children with complex communication needs.

Effects of dynamic text in an AAC app on sight word reading for individuals with autism spectrum disorder.

The purpose of this study was to investigate the effects of Transition to Literacy (T2L) software features (i.e., dynamic text and speech output upon selection of a graphic symbol) within a grid display in an augmentative and alternative communication (AAC) app, on the sight word reading skills of individuals with autism spectrum disorders (ASD) and complex communication needs. The study implemented a single-subject multiple probe research design across one set of three participants. The same design was utilized with an additional set of two participants. As part of the intervention, the participants were exposed to an AAC app with the T2L features during a highly structured matching task. With only limited exposure to the features, the five participants all demonstrated increased accuracy of identification of 12 targeted sight words. This study provides preliminary evidence that redesigning AAC apps to include the provision of dynamic text combined with speech output, can positively impact the sight-word reading of participants during a structured task. This adaptation in AAC system design could be used to complement literacy instruction and to potentially infuse components of literacy learning into daily communication.

Comparison of the effects of mobile technology AAC apps on programming visual scene displays.

Parents and professionals who work with individuals who use augmentative and alternative communication (AAC) face tremendous time pressures, especially when programming vocabulary in AAC technologies. System design (from programming functions to layout options) necessitates a range of skills related to operational competence and can impose intensive training demands for communication partners. In fact, some AAC applications impose considerable learning demands, which can lead to increased time to complete the same programming tasks. A within-subject design was used to investigate the comparative effects of three visual scene display AAC apps (GoTalk Now, AutisMate, EasyVSD) on the programming times for three off-line programming activities, by adults who were novices to programming AAC apps. The results indicated all participants were able to create scenes and add hotspots during off-line programming tasks with minimal self-guided training. The AAC app that had the least number of programming steps, EasyVSD, resulted in the fastest completion times across the three programming tasks. These results suggest that by simplifying the operational requirements of AAC apps the programming time is reduced, which may allow partners to better support individuals who use AAC.

Typical Toddlers' Participation in "Just-in-Time" Programming of Vocabulary for Visual Scene Display Augmentative and Alternative Communication Apps on Mobile Technology: A Descriptive Study.

PURPOSE: Augmentative and alternative communication (AAC) promotes communicative participation and language development for young children with complex communication needs. However, the motor, linguistic, and cognitive demands of many AAC technologies restrict young children's operational use of and influence over these technologies. The purpose of the current study is to better understand young children's participation in programming vocabulary "just in time" on an AAC application with minimized demands. METHOD: A descriptive study was implemented to highlight the participation of 10 typically developing toddlers (M age: 16 months, range: 10-22 months) in just-in-time vocabulary programming in an AAC app with visual scene displays. RESULTS: All 10 toddlers participated in some capacity in adding new visual scene displays and vocabulary to the app just in time. Differences in participation across steps were observed, suggesting variation in the developmental demands of controls involved in vocabulary programming. CONCLUSIONS: Results from the current study provide clinical insights toward involving young children in AAC programming just in time and steps that may allow for more independent participation or require more scaffolding. Technology designed to minimize motor, cognitive, and linguistic demands may allow children to participate in programming devices at a younger age.

Social media experiences of adolescents and young adults with cerebral palsy who use augmentative and alternative communication.

PURPOSE: This pilot study aimed to expand the current understanding of how adolescents and young adults with cerebral palsy (CP) and complex communication needs use social media. METHOD: An online focus group was used to investigate the social media experiences of seven individuals with CP who used Augmentative and Alternative Communication (AAC). Questions posed to the group related to social media: (a) advantages; (b) disadvantages; (c) barriers; (d) supports; and (e) recommendations. RESULT: Adolescents with CP who use AAC used a range of communication media to participate in daily interactions, including social media. An analysis of the focus group interaction revealed that the participants used social media to: bypass the constraints of face-to-face interactions; communicate for a number of reasons (e.g. maintain relationships, share experiences); and support independent leisure (e.g. playing games, looking at pictures/videos). Despite the advantages, the participants discussed barriers including limitations related to AAC technologies, social media sites and literacy skills. CONCLUSION: The results suggest that service providers should implement interventions to support social media use, including enhancement of linguistic, operational and strategic competence. Technology manufacturers should focus on improving the designs of AAC apps and social media sites to facilitate access by individuals who require AAC.