Research directions in augmentative and alternative communication for preschool children.

PURPOSE: To review issues related to the use of augmentative systems with young children and present a case study of one child and family's experience with the System for Augmenting Language (SAL). METHOD: The case involved a preschool child with severe developmental delays who had little functional speech. Acquisition and use of graphic symbols on a speech-output communication device was studied in home and clinical settings. Language and communication behaviours of the child and his communication partners were observed and language assessment measures were collected. RESULTS: Child engagement state varied across the two settings with a stable profile seen in the therapy setting and a clear increase at home. Child communicative attempts increased following the introduction of the augmented system. Parents reported successful use of the SAL. CONCLUSION: SAL is a viable communication intervention approach for young children.

Heart rate variability in cocaine-exposed newborn infants.

BACKGROUND: Infants born to cocaine-using mothers have a 3- to 8-fold increase in sudden infant death syndrome. Its underlying cause, in part, may be attributed to abnormal autonomic function. We proposed to study heart rate variability, reflecting autonomic control of the heart, in cocaine-exposed infants. METHODS: From 1997 to 2000, we studied 217 asymptomatic, term infants, of whom 68 had intrauterine cocaine exposure (group I). Their data were compared with infants exposed to drugs other than cocaine (group II, n = 77) and no drugs (group III, n = 72). Twenty-four-hour heart rate variability was measured within 72 hours of birth. RESULTS: Cocaine-exposed infants, as compared with the 2 control groups, had an overall significant decrease (P <.05) in global heart rate variability and a lower standard deviation of all valid N-N intervals in the recording (41.9 +/- 1.4 ms vs 47.6 +/- 1.3 ms and 46.9 +/- 1.3 ms, respectively). Vagal parameters such as high-frequency power and the square root of the mean of the squared differences between adjacent N-N intervals were also lower in newborns with heavy in utero cocaine exposure. CONCLUSIONS: Decreased heart rate variability was seen in cocaine-exposed infants. Whether low heart rate variability is a marker for increased risk of sudden death in infants (as it is in adults with structural heart disease) is unknown and requires further investigation.

Relation between Kaufman Brief Intelligence Test and WISC-III scores of children with RD.

Concurrent validity of the Kaufman Brief Intelligence Test (K-BIT) with the Wechsler Intelligence Scale for Children-Third Edition (WISC-III) was evaluated, as well as the K-BIT's accuracy as a predictor of WISC-III scores, in a sample of young children with reading disabilities. The two measures were administered to 65 children from Atlanta, Boston, and Toronto who ranged from 6-5 to 7-11 years of age at testing. Correlations between the verbal, nonverbal, and composite scales of the K-BIT and WISC-III were .60, .48, and .63, respectively. Mean K-BIT scores ranged from 1.2 to 5.0 points higher than the corresponding WISC-III scores. Standard errors of estimation ranged from 10.0 to 12.3 points. In individual cases, K-BIT scores can underestimate or overestimate WISC-III scores by as much as 25 points. Results suggest caution against using the K-BIT exclusively for placement and diagnostic purposes with young children with reading disabilities if IQ scores are required.

Communication patterns of youth with mental retardation with and without their speech-output communication devices.

The communication skills of 13 youth with moderate or severe mental retardation were compared while they communicated with a "standard partner" with and without access to their communication devices. When participants employed the communication device, they were able to convey more appropriate information as well as clearer and more specific information to an unfamiliar adult partner than they were able to convey without the device. These findings highlight the distinct contributions the participants' use of an augmented communication device make to the overall communicative interaction.

Issues in augmentative and alternative communication in child psychiatry.

This article provided an introduction to AAC systems for children and adolescents with severe spoken-language disorders. Over the last decade, significant advances have been made in assessment and intervention approaches. For children with severe spoken communication disabilities, the AAC assessment is an ongoing process that includes information about the child's communication development, the child's environments, and the child's physical abilities. Children with severe disabilities who use AAC systems can demonstrate communication achievements far beyond traditional expectations. Recommended assessment and intervention practices are continuing to develop and the future is certainly optimistic for children with severe spoken-language disorders who may use AAC to communicate.

Parental hypertension and cardiac alterations in normotensive children and adolescents.

The objective of this investigation was the examination of the relation of left ventricular mass (LVM) and function with cardiovascular response to exercise in normotensive adolescents at risk for hypertension. Carried out was a prospective, cross-sectional study of 47 subjects (age, 10 to 18 years), who underwent dynamic and isometric exercise, 24-hour Holter monitoring, and echocardiography. Twenty-nine had normotensive parents (group 2, "at risk"). Both groups were similar for age, race, sex, body mass index, blood pressures, and resting heart rates. Group 2 had a higher E/A ratio (2.3 +/- 0.5 vs 2.0 +/- 0.5; p = 0.039) and higher heart rates during stage IV of dynamic exercise (188 +/- 20 beats/min vs 176 +/- 18 beats/min; p = 0.046). The LVM, 24-hour heart rates, and exercise systolic blood pressures (SBP) were similar in both groups. Only in group 2, SBP at peak dynamic and isometric exercise correlated best with LVM (r = 0.74, p < 0.002; r = 0.82, p < 0.001). It is concluded that altered hemodynamic regulatory mechanisms may exist before the establishment of hypertension in normotensive subjects with parental hypertension.

Mapping the meanings of novel visual symbols by youth with moderate or severe mental retardation.

The word-learning ability of 12 school-age subjects with moderate or severe mental retardation was assessed. Subjects had little or no functional speech and used the System for Augmenting Language with visual-graphic symbols for communication. Their ability to fast map novel symbols revealed whether they possessed the novel name-nameless category (N3C) lexical operating principle. On first exposure, 7 subjects were able to map symbol meanings for novel objects. Follow-up assessments indicated that mappers retained comprehension of some of the novel words for up to delays of 15 days and generalized their knowledge to production. Ability to fast map reliably was related to symbol achievement status. Implications for understanding vocabulary acquisition by youth with mental retardation were discussed.

Adult partner-augmented communication input to youth with mental retardation using the System for Augmenting Language (SAL).

The primary purpose of this study was to characterize the frequency and nature of augmented input that adult partners provided to 13 youth with mental retardation as they began to use the System for Augmenting Language (SAL). Analyses of youth-partner interactions revealed differences in the frequency with which home and school partners provided augmented input and in the manner and style of home and school partners' augmented input, particularly in directiveness and position of lexigram symbols within Utterances. Overall, partners naturally provided augmented input in a manner likely to promote youth's learning of the SAL.

Emergence of visual-graphic symbol combinations by youth with moderate or severe mental retardation.

Research and practice on augmentative communication for persons with moderate or severe mental retardation have primarily targeted the acquisition and use of single symbols. Symbol combinations, however, provide insight into how augmented communicators use individual symbols to build more complex communications. In Study 1, untaught symbol combinations produced during natural communication interactions by 7 subjects with mental retardation were examined for their semantic, ordering, and generalization patterns. The symbol combinations largely resembled those produced by young speaking language learners, suggesting that the augmented communicators were following typical patterns of communication in generating their symbol combinations. In Study 2, we examined the symbol combinations modeled for subjects by their partners. The structure of the modeled combinations did not resemble the children's productions, indicating that the children could not have relied on simple rote imitation for their combination production. These results suggest that augmented communicators with mental retardation may use their symbols as speaking children use oral words in the development of complex communications.

Adult-directed communications of youth with mental retardation using the system for augmenting language.

This study characterizes the success and effectiveness of adult-directed communications of youth with mental retardation and little or no functional speech who used the System for Augmenting Language (SAL), in concert with vocalizations and gestures, to communicate over a 2-year period. Subjects were introduced to the SAL, a speech-output communication device used during daily interactions, to encourage attempts at communication either at home or school. All subjects used the SAL at home and at school during the second year. Results indicate that subjects used the SAL with their extant forms of communication, particularly vocalizations. Extant communications were more successful than SAL communications, although the environment influenced the success of all the youth's communications. The SAL, however, was more effective than vocalizations or gestures in conveying information and interacting with adults in both environments. Maintenance, generalization, and implications for practice are discussed.

Peer-directed communicative interactions of augmented language learners with mental retardation.

Naturally occurring peer-directed communicative interactions of 13 youth with mental retardation and little or no functional speech who used the System for Augmenting Language (SAL) as their primary means of communication were described. Findings suggest that this system was an integral component of both successful and effective conversations and may be one important means of enhancing social interactions with peer communicative partners who have and do not have mental retardation.

Transient myocardial ischemia in infants prenatally exposed to cocaine.

This prospective study examined whether neonates of pregnant women who used cocaine during pregnancy are at a risk for the development of transient myocardial ischemia and altered autonomic function, as in adults. We studied 21 of 35 infants with a history of prenatal exposure to cocaine. The ST segment changes and heart rate variability were evaluated from three-channel Holter monitors within 48 hours of birth. The data were compared with those on 20 control infants with similar birth weight, gestational age, and postnatal age. Six infants (29%) who were exposed to cocaine in utero had transient ST segment elevation, versus only one infant (5%) from the control group (odds ratio = 7.6; 95% confidence interval, 1.14, 50.64). Heart rates, results of total power and low-frequency power spectral analyses for heart rate variability, and arrhythmias were not significantly different in the two groups. However, a lower ratio of low-to high-frequency power reflected increased vagal activity in cocaine-exposed infants. We conclude that cocaine use in pregnant mothers is associated with transient ST segment abnormalities in their infants. These abnormalities are consistent with transient myocardial ischemia.

Language comprehension in ape and child.

Previous investigations of the linguistic capacities of apes have focused on the ape's ability to produce words, and there has been little concern for comprehension. By contrast, it is increasingly recognized that comprehension precedes production in the language development of normal human children, and it may indeed guide production. It has been demonstrated that some species can process speech sounds categorically in a manner similar to that observed in humans. Consequently, it should be possible for such species to comprehend language if they have the cognitive capacity to understand word-referent relations and syntactic structure. Popular theories of human language acquisition suggest that the ability to process syntactic information is unique to humans and reflects a novel biological adaptation not seen in other animals. The current report addresses this issue through systematic experimental comparisons of the language comprehension skills of a 2-year-old child and an 8 year-old bonobo (Pan paniscus) who was raised in a language environment similar to that in which children are raised but specifically modified to be appropriate for an ape. Both subjects (child and bonobo) were exposed to spoken English and lexigrams from infancy, and neither was trained to comprehend speech. A common caretaker participated in the rearing of both subjects. All language acquisition was through observational learning. Without prior training, subjects were asked to respond to the same 660 novel sentences. All responses were videotaped and scored for accuracy of comprehension of the English language. The results indicated that both subjects comprehended novel requests and simple syntactic devices. The bonobo decoded the syntactic device of word recursion with higher accuracy than the child; however, the child tended to do better than the bonobo on the conjunctive, a structure that places a greater burden on short-term memory. Both subjects performed as well on sentences that required the ability to reverse work order as they did on sentences that did not require this capacity. These results are discussed in light of a model of the evolution of language that suggests that the potential for language comprehension preceded the appearance of speech by several million years at minimum. The onset of speech is linked to the appearance of fully adapted bipedalism, which necessitated reorientation of the laryngeal tract and made closure of the soft palate possible. For the first time, such closure permitted mammals to easily produce sounds that could be interpreted by the mammalian auditory system in a categorical manner. When these sounds were paired with the previously extant capacity to produce vowels, it became possible to form "bounded vowels" or sound units that could readily be discriminated as units by the auditory system. It is suggested that this physical adaptation allowed the extant cognitive capacity of the hominids to embark on a speech-like mode of communication.

Symbol vocabulary and the focus of conversations: augmenting language development for youth with mental retardation.

Communication devices designed to augment the language development of individuals with severe cognitive disabilities and little or no functional speech typically contain primarily nouns because they seem easiest to acquire and evaluate. In this study, the effect of a more diverse vocabulary was assessed. Systematic observations of the use of computerized speech-output devices by 12 youth with moderate or severe mental retardation and severe spoken language disability and by their partners were made over a 2-year period. Social-regulative symbols (e.g., "please," "I'm finished") were used as soon as they were introduced, and their availability expanded the focus of conversations both at home and at school. Implications for conceptualizing variation in early language use and for the design of language intervention programs are discussed.

Youngsters with moderate or severe mental retardation and severe spoken language impairments. I: Extant communicative patterns.

This study characterizes the communicative patterns of youngsters with moderate or severe mental retardation and severe spoken language impairments who are not independent speakers with conversational partners at home and at school. Nine subjects were observed during six 1-hr mealtime sampling periods in both settings for a total of 12 hr. Live continuous observations were made, employing a coding scheme designed to record occurrences of the subjects' communicative behaviors. Findings are discussed with respect to the modes and functions of the youngsters' communications with home and school conversational partners.

Concomitants of success in acquiring an augmentative communication system: changes in attention, communication, and sociability.

Evidence was presented that successful participation in augmentative communication intervention can foster developmental changes that extend beyond the targeted effect. Ten persons with severe mental retardation were assigned in matched pairs to a lexigram condition (graphic symbols) or a control condition (social stimulation). A coding system, developed to assess pre- versus postintervention performance in four domains, was applied to videotapes of each subject in dyadic interaction. The 3 subjects who successfully acquired lexigrams exhibited changes in attention, intentional communication, and sociability; the other subjects improved only in sociability. Supporting results were obtained using an abbreviated coding system. Application of the coding systems to additional subject populations and interventions would clarify how broadly the results generalize.