Augmentative and Alternative Communication AAC

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Augmentative and Alternative Communication (AAC)

• A Research Review
• Claire Hess
• Caldwell College

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Overview

• Search Description
• Relevant Issues in AAC Research
• Research Summary
• Discussion of Studies
• Comparison with Criteria for Evidence-Based
  Practice (EBP)
• Future Research
• References

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Search Description

• PsychINFO
• Search for literature reviews
• AAC, review, autis (12)
• Search for peer-reviewed, empirical studies
• AAC (684)
• AAC, autis (47)
• AAC, VOCA (12)
• AAC, VOCA, autis (12)
• AAC, sign (32)
• AAC, sign, autis (8)
• AAC, picture (40)
• AAC, picture, autis (7)
• AAC, PECS (3)
• AAC, autis, aided (7)
• AAC, autis, unaided (4)
• Search for peer-reviewed, empirical comparison
  studies
• AAC, autis, compar (5)
• Search PsycINFO and Google Scholar for specific
  studies

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Relevant Issues in AAC Research

• One third to one half of all persons with autism
  are functionally non-vocal (National Research
  Council, 2001)
• Role of motor and vocal imitation as a predictive
  measure (Yoder Layton, 1988)
• Functions served by AAC
• Relation of AAC to the development of speech
• Role of unfamiliar listeners in supporting AAC
  users
• Maladaptive behavior
• Comparisons of various modes of AAC (picture
  exchange, sign, voice output communication aids
  VOCAs)
• Pros and Cons of each form of AAC
• Mirenda (2003) Millar, Light, Schlosser
  (2006) Wilkinson, Hennig (2007)

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Research Summary Picture Exchange

• Facilitating communication with picture exchange
  can decrease disruptive behavior (Frea, Arnold,
  Vittimberga, 2001)
• Picture communication symbols (PCS), as a form of
  AAC, can increase rates of social interaction
  (Garrison-Harrell, Kamps, Kravits, 1997)
• PECS training, as compared to sign training, can
  result in fewer instructional trials to
  criterion, improved generalization, more
  spontaneous communication, and more vocalizations
  (Adkins Axelrod, 2001)
• PCS, as compared to sign, can facilitate improved
  communication with unfamiliar listeners (Rotholz,
  Berkowitz, Burberry, 1989)
• PECS can facilitate vocal speech production
  (Charlop-Christy, Carpenter, Le, LeBlanc,
  Kellet, 2002)

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Research Summary Sign

• Manual sign or total communication training can
  result in faster and more complete acquisition of
  receptive and/or expressive vocabulary and more
  spontaneous communication (Barrera,
  Lobatos-Barrera Sulzer-Azaroff, 1980 Barrera
  Sulzer-Azaroff, 1983 Layton, 1988)
• Sign training can decrease aggressive behavior by
  decreasing the response effort of communication
  (Richman, Wacker, Winborn, 2001)
• Sign training can facilitate vocal speech
  production (Conaghan, Singh, Moe, Landrum,
  Ellis, 1992 Layton Watson, 1995 Goldstein,
  2002)
• Sign training can increase vocalizations and word
  combinations in already vocal learners (Linton
  Singh, 1984 Barrett Sisson, 1987)
• Sign training can facilitate cross-operant
  responding (Braam Sundberg, 1991)

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Research Summary VOCAs

• The use of VOCAs can increase spontaneous social
  interactions (Schepis, Reid, Behrmann, Sutton,
  1998)
• High-quality VOCAs, as compared to PCS, can
  improve communication with unfamiliar listeners
  (Doss, Locke, Johnston, Reichle, Sigafoos,
  Carpenter, et al., 1991)

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Research Summary Combination AAC

• A combination of AAC training can increase
  requesting and decrease aggressive behaviors
  (Sigafoos Drasgow, 2001)

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Research Summary Mirenda (2003)
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Response Efficacy During Functional Communication
Training Effects of Effort on Response
Allocation (Richman, Wacker, Winborn, 2001)

• Participants
• Non-vocal 3-year-old boy
• Diagnosed with pervasive developmental disorder
• Severe disruptive and aggressive behaviors
• Setting
• Inpatient unit for assessment and treatment of
  aggression
• Procedure
• 6-second partial-interval recording during
  functional analysis
• Count within partial-interval recording for
  independent mands and aggressions
• Phase 1 (3 conditions) use of communication card
  vs. aggression
• Phase 2 (3 conditions) use of communication card
  vs. sign
• IOA data were collected during 26 of sessions
  89 (84 100)
• Neither treatment integrity, nor generalization,
  nor maintenance data were collected

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Results (Richman, et al., 2001)
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Topography- Versus Selection-Based Responding
Comparison of Mand Acquisitions in Each Modality
(Adkins Axelrod, 2001)

• Participants
• 7-year-old boy
• Infrequent, nonfunctional vocalizations
• Diagnosed with pervasive developmental disorder
  and ADHD
• 3-5 sign words and 10-15 PECS words
• Setting
• Self-contained classroom for children with autism
  and developmental disabilities
• Procedure
• 4 types of experimental sessions PECS training,
  sign training, PECS generalization, and sign
  generalization
• Frequency data were collected on all spontaneous
  vocal responses throughout the school day
• Alternating treatments design
• Neither IOA, nor treatment integrity, nor
  generalization, nor maintenance data were
  collected

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Results (Adkins Axelrod, 2001)
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Results (Adkins Axelrod, 2001), cont.
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Results (Adkins Axelrod, 2001), cont.
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Conditional Use of Aided and Unaided AAC A
Review and Clinical Case Demonstration (Sigafoos
Drasgow, 2001)

• Participants
• 14-year-old boy
• Diagnosed with moderate to severe intellectual
  disability and communication deficit with
  characteristically autistic behaviors
• Severe disruptive and aggressive behaviors
• Very rarely emitted single words
• Setting
• University-affiliated clinic for individuals with
  developmental disabilities
• Procedure
• ABCD design
• Baseline, acquisition training, conditional use
• IOA data were collected during 100 of sessions
  91 (85 100)
• Neither treatment integrity, nor generalization,
  nor maintenance data were collected

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Results (Sigafoos Drasgow, 2001)
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Comparison with Criteria for EBP

• EBP (Gina Greens Gold Standard)
• At least three studies, conducted by three
  different experimenters, that demonstrate
  experimental control when comparing baseline to
  intervention phases
• Each phase of baseline, intervention, and
  replication comprised of at least six data points
  demonstrating stability
• Continuous measurement of the dependent variable
  (DV)
• Inter-observer agreement (IOA) and treatment
  integrity both assessed for at least 25 of
  sessions

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Comparison with Criteria for EBP (cont.)

• Overall efficacy of AAC for individuals with
  autism and other developmental disabilities (YES)
• Facilitation of vocal speech production (NO)
• Overall superiority of one mode of AAC (NO)
• Associated increases in spontaneous communication
  with AAC (NO)
• Reductions in disruptive or aggressive behaviors
  with AAC (NO)
• Identification of predictive participant
  variables (NO)

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Future Research

• Role of prerequisite motor and vocal imitation
  skills
• Common diagnoses and participant characteristics
• Replicated goals of intervention
• Methodological Precision
• Treatment integrity, maintenance, and
  generalization measures
• Comparison studies

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References

• Adkins, T., Axelrod, S. (2001).
  Topography-based versus selection-based
  responding Comparison of mand acquisition in
  each modality. The Behavior Analyst Today, 2,
  259-266.
• Barrera, R., Sulzer-Azaroff, B. (1983). An
  alternating treatment comparison of oral and
  total communication training programs with
  echolalic autistic children. Journal of Applied
  Behavior Analysis, 16, 379-394.
• Barrera, R., Lobatos-Barrera, D.,
  Sulzer-Azaroff, B. (1980). A simultaneous
  treatment comparison of three expressive language
  training programs with a mute autistic child.
  Journal of Autism and Developmental Disorders,
  10, 21-37.
• Barret, R. P., Sisson, L. A. (1987). Use of the
  alternating treatments design as a strategy for
  empirically determining language training
  approaches with mentally retarded children.
  Research in Developmental Disabilities, 8,
  401-412.
• Braam, S. J., Sundberg, M. L. (1991). The
  effects of specific versus nonspecific
  reinforcement on verbal behavior. Analysis of
  Verbal Behavior, 9, 19-28.
• Charlop-Christy, M., Carpenter, M., Le, L,
  LeBlanc, L., Kellet, K. (2002). Using the
  Picture Exchange Communication System (PECS) with
  children with autism Assessment of PES
  acquisition, speech, social-communicative
  behavior, and problem behavior. Journal of
  Applied Behavior Analysis, 35, 213-231.
• Conaghan, B. P., Singh, N. N., Moe, T. L.,
  Landrum, T., Ellis, C. R. (1992). Acquisition
  and generalization of manual signs by
  hearing-impaired adults with mental retardation.
  Journal of Behavioral Education, 2, 175-203.
• Doss, S., Locke, P., Johnston, S., Reichle, J.,
  Sigafoos, J., Carpenter, P., et al. (1991).
  Initial comparison of the efficiency of a variety
  of AAC systems for ordering meals in fast food
  restaurants. Augmentative and Alternative
  Communication, 7, 256-265.
• Frea, W., Arnold, C., Vittimberga, G. (2001). A
  demonstration of the effects of augmentative
  communication on the extreme aggressive behavior
  of a child with autism within an integrated
  preschool setting. Journal of Positive Behavior
  Interventions, 4, 194-198.
• Goldstein, H. (2002). Communication intervention
  for children with autism A review of treatment
  efficacy. Journal of Autism and Developmental
  Disorders, 32, 373-396.
• Layton, T. (1988). Language training with
  autistic children using four different modes of
  presentation. Journal of Communication Disorders,
  21, 333-350.

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References (cont.)

• Millar, D. C., Light, J. C., Schlosser, R. W.
  (2006). The impact of augmentative and
  alternative communication intervention on the
  speech production of individuals with
  developmental disabilities A research review.
  Journal of Speech, Language, and Hearing
  Research, 49, 248-264.
• Mirenda, P. (2003). Toward a functional
  augmentative and alternative communication for
  students with autism Manual signs, graphic
  symbols, and voice output communication aids.
  Language, Speech, and Hearing Services in
  Schools, 34(3), 203-216.
• National Research Council. (2001). Educating
  children with autism. Washington, DC National
  Academy Press.
• Richman, D., Wacker, D., Winborn, L. (2001).
  Response efficiency during functional
  communication training Effects of effort on
  response allocation. Journal of Applied Behavior
  Analysis, 34, 73-76.
• Rotholz, D., Berkowitz, S., Burberry, J.
  (1989). Functionality of two modes of
  communication in the community by students with
  developmental disabilities A comparison of
  signing and communication books. Journal of the
  Association for Persons with Severe Handicaps,
  14, 227-233.
• Schepis, M., Reid, D., Behrmann, M., Sutton, K.
  (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.
• Schlosser, R. W., Blischak, D. M. (2001). Is
  there a role for speech output in interventions
  for persons with autism. Focus on Autism and
  Other Developmental Disabilities, 16(3), 170-178.
• Sigafoos, J., Drasgow, E. (2001). Conditional
  use of aided and unaided AAC A review and
  clinical case demonstration. Focus on Autism and
  Other Developmental Disabilities, 16, 152-161.
• Sigafoos, J., Drasgow, E.(2001). Conditional
  use of aided and unaided AAC A review and
  clinical case demonstration. Focus on Autism and
  Other Developmental Disorders, 16(3), 152-161.
• Sigafoos, J., OReilly, M., Seely-York, S.,
  Edrisinha, C. (2004). Teaching students with
  developmental disabilities to locate their AAC
  device. Research in Developmental Disabiliites,
  25(4), 371-383.
• Wilkinson, K. M., Hennig, S. (2007). The state
  of research and practice in augmentative and
  alternative communication for children with
  developmental/intellectual disabilities. Mental
  Retardation and Developmental Disabilities, 13,
  58-69.

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• QUESTIONS?