Alternative Augmentative Communication (AAC)

Alternative Augmentative Communication (AAC)

Alternative Augmentative Communication (AAC) & Autism Spectrum Disorder (ASD) UNM LEND Capstone Project Hyuna B. Kim 04/27/2018

Simple eveled Speech Generating Devices Sequential Message Communicators Single Message Communicators Communication Boards Eye Gaze Devices T bl ts with Communic tlon Applications t Mid Tech Communication Books Dedicated Dynamic Screen Devices Text to Speech Devices/Applications What is AAC?

  • Project Questions
  • Does aided Augmentative Alternative Communication (AAC) promote social communication in children with Autism Spectrum Disorder (ASD)?
  • How does aided AAC affect social communication in children with ASD?
  • Why is it important?
  • Social communication situations present challenges to children with ASD. - Up to 25% of children with ASD do not develop functional speech - Lack of motivation and communication skills - Social communication beyond simple requests - Cultural acceptance of their communication partners.
  • Method: Literature Search
  • Systematic mini-meta analysis
  • Database Engines used:
  • PsychINFO, ASHA(JSLHR), Googlescholar, and Pubmed.
  • Search Criteria:
  • Date: 1997 to 2017
  • Search terms: aided AAC, autism/ASD, social communication functions
  • # of article found: 48
  • # of article chosen for the analysis: 7
  • Inclusion Criteria
  • Children of age 2 through 18 diagnosed with ASD (previous terms used: autistic disorder, Asperger’s disorder, or pervasive developmental disorder)
  • Using aided AAC for expressive communication:
  • High tech AAC, PECS (Picture Exchange Communication System)
  • Communication functions beyond object requests were targeted:
  • Various communication functions for social communicationrequesting, questioning, answering, commenting, greeting, calling, providing information...
  • Exclusion Criteria
  • Studies solely focusing on PECS.
  • AAC studies on pre-linguistic communication in children with ASD.
  • Studies employing low tech AAC devices only.

Study Design Participants Types of Dependent Communica Intervention AAC used Variable(s) tion strategy functions Xing & Leonard Sigle subject 8–12 years, High tech Use of SGD to Acknowledge Least to most prompting (2015) study: minimally verbal AAC: communicate hierarchy with an iPad Multiple Base (n = 2) iPad specific line study function Lorah, Parnell, Sigle subject 4–6 years, High tech Frequency of Comment 5-s time delay, with full and Speight study: minimally verbal AAC: independent physical prompts with an (2014) Multiple Base or up to 1–2 iPad responses with iPad line study word phrases SGD (n = 2/3 with ASD) Strasberger and Sigle subject 5–13 years, High tech Frequency of Request Peer-assisted Ferreri (2014) study: minimally AAC: iPad requests and object; communication Multiple Base verbal (n = 4) responses acknowledg application training line study e with an iPod© Kagohara et al.

Sigle subject 13–17 years, High tech Correct Acknowledg Time delay, least to (2012) study: minimally AAC: iPad responses e most prompting, Multiple probe verbal (n = 2) with SGD designs

Study Design Participants Types of AAC used Dependent Variable(s) Communicati on functions Intervention strategy Schepis Sigle subject 3–5 years, High Tech AAC Frequency of Request, Naturalistic et al.(1998) study: minimally verbal communicativ acknowledge, teaching with Multiple probe (n = 4) e interactions comment an SGD designs Kravits Sigle subject 6 years, PECS Frequency of Request and PECS plus et al. study: minimallyverbal use of comment social skills (2002) Multiple base (n = 1) symbolic training with designs communicatio pictures n; length of interaction CharlopSigle subject 3–12 years, PECS N of trials to Request PECS with Christy study: minimally verbal reach object and pictures et al.

Multiple base (n = 3) criterion in acknowledge (2002). designs each phase; N minutes until criterion met


  • Question #1: Yes, aided Augmentative Alternative Communication (AAC) can promote social communication in children with Autism Spectrum Disorder (confirmed in 6 studies)
  • Question #2: Types of aided AAC:
  • PECS are more effective for addressing communication and social skills.
  • SGD (high tech AAC) are shown effective for reduce challenging behaviors.
  • Picture based AAC (solely) are not as effective as PECS or SGD.

  • Results continued
  • Types of aided AAC and social communication functions:
  • PECS are effective for teaching object requests, but inconsistently for other communication functions such as comments and joint attention. (mixed results)
  • SGD + spoken words, as opposed to spoken words alone, showed improvements in children’s use of social communication functions.
Tips for parents:
  • Follow your child’s needs and family’s preferences:  Their behavioral challenges, fine motor skills, hearing/vision problems.
  • Advocate for your child at school:  Express your preferences regarding AAC use at your child’s IEP meeting  Refer your child for AAC evaluation Consistency is important:  Use AAC devices at home as well: slow and steady increment in time for AAC use  Parents need to model communication with AAC by themselves.  Incorporate AAC into fun play time with your kid’s siblings/close friends.
  • Plan ahead for your kids’ future social communication:
  • Tips for professionals
  • Refer for AAC treatment:  Refer to AAC evaluation to find a matching AAC solution for a child.
  • Peer-mediated AAC intervention for a child social communication:  Encourage and train peer volunteers for AAC intervention  Make it fun!
  • Clinician’s modeling for AAC use found effective:  Speech + AAC modeling
  • Consistency is important:  Work with classroom teachers, special education teachers, and parents for consistent AAC use at school and home.
What I have learned:
  • I have learned how to establish evidence base for AAC intervention services.
  • I became more aware of the needs of practical applications of AAC that can help clients with ASD, and gained experiences to act on it as a leader in my profession.
  • In the future, I would like to continue advocate for positively impacting social communication in such experiences and academics for children who use AAC.
  • References
  • Lorah, E, Parnell, A, and Speight, R. (2014), Acquisition of sentence frame discrimination using the iPad (TM) as a speech generating device in young children with developmental disabilities. Research in Autism Spectrum Disorders. Vol 8(12): 1734-1740. DOI: 10.1016/j.rasd.2014.09.004.
  • Xin JF and Leonard DA. (2015). Using iPads to Teach Communication Skills of Students with Autism. Journal of Autism, 45(12):4154-64. doi: 10.1007/s10803-014-2266-8.
  • Strasberger and Ferreri. (2014). The effects of peer assisted communication application training on the communicative and social behaviors of children with autism. Journal of Developmental and Physical Disabilities, (26) 513–526. doi:10.1007/s10882-013-9358-9.
  • Kagohara et al. (2012). Teaching picture naming to two adolescents with autism spectrum disorders using systematic instruction and speech-generating devices. Research in Autism Spectrum Disorders, 6, 1224–1233. doi:10.1016/j.rasd.2012.04.001.
  • Schepis et al.(1998). Increasing communicative interactions of young children with autism using a voice output communication aid and naturalistic teaching. Journal of Applied Behavior Analysis(31):561–578. doi:10.1901/jaba.1998.31-561.
  • Kravits et al. (2002). Brief report: Increasing communication skills for an elementary-aged student with autism using the picture exchange communication system. Journal of Autism and Developmental Disorders (32): 225– 230. doi:10.1023/A:1015457931788.

Charlop-Christy et al. (2002). Using the picture exchange communication system (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis (35):213–231. doi:10.1901/jaba.2002.35-213.

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