Assistive Technology and Communication

Alternative and Augmentative Communication and Speech Modelling

Armstrong, L., D. Jans, et al. (2000). "Parkinson's disease and aided AAC: some evidence from practice." International Journal of Language & Communication Disorders 35(3): 377-389.
Clinical observation that people with Parkinson's disease (PD) seem to have different training needs from other adult client-groups in developing effective use of aided augmentative and alternative communication (AAC) was the catalyst for this study. There is little good-quality research evidence available on the effectiveness (or lack of effectiveness) of aided AAC use by those with PD. One of the main aims of this preliminary study, therefore, was to elicit the experiences and attitudes of speech and language therapists in this specific area of their practice as the basis for future efficacy research and clinical practice. Thirty speech and language therapists were questioned about their experience of introducing low- and high-tech AAC devices to this client-group. Of particular interest was the discovery of the factors identified by the therapists as influencing their introduction of aided AAC to someone with PD and affecting implementation and successful use. The factors reported were both disease-specific (e.g. motor problems) and more general factors (e.g. carer support) relevant to the process of introducing aided AAC to other adult client-groups. Implications for future research and practice are discussed. Some research questions are posed and the inclusion of people with PD and their carers in practice development is promoted.

Bingham, M. A., F. Spooner, et al. (2007). "Training paraeducators to promote the use of augmentative and alternative communication by students with significant disabilities." Education and Training in Developmental Disabilities 42(3): 339-352.
The purpose of this study was to determine the impact of training paraeducators on (a) paraeducator prompting use of augmentative communication (AAC) systems, (b) paraeducator responding to student requests, (c) student use of AAC, and (d) student problem behavior via a series of multiple probe designs. Participants were three paraeducators and students. Paraeducators were trained on (a) importance of communication, (b) relationship between behavior and communication, (c) use of AAC, (d) how to prompt students to use AAC and respond to communications, and (e) how to self evaluate their behavior. All paraeducators increased the number of times they prompted student use of AAC and responded to student requests. All students increased use of AAC and exhibited fewer problem behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)

Bruno, J. and M. Dribbon (1998). "Outcomes in AAC: evaluating the effectiveness of a parent training program." AAC: Augmentative & Alternative Communication 14(2): 59-70.
The purpose of the paper is to report the outcome of the parent training program of Camp Chatterbox '95 that was combined with an intervention program for the children. Sixteen parents participated in the training program. Each of these parents completed questionnaires at three intervals describing (a) their skills in device operation and management, (b) their augmentative and alternative communication (AAC) interaction skills, and (c) their children's AAC device performance. Results demonstrate that parents perceived a positive change in their device operation, management, and interaction skills. They also perceived positive changes in their children's AAC device performance.

Collier, B. and S. Blackstien-Adler (1998). "Building competencies in augmentative and alternative communication among professionals." AAC: Augmentative & Alternative Communication 14(4): 250-260.
A three-pronged training and support model to develop competencies in augmentative and alternative communication (AAC) for professionals is described. It includes competency in AAC at an awareness level, basic AAC competencies for speech-language pathologists and occupational therapists, and specialized AAC competencies for transdisciplinary AAC service providers. Competency building techniques for these levels are described and evaluative data and recommendations for future research are shared.

Cress, C. J. and J. M. King (1999). "AAC strategies for people with primary progressive aphasia without dementia: two case studies." AAC: Augmentative & Alternative Communication 15(4): 248-259.
This paper describes multimodality augmentative and alternative communication (AAC) strategies developed for two people with primary progressive aphasia (PPA) without dementia. One case focused primarily on an initial assessment while the other case emphasized intervention. AAC system development included communication needs analyses, communication board and book development, and gesture modeling. Intervention focused on providing contextual cues, teaching visually based AAC strategies, and facilitator training. Both people with PPA successfully learned AAC strategies to augment the strategies they generated themselves to improve their functional communication. The authors suggest specific features of AAC that may be useful for people with PPA.

Dattilo, J., Estrella, G., Estrella, L., Light, J., McNaughton, D., & Seabury, M. (2008). 'I have chosen to live life abundently' Perceptions of leisure by adults who use alternative and augmentative communication Alternative and Augmentative Communication, 24(1).

Fishman, I. (2008). "What Alex the Parrot can teach us about working with children with complex communication needs." Perspectives on Augmentative & Alternative Communication 17(4): 144-149.
Alex the Parrot was an African grey trained by Dr. Irene Pepperberg to communicate at the level of a 5 year old. Pepperberg used a training method called the model/ rival technique where one person was the trainer, while the other was the model for the bird--and consequently, its rival for the trainer's attention. This model has implications for delivery of AAC treatment services. Although good clinical practice dictates that we deliver AAC services to children with complex communication needs in the same setting in which they will ultimately use their systems, services are still often delivered in one on one sessions. Very often these sessions are conducted without any of the child's significant communication partners present but the clinician herself. The manner in which services are delivered may be the decision of the clinician or it may be dictated by circumstances beyond her control (e.g., school policy, parental decisions, etc.). When services are delivered in a one-on-one setting, the natural social interaction provided by a third person, whether it is a peer or an adult caregiver, is absent. Thus, the clinician may want to create a treatment situation that includes a Helping Doll to model language for the child and create a rival for the child's attention and participation. The Doll was described by Goossens' et al. (1992) to be used with the aided language stimulation approach with a group of children in a preschool setting and detailed scripts of how the Doll could model language using color coded communication displays were provided. These scripts can effectively be used in a one on one situation with low tech displays as well as speech generating devices. Use of the Helping Doll can also be used to promote greater communication partner involvement.

Hazell, G. (2006). "Review of 'AAC and Severe Disabilities: Beyond Poverty'." International Journal of Language & Communication Disorders 41(6): 748-749.
Reviews the book, "AAC and Severe Disabilities: Beyond Poverty" edited by Erna Alant and Lyle Lloyd (2005). This book raises issues regarding the use of Augmentative and Alternative Communication (AAC) in developing/low-income countries (these terms are used interchangeably in the book). The first three chapters provide a good overview of AAC strategies and interventions while highlighting the human elements of involvement and participation. Challenges in the process of implementing AAC are described in terms of myths, team involvement, and support and training. Another chapter deals with the thorny issue of assistive technology (primarily AAC technologies) in low-income countries. The final chapter identifies the basic themes running through the book and highlights the need for research and training. In sum, this is a professionally challenging and informative book: challenging because it makes one consider the wider world and its impact on AAC implementation and use. It challenges our methods of working as well as providing thought provoking research and concepts. It is an excellent text for widening our vision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Johnson, J. M., E. Inglebret, et al. (2006). "Perspectives of speech language pathologists regarding success versus abandonment of AAC." AAC: Augmentative & Alternative Communication 22(2): 85-99.
This three-phase investigation used focus groups and a survey to identify factors that perceived by speech language pathologists as being related to long-term success versus inappropriate abandonment of augmentative and alternative communication (AAC) systems. Factors deemed most important by six focus groups were included in a 106-question survey that was returned by 275 ASHA Special Interest Division #12 (AAC) members. Factor analysis indicated the constructs of Support, Attitude, and System characteristics and Fit as most important to the long-term success of AAC systems. The constructs of Not Maintaining/Adjusting the System, Attitude, Lack of Training, Lack of Support, and Poor Fit were most often related to inappropriate abandonment of AAC systems. Systematic implementation of intervention targeting the constructs is recommended.

Matthews, R. (2001). "A survey to identify therapists' high-tech AAC knowledge, application and training." International Journal of Language & Communication Disorders 36: 64-69.
Recent research in Australia (Balandin and Iacono 1998) has identified a lack of postgraduate training in high tech or electronic alternative and augmentative communication (AAC) equipment for speech and language therapists (SLTs). At Treloar College (TC) the SLTs have acquired wide experience and knowledge that could be shared with others who have fewer clinical opportunities to acquire skill in this area of expertise. Questionnaires were sent to 500 SLTs selected at random. The purpose of the questionnaire was to identify how knowledgeable SLTs in various clinical settings across the UK considered themselves to be in the prescription, training, support and use of high tech AAC in an increasingly technological world.

McCall, F. and E. Moodie (1998). "Training staff to support AAC users in Scotland: current status and needs." AAC: Augmentative & Alternative Communication 14(4): 228-238.
The focus of the present study was twofold: to discover what types of training in augmentative and alternative communication (AAC) are perceived to be both available and desired by those people involved in the implementation of AAC equipment for adults in Scotland and to document the extent to which they have received relevant training in AAC. Two questionnaires were distributed to those people responsible for AAC implementation (e.g., speech and language therapists [SLTs], day and residential staff, nurses, teachers). One questionnaire requested details of any "general" AAC training received by the respondent, and the other questionnaire requested details of any training received by the respondent that was specific to a particular AAC system. With respect to general training, perceptions suggested that what training exists is beneficial, but that there is insufficient training available, and non-SLTs, in particular, have had little general training. With respect to "specific" training, about half of the respondents had received training. Those who had received specific training desired more both for themselves and for others working in the field of AAC. The study demonstrates both a need and a desire for more training at all levels for those involved in the process of AAC implementation.

McConachie, H. and L. Pennington (1997). "In-service training for schools on augmentative and alternative communication." European Journal of Disorders of Communication 32(3, Spec Iss): 277-288.
Evaluated a training package developed by the authors to help schools develop a consistent and cohesive team approach to augmentative and alternative communication (AAC) and whether, following training, participants showed greater skill in facilitating the communication of children using AAC. 7 training workshops were run in which 9 students (aged 7–17 yrs) with cerebral palsy who had an AAC system were targeted. 33 teaching and nonteaching staff members working with the students were assigned to either a workshop participant or comparison group. Each staff member was videotaped interacting with a target student before and after a 5-session training workshop. At least 2 5-min videoclips of interaction were coded to examine the extent to which adults facilitated the student's communication. Significant improvements in the quality of adults' facilitation of the children's communication was discernible at 4 mo follow-up after training. Teachers were found to alter their behaviour more quickly. Results suggest that the school-based training package was effective in improving the quality of how adults interact with severely physically disabled young people.

McNaughton, D., T. Rackensperger, et al. (2008). ""A child needs to be given a chance to succeed": parents of individuals who use AAC describe the benefits and challenges of learning AAC technologies." AAC: Augmentative & Alternative Communication 24(1): 43-55.
Seven parents of individuals with cerebral palsy who used augmentative and alternative communication (AAC) devices participated in a focus group discussion on the benefits and challenges of learning AAC technology. The focus group was conducted on the Internet over a 9-week period. Six major themes emerged from the discussion: (a) issues in the selection of AAC technology; (b) knowledge and skills needed to use AAC technology; (c) barriers to learning AAC technology; (d) teaching the individual; (e) educating society; and (f) recommendations to others. Important supports to learning how to make effective use of AAC technology included opportunities for individual exploration, use of the technology in role play activities, organized instruction, and opportunities for functional use in the community.

Mirenda, P. (1997). "Supporting individuals with challenging behavior through functional communication training and AAC: research review." AAC: Augmentative & Alternative Communication 13(4): 207-225.
The term "functional communication training" (FCT) has been used over the past decade to refer to a set of procedures designed to reduce challenging behavior by teaching functionally equivalent communication skills. Functional communication training requires a thorough assessment to identify the function (or "message") of the behavior of concern and systematic instruction related to the new communicative behaviors. The growing body of empirical literature demonstrating the efficacy and mechanisms of this procedure has included a number of examples in which augmentative and alternative communication (AAC) techniques were used during intervention. The purpose of this review is to summarize the extant FCT/AAC research in an accessible format and to identify areas for future research in this area.

Mwm (2004). "High-tech AAC and aphasia: widening horizons?" Aphasiology 18(3): 245-263.
Background: Many people with aphasia are trained to use low-tech AAC strategies (Alternative and Augmentative Communication) to support communication, but high-tech communication aids are introduced only incidentally. The factors influencing success and failure of low-tech AAC are relevant for the development of high-tech communication aids for aphasia.
Aims: To review the state of the art in low-tech and high-tech AAC applications for aphasia.
Main Contribution: Although there is there is a wealth of knowledge among therapists, there is very little research to support the efficacy of AAC techniques. Many authors stress the heterogeneity of the aphasic population, not only in the characteristics of the aphasia, but also in communicative abilities and needs, cognitive abilities, motivation, and social situation. Therefore, AAC devices should be individualised and "tailor-made", taking advantage of residual language skills and communicative strengths. A common problem is that acquired AAC skills are often not used in daily communication. Several factors may play a role, e.g., lack of motivation, inadequate vocabulary, insufficient training, or cognitive or linguistic limitations. So far, functional use of assistive technology has received relatively little attention, but a portable device with ready-made messages for specific communicative situations appeared to be used in every day life.
Conclusions: Computer technology has much to offer for supporting aphasic communication, not only for people with a very severe aphasia, who do not benefit from disorder-oriented therapy, but also for people with a moderate or mild aphasia. Research into AAC and aphasia, focusing on functional use, is needed in order to build and refine communication aids that are easy to use and can be tailored individually.

Patel, R. and R. Khamis-Dakwar (2005). "An AAC training program for special education teachers: a case study of Palestinian Arab teachers in Israel." AAC: Augmentative & Alternative Communication 21(3): 205-217.
We present an augmentative and alternative communication (AAC) training program provided to 20 special education teachers in a Palestinian Arab community in Israel. The training program consisted of didactic workshops interleaved with on-site supervision. Instructional goals included creating awareness, imparting knowledge, and assisting teachers to develop and use AAC within their classrooms. Prior to training, we administered a questionnaire to assess teachers' knowledge, practices, and attitudes in relation to AAC. The questionnaire was re-administered and individual interviews were conducted post-training to determine the program's impact on knowledge, practices, and attitude barriers. Teachers' responses revealed that training helped them to address barriers to AAC intervention. The responses also provided insights into the linguistic and cultural challenges of AAC implementation within the Palestinian Arab community.

Pennington, L., J. Goldbart, et al. (2004). "Speech and language therapy to improve the communication skills of children with cerebral palsy." Cochrane database of systematic reviews (Online)(2): CD003466.
BACKGROUND: The production of speech, language and gesture for communication is often affected by cerebral palsy. Communication difficulties associated with cerebral palsy can be multifactorial, arising from motor, intellectual and / or sensory impairments, and children with this diagnosis can experience mild to severe difficulties in expressing themselves. They are often referred to speech and language therapy (SLT) services, to maximise their communication skills and help them to take an independent a role as possible in interaction. This can include introducing augmentative and alternative communication (AAC) systems, such as symbol charts or speech synthesizers, as well treating children's natural forms of communication. Various strategies have been used to treat the communication disorders associated with cerebral palsy but evidence of their effectiveness is limited. OBJECTIVES: To determine the effectiveness of SLT that focuses on the child or their familiar communication partners, as measured by change in interaction patterns. To determine if individual types of SLT intervention are more effective than others in changing interaction patterns. SEARCH STRATEGY: Searches were conducted of MEDLINE, CINAHL, EMBASE, PSYCH INFO, LLBA, ERIC, WEB of SCIENCE, NRR, BEI, SIGLE up to December 2002. References from identified studies were examined and relevant journals and conference reports were hand-searched. SELECTION CRITERIA: Any experimental study containing an element of control was included in this review. This includes non-randomised group studies and single case experimental designs in which two interventions were compared or two communication processes were examined. DATA COLLECTION AND ANALYSIS: L Pennington searched for and selected studies for inclusion. J Goldbart and J Marshall independently assessed separate random samples each comprising 25% of all identified studies. Two reviewers independently abstracted data from each selected study. Disagreements were settled by discussion between the three reviewers. MAIN RESULTS: Eleven studies were included in the review. Seven studies evaluated treatment given directly to children, four investigated the effects of training for communication partners. Subjects in the studies varied widely in age, type and severity of cerebral palsy, cognitive and linguistic skills. Studies focusing directly on children suggest that this model of therapy delivery has been associated with increases in treated communication skills by individual children. However, methodological flaws prevent firm conclusions being made about the effectiveness of therapy. In addition, maintenance of these skills was not investigated thoroughly. The studies targeting communication partners describe small exploratory group projects which contain insufficient detail to allow replication, have very low power and cannot provide evidence of effectiveness of this type of treatment. REVIEWERS' CONCLUSIONS: Firm evidence of the positive effects of SLT for children with cerebral palsy has not been demonstrated by this review. However, positive trends in communication change were shown. No change in practice is recommended from this review. Further research is needed to describe this client group, and its possible clinical subgroups, and the methods of treatment currently used in SLT. Research is also needed to investigate the effectiveness of new and established interventions and their acceptability to families. Rigour in research practice needs to be extended to enable firm associations between therapy and communication change to be made.

Simpson, K. O., G. D. Cumley, et al. (1997). "Effects of three instructional modes on the performance of novice preprofessional students with AAC technology." AAC: Augmentative & Alternative Communication 13(2): 81-86.
The purposes of this investigation were twofold. The primary goal was to examine the efficacy of three modes of instruction for training preservice students in speech and language pathology (SLP) to program an augmentative and alternative communication (AAC) device. A secondary goal was to evaluate knowledge retention 2 weeks after the training sessions. The participants were preprofessional students enrolled In an AAC course. The modes of instruction included face-to-face demonstration, written tutorial, and videotape. Results indicated that performance across the three modes was equivalent at the acquisition and retention evaluations. However, performance on the retention evaluations was significantly less compared with the acquisition evaluation. Clinical and research implications are discussed.

Solomon-Rice, P. and G. Soto (2009). "Language modeling as an efficacious early language intervention approach with young children demonstrating complex communication needs." Perspectives on Augmentative & Alternative Communication 18(1): 21-27.
This article highlights evidence supporting the efficacy of adult language modeling and child imitation, including use of aided AAC modeling, during language intervention with young children demonstrating complex communication needs. First, four evidence-based language intervention approaches that incorporate adult language modeling and child imitation with young children demonstrating language delays are described. Second, two additional evidence-based language intervention approaches that incorporate aided AAC modeling during communication partner training, and direct clinical intervention with young children using aided AAC are further discussed. The article concludes with suggestions for strategies to use during language intervention with young children who use aided AAC.

Starble, A., T. Hutchins, et al. (2005). "Family-centered intervention and satisfaction with AAC device training." Communication Disorders Quarterly 27(1): 47.
The purpose of this article is to describe a family-centered collaborative approach for developing and implementing augmentative and alternative communication (AAC) device training for one family. Family-centered training emphasized collaboration with the primary investigator and focused on needs assessment, the identification of priority communicative contexts, AAC device implementation, and communication partner training. Responses to a questionnaire to assess satisfaction at posttraining revealed high degrees of satisfaction for most dimensions (e.g., expertise and sensitivity of the trainer, relevance and appropriateness of the training). Other dimensions (e.g., family's comfort when using the AAC device), by comparison, were associated with less satisfaction, which provides important information to guide further intervention efforts. Clinical implications, directions for future research, and the importance of a family-centered approach to practice are discussed.

Sutherland, D. E., G. G. Gillon, et al. (2005). "AAC use and service provision: a survey of New Zealand speech-language therapists." AAC: Augmentative & Alternative Communication 21(4): 295-307.
Augmentative and alternative communication (AAC) services for people with complex communication needs in New Zealand were investigated by surveying speech-language therapists. Two separate survey forms were developed and mailed to speech-language therapists who worked with either students or adults. In both survey forms, information was requested about (a) the provision of AAC intervention, (b) the professional needs of speech-language therapists providing AAC services, and (c) demographic information about students with complex communication needs. Low-tech communication options and sign language were the most commonly reported AAC strategies used by adults and students with complex communication needs. Students aged 5-10 years received the most AAC intervention. Cerebral palsy, intellectual disabilities and autism spectrum disorders were the most commonly reported etiologies of students who used AAC. A total of 86% of the respondents indicated a desire for further AAC information or training.

Todman, J. (2000). "Rate and quality of conversations using a text-storage AAC system: single-case training study." AAC: Augmentative & Alternative Communication 16(3): 164-179.
"TALK" is a text-storage and retrieval AAC system designed for literate people who are unable to speak. It aims to support free-flowing social conversation by means of features that model pragmatic aspects of unaided conversation. A single-case, six-phase training study was carried out to help a user to take advantage of the pragmatic potential of the system. She had 10 conversations in a baseline phase, 4 following each of 4 training interventions (about 6 hours in total), and 4 in a maintenance phase. Over phases, her average prespeech pause times decreased (from 9 to 5 seconds) and her conversational rate increased (from 36 to 64 words per minute). Participant and observer ratings indicated that the quality of the conversations increased and perceptions of the user's competence and personal qualities became more positive as her conversational rate increased. Speed and rating gains were sustained in the maintenance phase.

Torrison, C., E. Jung, et al. (2007). "The impact of staff training in augmentative/alternative communication (AAC) on the communication abilities of adults with developmental disabilities." Developmental Disabilities Bulletin 35(1-2): 103-130.
Staff at a day program were trained in Augmentative/Alternative Communication (AAC) strategies and techniques. The goal was to provide training that would allow staff at the centre to use communication strategies when working with their clients. Two training sessions were provided on AAC and communication strategies for all staff at the centre. Additional training was provided on the use of Boardmaker software. The research team also worked directly with four clients and their key workers to implement AAC strategies. These selected staff members were provided with the opportunity to observe and participate in communication intervention sessions with their client. These sessions were intended to provide the staff with AAC skills and knowledge. An initial assessment established the client communication needs and obstacles. A plan was developed for each client and key-worker, and they were trained based on the plan. There was a range of success among the four clients, but impact was seen on both clients and key-workers.

Camarata, S. and P. Yoder (2002). "Language transactions during development and intervention: Theoretical implications for developmental neuroscience." International Journal of Developmental Neuroscience 20(3-5): 459-465.
Recent modeling of language development and intervention for children with disabilities has increasingly focused on the interactions between adults and children. These models have resulted in a number of recent advances in the behavioral treatment of language abilities in children with disabilities. Because these interventions are associated with substantial growth in a number of skills including speech, grammar, and vocabulary, these paradigms may provide a useful model for studying neurological development of these aspects of language. The purpose of this paper is to discuss the potential neurodevelopmental ramifications of this type of theoretical model for facilitating language growth in children with and without disabilities. Indeed, because intervention can sometimes trigger rapid advances in language skills and presumably, associated neurological organization, this may prove to be a very useful paradigm for understanding the neurological correlates of language growth.

Clarke, M. T., McConachie, H. R., Price, K., & Wood, P. (2001). Views of young people using augmentative and alternative communication systems. International Journal of Language and Communication Disorders, 36, 107-115.

Charlop-Christy, M. H. and C. Jones (2006). The Picture Exchange Communication System: Nonverbal Communication Program for Children with Autism Spectrum Disorders. Treatment of language disorders in children. R. J. McCauley and M. E. Fey. Baltimore, MD US, Paul H Brookes Publishing: 105-122.
(from the chapter) In the Picture Exchange Communication System (PECS), children are taught functional communication using a picture-based augmentative and alternative communication (AAC) system. Using a system of modeling and decreasing prompts, children move from using pictures to request desired objects to more elaborate communications that may include written language. PECS has primarily been used for children with autism spectrum disorders as well as other severe communication deficits. With few prerequisite requirements, it is seen as particularly promising for children who rarely initiate communication. Its clinical application is broadening to include other populations, and its empirical base has expanded but still consists primarily of case studies and single-subject experimental designs.

Charlop, M. H. and J. P. Milstein (1989). "Teaching autistic children conversational speech using video modeling." Journal Of Applied Behavior Analysis 22(3): 275-285.
We assessed the effects of video modeling on acquisition and generalization of conversational skills among autistic children. Three autistic boys observed videotaped conversations consisting of two people discussing specific toys. When criterion for learning was met, generalization of conversational skills was assessed with untrained topics of conversation; new stimuli (toys); unfamiliar persons, siblings, and autistic peers; and other settings. The results indicated that the children learned through video modeling, generalized their conversational skills, and maintained conversational speech over a 15-month period. Video modeling shows much promise as a rapid and effective procedure for teaching complex verbal skills such as conversational speech.

Courtright, J. A. and I. C. Courtright (1979). "Imitative modeling as a language intervention strategy: The effects of two mediating variables." Journal of Speech & Hearing Research 22(2): 389-402.
Studied 36 language-disordered children (ages 3 yrs 11 mo to 6 yrs 11 mo) to examine the influence of (a) reinforcement and (b) whether modeled examples originated with the clinician or with a separate, 3rd-person model on the modeling process. Results suggest that modeling strategies were superior to mimicry in teaching Ss rules that they previously lacked. Neither reinforcement nor 3rd-person models significantly increased teaching effectiveness of modeling techniques.

Drager, K. D. R., V. J. Postal, et al. (2006). "The effect of aided language modeling on symbol comprehension and production in 2 preschoolers with autism." American Journal of Speech-Language Pathology 15(2): 112-125.
PURPOSE: The purpose of the present study was to examine the effectiveness of an instructional procedure called aided language modeling (ALM) on symbol comprehension and expression in 2 preschool children with autism who used few words functionally. ALM consists of engaging the child in interactive play activities and providing models of use of augmentative and alternative communication symbols during play.
METHOD: A multiple-baseline design across sets of symbol vocabulary was used with 2 children who had autism. Four vocabulary items were taught in each of 3 legs of the design, for each child.
RESULTS: Both participants demonstrated increased symbol comprehension and elicited symbol production. In addition, both participants demonstrated that symbol comprehension and symbol production could be maintained. For both children, performance on symbol production lagged behind rate of responses on symbol comprehension.
CONCLUSIONS: The current research presents preliminary evidence that a modeling intervention may be effective in increasing symbol comprehension and production, and may be an appropriate intervention strategy for some preschoolers with autism. Future research should continue to investigate this strategy and its effects on functional communication.

Ganz, J. B., A. K. Heath, et al. (2010). "Impact of AAC versus verbal modeling on verbal imitation, picture discrimination, and related speech: A pilot investigation." Journal of Developmental and Physical Disabilities 22(2): 179-196.
Delays in or lack of language development are a primary characteristic of autism. Thus, teachers, families and researchers face the challenge of determining which teaching strategies are most effective and efficient in addressing these communication deficits. This study attempts to add to the literature regarding this issue. A multi-treatment/multi-measure single-case design was used to compare the effects of the Picture Exchange Communication System (PECS) with a verbal modeling intervention on four communicative behaviors: (a) picture requests, (b) imitated verbalizations, (c) picture discrimination, and (d) any related speech for a 3 year old child with autism. Results indicated that the PECS training led to increases in picture requests and these results were maintained during the verbal modeling intervention phase. No change in imitated verbalizations was observed following either intervention. With respect to both picture discrimination and related speech, no significant results were achieved following PECS training or verbal modeling. However, during the verbal modeling phase the participant demonstrated a small increase in both picture discrimination and any related speech for both the PECS and verbal modeling item sets.

Girolametto, L., E. Weitzman, et al. (2006). "Facilitating language skills. Inservice education for early childhood educators and preschool teachers." Infants & Young Children: An Interdisciplinary Journal of Special Care Practices 19(1): 36-49.
Learning Language and Loving It is a well-known model of inservice education for early childhood educators and preschool teachers. Its objectives are to facilitate language learning, peer interaction, and literacy development in naturalistic classroom contexts. The inservice education program consists of 8 evening group sessions and 6 individual video feedback sessions. Early childhood educators are taught to use (a) child-centered strategies (eg, follow the children's lead), (b) interaction-promoting strategies (eg, ask questions that continue the conversation, wait for the child to take a turn), and (c) language-modeling strategies (eg, label, expand, comment). Educators also learn strategies to facilitate peer interactions and early literacy skills. Investigations of the efficacy of this inservice program indicate that it effectively improves educators' language facilitation strategies and verbal supports for peer interaction. Typically developing children evidenced increased talkativeness, used a more diverse vocabulary, and increased their peer interactions. The program's use with children who have disabilities (eg, language disorders) and children who are learning English as a second language is beginning to be explored.

Ihrig, K. and S. A. Wolchik (1988). "Peer versus adult models and autistic children's learning: Acquisition, generalization, and maintenance." Journal of Autism and Developmental Disorders 18(1): 67-79.
Compared the effectiveness of a peer model and an adult model in teaching an expressive language task to 4 autistic boys (aged 7.11–10.4 yrs). A BCBC design, counterbalanced across Ss, was used. After training criterion was reached, generalization of responding to an extratherapy school setting and to the home was measured. 13 weekly maintenance probes were conducted after training in each condition. Results indicate that all children learned through observing the peer and adult models and that few consistent differences occurred across the 2 conditions. The degree of generalization and maintenance of responding was consistently high in both conditions.

Koester, H. H. and S. P. Levine (1998). "Model simulations of user performance with word prediction." AAC: Augmentative and Alternative Communication 14(1): 25-35.
Previous work has demonstrated that, under well-defined conditions, a quantitative model can accurately represent user performance with word prediction systems (H. H. Koester, 1994; H. H. Koester & S. P. Levine, 1994, 1995, 1997). This paper illustrates the use of this model to simulate user performance across a broad range of conditions. Examples of simulation results are presented to show how user characteristics, strategy of use, and system characteristics combine to determine overall performance. The use of model simulations to inform clinical decision-making and research questions is discussed.

Law, J., R. Rush, et al. (2009). "Modeling developmental language difficulties from school entry into adulthood: literacy, mental health, and employment outcomes." Journal Of Speech, Language, And Hearing Research: JSLHR 52(6): 1401-1416.
PURPOSE: Understanding the long-term outcomes of developmental language difficulties is key to knowing what significance to attach to them. To date, most prognostic studies have tended to be clinical rather than population-based, which necessarily affects the interpretation. This study sought to address this issue using data from a U.K. birth cohort of 17,196 children, following them from school entry to adulthood, examining literacy, mental health, and employment at 34 years of age. The study compared groups with specific language impairment (SLI), nonspecific language impairment (N-SLI), and typically developing language (TL). METHOD: Secondary data analysis of the imputed 5-year and 34-year data was carried using multivariate logistic regressions. RESULTS: The results show strong associations for demographic and biological risk for both impairment groups. The associations are consistent for the N-SLI group but rather more mixed for the SLI group. CONCLUSIONS: The data indicate that both SLI and N-SLI represent significant risk factors for all the outcomes identified. There is a strong case for the identification of these children and the development of appropriate interventions. The results are discussed in terms of the measures used and the implications for practice.

Nyamapfene, A. (2009). "Computational investigation of early child language acquisition using multimodal neural networks: A review of three models." Artificial Intelligence Review 31(1-4): 35-44.
Current opinion suggests that language is a cognitive process in which different modalities such as perceptual entities, communicative intentions and speech are inextricably linked. As such, the process of child language acquisition is one in which the child learns to decipher this inextricability and to acquire language capabilities starting from gesturing, followed by language dominated by single word utterances, through to full-blown native language capability. In this paper I review three multimodal neural network models of early child language acquisition. Using these models, I show how computational modelling, in conjunction with the availability of empirical data, can contribute towards our understanding of child language acquisition. I conclude this paper by proposing a control theoretic approach towards modelling child language acquisition using neural networks.

Scattone, D. (2008). "Enhancing the conversation skills of a boy with Asperger's Disorder through Social Stories and video modeling." Journal of Autism and Developmental Disorders 38(2): 395-400.
This study combined Social Stories with video modeling in an effort to enhance the conversation skills of a boy with Asperger's Disorder. Treatment consisted of two components: (a) observation of video taped Social Stories that included two adults modeling targeted conversational skills and (b) 5-min social interactions. A multiple baseline design across behaviors was used to evaluate the intervention and an increase in 2 out of 3 targeted conversation skills occurred. In addition, generalized behavior changes were observed. These findings provide support for including Social Stories as part of a video treatment package in teaching complex social interaction behaviors to young children with Asperger's Disorder.

Solomon-Rice, P. and G. Soto (2009). "Language modeling as an efficacious early language intervention approach with young children demonstrating complex communication needs." Perspectives on Augmentative & Alternative Communication 18(1): 21-27.
This article highlights evidence supporting the efficacy of adult language modeling and child imitation, including use of aided AAC modeling, during language intervention with young children demonstrating complex communication needs. First, four evidence-based language intervention approaches that incorporate adult language modeling and child imitation with young children demonstrating language delays are described. Second, two additional evidence-based language intervention approaches that incorporate aided AAC modeling during communication partner training, and direct clinical intervention with young children using aided AAC are further discussed. The article concludes with suggestions for strategies to use during language intervention with young children who use aided AAC.

Tykkyläinen, T. (2009). "Task-setting at home and in speech and language therapy." Child Language Teaching & Therapy 25(3): 319-340.

Weismer, S. E., J. Murray-Branch, et al. (1993). "Comparison of two methods for promoting productive vocabulary in late talkers." Journal Of Speech And Hearing Research 36(5): 1037-1050.
This investigation compared the effectiveness of two language treatment methods, modeling versus modeling plus evoked production, in promoting productive vocabulary in three toddlers identified as late talkers. A single-subject alternating treatments design was employed in this study in which different sets of words were taught under the two treatment methods during group and individual instruction. Some evidence of differential patterns of response to the treatment types was found for two subjects, but the subjects differed as to which particular treatment method was associated with better performance. Neither treatment method was effective for the third subject. Dynamic assessment measures were only marginally useful in predicting overall lexical learning potential in these subjects, and did not predict response to the two teaching methods. Implications of these results are discussed with regard to the role of language intervention for late talkers.

Whitworth, A. (2010). "Using narrative as a bridge: linking language processing models with real-life communic." Seminars in Speech & Language 31(1): 64-75.
In chronic aphasia, maximizing generalization of improved language abilities from clinical tasks to everyday communication can require the same systematic planning process as the early stages of therapy, often drawing on additional areas of knowledge and successes from other clinical populations. The use of narrative structure is shown here to be a useful framework for building on the developments within sentence processing impairments in aphasia and creating a bridge to more real-life language tasks. An intervention based on narrative structure is described with two people with different language profiles and at different stages of the chronic aphasia spectrum. The insights gained in assessing language ability, underpinning intervention, and capturing therapeutic changes are demonstrated.

Williams, M. B., Krezman, C., & McNaughton, D. (2008). "Reach for the stars": five principles for the next 25 years of AAC. AAC: Augmentative & Alternative Communication, 24(3), 194-206.

Return to index

Speech Generating Devices

Alamsaputra, D. M., K. J. Kohnert, et al. (2006). "Synthesized Speech Intelligibility among Native Speakers and Non-Native Speakers of English." AAC: Augmentative and Alternative Communication 22(4): 258-268.
Using synthesized and digitized speech in electronic communication devices may greatly benefit individuals who cannot produce intelligible speech. However, multiple investigations have demonstrated that synthesized speech is not always sufficiently intelligible for its listeners. Listening to synthesized speech may be particularly problematic for listeners for whom English is a second language. We compared native and non-native English-speaking adults' listening accuracy for English sentences in natural voice and synthesized voice conditions. Results indicated a disproportionate disadvantage for the non-native English-speaking group when listening to synthesized speech compared to their native English-speaking age peers. There was, however, significant variability in performance within the non-native English group, and this was strongly related to independent measures of English language skill. Specifically, a large portion of the variance in performance on the synthesized speech task was predicted by participants' receptive vocabulary scores.

Angermeier, K., K. Schooley, et al. (2010). "The role of fingerspelled self-cues during spelling with a speech generating device by a child with autism: A brief report." Journal of Developmental and Physical Disabilities 22(2): 197-200.
This brief report represents a post-hoc analysis on the use of fingerspelling as a self-cue by a child with autism who was previously taught to spell with a speech generating device under three feedback conditions: auditory (speech output), visual (Liquid Crystal Display), and auditory-visual (Schlosser et al., Journal of Autism and Developmental Disorders, 28:309–319, 1998). During instruction for this study, the child was provided with fingerspelled input across conditions. In coding the videotaped sessions for correct spelling performance, it was noted that this child seemed to use fingerspelling as self-cues as he was entering a letter into the keyboard. The purpose of this post-hoc analysis was to determine whether he used these fingerspelled self-cues more in certain feedback conditions than others. Results revealed that although the child produced fingerspelled self-cues across conditions, he used them most frequently in the auditory condition and least often in the visual condition. It is hypothesized that this child may have self-generated a visual mnemonic as needed (as a function of the condition) in order to facilitate memory retrieval of letters during spelling. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)

Banda, D. R., K. S. Copple, et al. (2010). "Video modelling interventions to teach spontaneous requesting using AAC devices to individuals with autism: a preliminary investigation." DISABILITY AND REHABILITATION 32(16): 1364-1372.
This multiple baseline study investigated to what extent individuals with autism would learn to operate a speech generating device (SGD) to request a preferred object by observing a video model. The intervention consisted of each participant viewing a 10- to15-s video model that demonstrated the requesting of a preferred object using a SGD. Baseline, intervention and generalisation were all implemented within a public school, special education classroom. After viewing the video model, two participants displayed the ability to request preferred items using the SGD without prompting or cues. However, the participants did not generalise requesting using the SGD to a second preferred object. The study provides preliminary evidence that video modelling can be used to teach individuals with autism and severe cognitive disabilities requesting skills using an SGD.

Blischak, D. M., L. J. Lombardino, et al. (2003). "Use of speech-generating devices: In support of natural speech." AAC: Augmentative and Alternative Communication 19(1): 29-35.
One of the most frequently cited concerns from parents, teachers, and other caregivers, upon hearing a recommendation for the use of augmentative and alternative communication (AAC) is, 'Will its use interfere with natural speech?' Reports of positive effects of AAC use, particularly that of speech output, are increasingly available, whereas evidence to support negative consequences of AAC use has not been widely reported. In this paper, possible explanations for increases in natural speech production associated with AAC use are explored, along with a discussion of clinical implications and future research.

Blischak, D. M. and R. W. Schlosser (2003). "Use of technology to support independent spelling by students with Autism." Topics in Language Disorders 23(4): 293-304.
For individuals with little or no functional speech, the ability to spell is critical in generating spontaneous, novel utterances. The purpose of this article is to discuss evidence regarding the role of speech-generating devices (SGDs) and talking word processing software in supporting independent spelling in children with autism. Implications for understanding the learning characteristics of children with autism and discussion regarding practice and future research are derived. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)

Bruno, J. and D. Trembath (2006). "Use of aided language stimulation to improve syntactic performance during a weeklong intervention program." AAC: Augmentative & Alternative Communication 22(4): 300-313.
This pilot study assessed the performance of nine children, aged 4;8 - 14;5, who used augmentative and alternative communication (AAC) systems before and after a weeklong aided language stimulation intervention program. Pre/post test data were analyzed to evaluate the participants' syntactic complexity when using (a) a manual communication board and (b) a dynamic display speech generating device (DD-SGD). Results indicate that most participants improved their syntactic performance and that these gains were more pronounced when the participants used a manual communication board as compared with a DD-SGD. There was considerable individual variation in performance.

Cheslock, M. A., A. Barton-Hulsey, et al. (2008). "Using a speech-generating device to enhance communicative abilities for an adult with moderate intellectual disability." Intellectual & Developmental Disabilities 46(5): 376-386.

Choi, H., M. O’Reilly, et al. (2010). "Teaching requesting and rejecting sequences to four children with developmental disabilities using augmentative and alternative communication." Research in Developmental Disabilities 31(2): 560-567.
The purpose of this study was to evaluate the feasibility of teaching an integrated requesting–rejecting sequence. Four children with developmental disabilities were taught to request missing items and reject wrong items using either speech-generating devices (SGD) or picture-exchange (PE) communication. Data showed that the introduction of the teaching procedures were associated with acquisition of the targeted requesting and rejecting responses. The newly acquired rejecting responses generalized across two untrained activities and were maintained for up to four weeks following intervention for three of the four participants. The missing-item and wrong-item formats can be successfully combined to teach an integrated sequence of requesting and rejecting to students with developmental disabilities who use speech-generating devices (SGD) or picture-exchange (PE) communication.

DiCarlo, C. F. and M. Banajee (2000). "Using voice output devices to increase initiations of young children with disabilities." Journal of Early Intervention 23(3): 191-199.
Examined effects of using voice output devices to facilitate communicative initiation behaviors in developmentally delayed and nonverbal young children. Two nonverbal male children (aged 24–28 mo) with low levels of communicative initiation behaviors were assessed for motor and visual skills and given appropriate augmentative communication devices labeled with Picture Communication Symbols. Ss' communicative behaviors were observed and rated at baseline and during the 4-mo period of the intervention. Results show that Ss' specific initiations of communicative requests increased and became more similar to controls. Gains in specific initiated communicative behaviors involving augmentative voice output device use were accompanied by increases in specific initiated gestures and sign language use. Findings suggest that the use of augmentative voice output communication devices is effective in increasing communicative initiations in developmentally delayed nonverbal young children.

Dickey, R. and S. H. Shealey (1987). "Using technology to control the environment." American Journal of Occupational Therapy 41(11): 717-721.
Describes the technical aids, such as electronic communication devices, computer input devices, and environmental control system, that have made it possible for the severely physically disabled to enjoy greater functional independence within the home, school, workplace, and the community. The process of matching environmental control systems with clients' needs through evaluation of the client's cognitive status, motivation, and functional capabilities is discussed.

Dyches, T. T., A. Davis, et al. (2002). "Generalization of skills using pictographic and voice output communication devices." AAC: Augmentative and Alternative Communication 18(2): 124-131.
This case study focused on skill generalization following instruction of an adolescent girl with multiple disabilities using two augmentative and alternative communication (AAC) devices: a simple pictographic display and a voice output communication aid with an identical display used as an overlay. An alternating treatments design was used to assess community members' response latency, focus of attention, and comprehension of requests made via the two AAC devices. Skill generalization occurred for both devices, with similar rates of efficiency. These findings underscore the importance of the use of multiple modalities and of incorporating individual preferences to enhance the communicative competence of individuals who use AAC in natural environments.

Ferris, K. J. and M. A. Fabrizio (2008). "Comparison of error correction procedures involving a speech-generating device to teach a child with autism new tacts." Journal of Speech-Language Pathology & Applied Behavior Analysis 3(2-3): 47-59.
Using an alternating treatments design, this study compared the effects of Tutor-Modeled error corrections to those of Machine-Modeled error corrections using a voice model from a speechgenerating augmentative communication device on the acquisition of vocal tact responses with a preschool child with autism. Results of the study indicated that the child acquired new tact responses more effectively and efficiently with spoken models from his tutor rather than from vocal models presented by his speech-generating device.

Franco, J. H., R. L. Lang, et al. (2009). "Functional analysis and treatment of inappropriate vocalizations using a speech-generating device for a child with autism." Focus on Autism & Other Developmental Disabilities 24(3): 146-155.
The purpose of this study was to extend the research on functional communication training by examining the use of a speech-generating device (SGD) for a 7-year-old child with autism and no spoken language who demonstrated inappropriate vocalizations that served multiple functions. An analog functional analysis was used to determine the function of the behavior and the potential viability of the SGD as a treatment option. The child was taught to discriminate among multiple options on the SGD and then to choose an appropriate message in two generalization settings. When the SGD was available the child reduced his inappropriate vocalizations across all settings and increased his engagement in both appropriate activities and interactions with others.

Iacono, T. A. and J. E. Duncum (1995). "Comparison of sign alone and in combination with an electronic communication device in early language intervention: case study." AAC: Augmentative & Alternative Communication 11(4): 249-259.
An alternating treatments design was implemented to compare the use of sign alone and sign in combination with an electronic device in early language intervention. The subject was a preschool girl with Down syndrome who had failed to demonstrate functional speech skills, despite evidencing symbolic play and comprehension skills at a 2-year level. The intervention incorporated the use of a scripted-play approach in which the subject and researcher cocreated scripts around two sets of props. The combined use of signs and the electronic device was found to be more effective than sign alone in eliciting single-word productions. In addition, the subject demonstrated two- and three-word combinations, which were more likely to be produced using the electronic device than in sign. An overall preference for the electronic device was evident for both spontaneous/responsive and imitated productions. The results support past research that has found augmentative and alternative communication (AAC) to be effective in facilitating early language skills in children with Down syndrome. In addition, the findings contribute to evidence that signs may not be as facilitative of language production beyond the single-word level as are aided AAC techniques. Finally, the use of cocreated scripts was shown to allow for a child-directed approach in early language intervention incorporating AAC.

Kee, C. H., D. S. Fung, et al. (2001). "An electronic communication device for selective mutism." Journal Of The American Academy Of Child And Adolescent Psychiatry 40(4): 389-389.

Koul, R. (2003). "Synthetic speech perception in individuals with and without disabilities." AAC: Augmentative and Alternative Communication 19(1): 49-58.
Individuals with little or no functional speech frequently rely on non-speech communication systems to augment or replace natural speech. These systems include speech generating devices (SGDs), which provide synthetic speech upon activation. This paper comprises a summary of research conducted over the past 20 years on the perception of synthetic speech by nondisabled listeners and listeners with intellectual, language, and hearing impairments. A wide variety of perceptual studies have been conducted into how human listeners understand synthetic speech. Research has shown that perceptions of synthetic speech in individuals with intellectual and/or language impairments depend upon several general factors, including the acoustic-phonetic properties of the synthesizer, complexity of the perceptual task, and the experience of the listener. Additionally, individuals with intellectual and/or language impairments exhibit greater difficulties than nondisabled listeners with regard to processing synthetic speech signals that impose substantial cognitive demands.

Koul, R. and K. Hester (2006). "Effects of repeated listening experiences on the recognition of synthetic speech by individuals with severe intellectual disabilities." Journal of Speech, Language, and Hearing Research 49(1): 47-57.
Purpose: To examine the perception of synthetic speech by individuals with severe intellectual disabilities using a closed-response format task. Method: Participants were 14 individuals with severe intellectual disabilities and a group of 14 typical individuals. A between-groups design was used to compare the performance of the 2 groups on word identification accuracy and word latency tasks. Data were analyzed using a repeated measures design. Results: The results indicated that the performance of a group of individuals with severe intellectual disabilities was significantly poorer (p < .05) than that of typical individuals on the word identification task. Data analyzed for practice effects indicated that individuals with severe intellectual disabilities demonstrated a significant reduction (p < .01) in their word latency scores across sessions. Furthermore, there was an absence of significant effect (p > .01) of stimulus type (i.e., repeated vs. novel), indicating that individuals with intellectual disabilities are able to generalize their knowledge of the acoustic-phonetic properties of synthetic speech to novel stimuli. Conclusions: This study indicates that persons with severe intellectual impairments become more proficient at recognizing synthetic speech as a result of repeated exposure to it. These results have significant clinical implications for people who use speech-generating devices. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)

Koul, R. K. and R. Harding (1998). "Identification and production of graphic symbols by individuals with aphasia: efficacy of a software application." AAC: Augmentative & Alternative Communication 14(1): 11-23.
The purpose of the current study was to evaluate the ability of individuals with severe or global aphasia to identify and produce graphic symbols using a software program that turns a microcomputer into an electronic communication device. During the first phase of the treatment program, subjects were trained to identify single symbols and two-symbol combinations from different grammatical categories. The second phase involved training on production of simple subject-verb and subject-verb-object constructions using symbols correctly identified by subjects in the first phase. A single-subject, multiple-baseline design across behaviors replicated across five subjects was used to assess the effects of treatment on symbol identification. Results indicated that all subjects identified noun symbols with a greater degree of accuracy than symbols representing verb referents. Performance on symbol production task varied across subjects. The most frequently observed errors on the symbol production task were omission or incorrect selection of the symbols for the verb referents. Implications as to the efficacy of augmentative and alternative communication (AAC) systems for individuals with chronic severe aphasia are discussed.

Loncke, F. (2008). "Basic principles of language intervention for children who use AAC." Perspectives on Augmentative & Alternative Communication 17(2): 50-55.
The study of language acquisition and processing and the practice of augmentative and alternative communication (AAC) intervention have a mutual beneficial impact. Each of the three major approaches in explaining language acquisition (rationalistic, empiricist, and functionalist) provides interesting perspectives in understanding the uniqueness of language acquisition through AAC. When looking at language processing, studies of AAC use can provide information on the multimodality and internal multimodal representational networks. The study of the main language components (phonology, morphology and syntax, lexicon) in AAC users raises interesting questions concerning (a) the effect of the use of a speech-generating device on an internal phonology, (b) the relation between morphological and syntactic rules and communicative effectiveness, and (c) the effect of the use of communication boards and devices on lexical development and lexical growth. AAC practice is a potential source of data that can lead to more effective intervention as well as to a better understanding of language processes in general.

Mathisen, B., M. Arthur-Kelly, et al. (2009). "Using MINSPEAK: a case study of a preschool child with complex communication needs." Disability and rehabilitation. Assistive technology 4(5): 376-383.
Young children with complex communication needs require the best possible start to their educational lives, and for some, this will involve the use of communication technology supports and collaborative teams. This case study describes the outcomes of a pilot investigation that utilised MINSPEAK as a means of enhancing emergent language and literacy skills in a young girl with a range of participatory challenges. Results indicated that when family members and educational teams work together, it is possible to achieve important progress in early language skills using relevant software, systematic teaching and an accessible speech generating device (SGD). The implications of this modest case study are discussed in terms of innovative practice amongst collaborative alternative and augmentative communication teams.

Nguyen, T., R. Garrett, et al. (2008). "An interfacing system that enables speech generating device users to independently access and use a mobile phone." Technology & Disability 20(3): 225-239.
Accessible mobile phones for people with physical disabilities is an area that is still developing with new products and services emerging to assist these people to access the telecommunications equipment that is currently available. This research evaluated the effectiveness a prototype interface system for a mobile phone and accompanying speech generating device that enabled the user to independently initiate, answer, conduct and terminate voice calls and send text messages through the use of their communication device. Separate trials were conducted with two teenage participants with a physical disability who cannot speak and require a communication device to communicate. After their respective trials, both participants recorded very high overall performance and satisfaction outcomes. This paper highlights that involving the end-user in customization of the interface system during the trial had resulted in a very successful outcome. The trials demonstrated that people with severe mobility and speech impairments are able to effectively use a mobile phone in its many modes of operation. The trials affirmed that the system has given the participants a sense of independence, safety and security, and also contributed to improving their communication skills, leading to the self confidence to engage in conversation and social activities.

Peters, M. T. (1993). The effects of an aided communication device on the communicative interactions of preschool students with disabilities and their age-mate peers. US, ProQuest Information & Learning. 53.

Petersen, K., J. Reichle, et al. (2000). "Examining preschoolers' performance in linear and row-column scanning techniques." AAC: Augmentative & Alternative Communication 16(1): 27-36.
The purpose of this study was to compare preschoolers' performance on linear and row-column scanning selection techniques. Twelve typically developing children between 2 and 4 years of age participated in an identity matching task in which each child was asked to select black and white line-drawn symbols from linear and row-column scanning arrays displayed on the Sentient Systems DYNAVOX electronic communication device. Overall errors emitted by participants in linear scanning and row-column scanning were not significantly different. However, substantial differences in errors emitted were noted with regard to (a) number of cursor movements necessary to access the desired symbol and (b) number of passes of the cursor across the symbol display.

Raghavendra, P. and R. Oaten (2007). "Effects of speech and print feedback on spelling performance of a child with cerebral palsy using a speech generating device." Disability & Rehabilitation: Assistive Technology 2(5): 299-308.
Purpose. The aim of the study was to investigate the effectiveness of three feedback conditions, using a speech-generating device, on spelling performance of Tom, an 11-year-old boy with cerebral palsy and complex communication needs. Method. Tom was taught to spell 12 words under three feedback conditions. In the SPEECH condition, he received only speech feedback from the device and in the PRINT condition he received only the orthographic feedback on the display of the device. In the SPEECH DSPRINT condition, Tom received both speech output and orthographic feedback. An adapted alternating treatment design was used to investigate the effects of the three-feedback conditions. To strengthen the reliability and increase the internal validity of the findings, an intrasubject direct replication was carried out using the same procedure, but teaching 12 different spelling words to Tom. Results. Tom reached criterion with the PRINT feedback condition first, followed by SPEECH and SPEECHDS PRINT conditions simultaneously for the first 12 words, and the same order for the second set of 12 words. Conclusions. Overall, the PRINT condition was most efficient for Tom. The results are discussed in terms of evidence for learning style preferences within spelling instruction for a child with complex communication needs. Furthermore, the implications for targeting intervention to optimise spelling achievement amongst this group are considered.

Ratcliff, A., S. Coughlin, et al. (2002). "Factors influencing ratings of speech naturalness in augmentative and alternative communication." AAC: Augmentative & Alternative Communication 18(1): 11-19.
The concept of speech naturalness has been used in the field of speech-language pathology as a clinical measure of perceptual quality of "normal" and "not normal" speech. Whereas measures of intelligibility have been commonly used to assess the quality of voice output augmentative and alternative communication (AAC) devices using DECTALK speech, measures of speech naturalness have not. Three studies were conducted to determine the effects of manipulation of rate, pitch, and pause on ratings of speech naturalness by naive listeners of DECTalk synthetic speech. The results indicate that DECTalk speech characterized by faster rate and no added pauses was perceived as being more natural than speech with slow rate and added pauses. Manipulation of pitch had no effect on naturalness ratings.

Rodriguez, C. and M. Rowe (2010). "Use of a speech-generating device for hospitalized postoperative patients with head and neck cancer experiencing speechlessness." Oncology Nursing Forum 37(2): 199-205.
Purpose/Objectives: To test the feasibility of using a programmable speech-generating device (PSGD) in hospitalized adults with head and neck cancer experiencing speechlessness.Design: Time-series design.Setting: Tertiary care institution, inpatient setting.Sample: 9 female and 12 male postoperative patients (X age = 62 years) experiencing speechlessness as a result of a surgical intervention to treat head and neck cancer.Methods: Patients participated in a communication intervention that incorporated use of a PSGD during their hospital stay. Data about PSGD use and functionality- and technology-related issues were collected. Satisfaction and usability of the PSGD were rated with the Satisfaction and Usability Instrument.Main Research Variables: Use of, satisfaction with, and usability of the PSGD.Findings: Participants demonstrated significant improvement in ability to use the PSGD over a four-day period for all communication functions assessed. Results indicated that participants were "quite satisfied" with using the device and considered the technology to be "quite important" during the postoperative period. PSGD messages generated by participants via the hospital call system were understood by clerks. However, participants admitted to intensive care units experienced issues associated with accessibility of the device.Conclusions: Participants demonstrated proficient and independent use of the PSGD to communicate programmed messages; however, other strategies were necessary to meet their communication needs as the postoperative period progressed. Additional research on technologic communication options and strategies to tailor technology to meet the needs of speechless patients is warranted.Implications for Nursing: PSGDs may offer a more reliable option to facilitate communication between patients and nurses during the postoperative period. Technology should be tailored to meet speechless patients' unique needs as they progress through the rehabilitation process.

Rodriguez, C., M. Rowe, et al. (2006). "Head and neck cancer: technology feasibility of a speech generating device during the post-operative period... Oncology Nursing Society 31st Annual Congress podium and poster abstracts." Oncology Nursing Forum 33(2): 466-466.

Schepis, M. M. and D. H. Reid (2003). "Issues affecting staff enhancement of speech-generating device use among people with severe cognitive disabilities." AAC: Augmentative & Alternative Communication 19(1): 59-65.
This paper focuses on the role of human service staff when supporting individuals with severe disabilities who use speech-generating devices (SGDs) for functional communication. Following a brief overview of research that demonstrates the efficacy of SGDs within this group, a summary is provided of skills staff require to help ensure that individuals with severe disabilities have opportunities to use SGDs in effective ways. A competency- and performance-based training model (based on adult learning principles) which has evolved through applied research is discussed in relation to providing relevant skills training. An applied research-based model for supervising and monitoring staff performance of SGD-related duties and responsibilities is also presented. Directions for future research, aimed at further enhancing the capacity of human service personnel to support people with severe cognitive disabilities in using SGDs, are noted.

Schlosser, R. W. (2003). "Roles of speech output in augmentative and alternative communication: Narrative review." AAC: Augmentative and Alternative Communication 19(1): 5-27.
Speech output from speech-generating devices (SGD) and SGD software, such as talking word processors, has changed the landscape of options for aided communication. The purpose of this paper is to review and critique research into the roles of speech output for communication partners, learners, and learner partner dyads. Research on partner-oriented roles is reviewed in terms of attitudes and perceived communicative competence, and communicative behavior. Learner-oriented roles of speech output are summarized in terms of graphic symbol learning, communicative functions and social regulation, learner preference, challenging behaviors, natural speech production, comprehension, and literacy. Roles for the learner-partner dyad include changes to interaction patterns. Methodological issues are discussed and practical implications are drawn where appropriate. Finally, directions for future research are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)

Schlosser, R. W. (2003). "Speech output: Taking stock and moving forward." AAC: Augmentative and Alternative Communication 19(1): 3-4.
Examines speech generating devices (SGDs) and SGD software, a recent addition to the repertoire of options in augmentative and alternative communication (AAC) and introduces articles that comprise this special issue on speech ouptut for AAC.

Schlosser, R. W. and D. M. Blischak (2004). "Effects of speech and print feedback on spelling by children with autism." Journal of Speech, Language & Hearing Research 47(4): 848-862.
In this systematic replication of a previous study (R. W. Schlosser, D. M. Blischak, P. J. Belfiore, C. Bartley, and N. Barnett, 1998), the effects of speech and print feedback on spelling performance were evaluated. Four children with autism and no functional speech were taught to spell words with a speech-generating device under 3 feedback conditions. In the auditory-visual condition, children received both speech and print feedback, whereas in the auditory and visual conditions, only 1 type of feedback was provided. An adapted alternating treatments design was used. All 4 children reached criterion across conditions. Although 3 children reached criterion first with print or speech-print feedback, 1 child was most efficient with speech-print followed by speech feedback. Based on the findings of both studies, 2 distinct profiles of feedback efficiency are proposed. Children that exemplify the primarily visual profile spell words most efficiently when feedback involves print. Children that fit the auditory profile spell words most efficiently when feedback involves speech. The implications for understanding the learning characteristics of children with autism, as well as those for practice and further research are derived.

Schlosser, R. W., J. Sigafoos, et al. (2007). "Effects of synthetic speech output on requesting and natural speech production in children with autism: A preliminary study." Research in Autism Spectrum Disorders 1(2): 139-163.
Requesting is often taught as an initial target during augmentative and alternative communication intervention in children with autism. Speech-generating devices are purported to have advantages over non-electronic systems due to their synthetic speech output. On the other hand, it has been argued that speech output, being in the auditory modality, may not be compatible with the processing preferences of learners with autism. The purpose of this study was to evaluate whether five children with autism and little or no functional speech learn to request more efficiently when provided with speech output during instruction (SPEECH condition) rather than without speech output (NOSPEECH condition). A secondary purpose was to monitor changes in natural speech production. An adapted alternating treatments design was used to evaluate the relative effectiveness and efficiency of both conditions. The results showed frequent requesting under both conditions. Two students requested more effectively with speech output and one student requested more effectively without speech output while there was no difference for the remaining two students. In terms of elicited vocalizations, only one student showed some improvement. The other children did not show any improvement in natural speech production. These data extend previous research on the effects of speech output on requesting in children with autism.

Sigafoos, J., R. Didden, et al. (2003). "Effects of speech output on maintenance of requesting and frequency of vocalizations in three children with developmental disabilities." AAC: Augmentative & Alternative Communication 19(1): 37-47.
We evaluated the role of digitized speech output on the maintenance of requesting and frequency of vocalizations in three children with developmental disabilities. The children were taught to request access to preferred objects using an augmentative communication speech-generating device (SGD). Following acquisition, rates of requesting and vocalizations were compared across two conditions (speech output on versus speech output off) that were alternated on a session-by-session basis. There were no major or consistent differences across the two conditions for the three children, suggesting that access to preferred objects was the critical variable maintaining use of the SGDs. The results also suggest that feedback in the form of digitized speech from the SGD did not inhibit vocalizations. One child began to speak single words during the latter part of the study, suggesting that in some cases AAC intervention involving SGDs may facilitate speech.

Sigafoos, J., V. A. Green, et al. (2009). "A comparison of picture exchange and speech-generating devices: Acquisition, preference, and effects on social interaction." AAC: Augmentative and Alternative Communication 25(2): 99-109.
Augmentative and alternative communication (AAC) includes picture exchange (PE) and speech-generating devices (SGD), but these two systems have rarely been compared. We therefore conducted three studies comparing PE and SGD for an adolescent boy with a developmental disability. Study 1 compared acquisition of a PE- and SGD-based requesting response and monitored the effects on social interaction. For Study 2, both communication modes were made simultaneously available and the child could choose to use either PE or the SGD. For Study 3, only PE intervention continued, with the distance between the child and trainer systematically increased to prompt social interaction. The results showed equally rapid acquisition of the PE- and SGD-based requesting response, but only the distancing manipulation had any positive effect on social interaction. We conclude that PE and SGD are equally viable modes of communication, but acquisition of an initial PE- or SGD-based requesting response may not be sufficient to promote social interaction.

Sigafoos, J., M. F. O'Reilly, et al. (2004). "Transferring AAC intervention to the home." Disability & Rehabilitation 26(21/22): 1330-1334.
PURPOSE: To evaluate the acquisition of AAC skills during an initial clinical trial and assess subsequent transfer of the training to the home setting. METHOD: A 12-year-old male with autism was first seen in a clinical setting to establish the use of a voice-output communication device. After learning to use the device to request access to preferred objects in the clinical trial, the intervention was transferred to the home. Follow-up with the parent was conducted via e-mail and telephone. Videotapes were made of initial home-based sessions to enable evaluation of the participant's progress. RESULTS: The programme was successful in teaching the participant to use a portable AAC device to make requests during the clinical trial and then in two home-based activities. CONCLUSION: An initial clinical trial with follow-up support for parents may be an efficient method for beginning AAC intervention and transferring the training procedures to the home setting.

Stuart, S. and C. Ritthaler (2008). "Case studies of intermediate steps/between AAC evaluations and implementation." Perspectives on Augmentative & Alternative Communication 17(4): 150-155.
This article presents two case studies of children with complex communication needs, including a diagnosis of autism. Although different in age and overall diagnoses, both children primarily used behaviors, gestures, and limited overall vocalizations for communication. In each case, some pictures and signing had been intermittently incorporated into their school programs with very little success. The school-based augmentative and alternative communication (AAC) teams had used the candidacy model and decided that, until the children made gains in cognition and behavior, they could not use any type of speech generating device. In each instance, the child's parent disagreed and requested a second AAC evaluation. The second opinion evaluating center incorporated Language Acquisition Though Motor Planning (LAMP) to utilize a speech generating device for participation in some motivating activities. Results were sufficiently positive to support trial use of this approach and private outpatient sessions were provided. The article includes a brief overview of the resulting journey: the give-and-take process between second opinion center, parents, and school to arrive at a form of successful communication for each child.

Szeto, A. Y. J., E. J. Allen, et al. (1993). "Comparison of speed and accuracy for selected electronic communication devices and input methods." AAC: Augmentative and Alternative Communication 9(4): 229-242.
Four brands of electronic communication devices and 3 input selection methods were compared in terms of speech and accuracy. 16 college students (aged 18–35 yrs) used 1 of 8 possible device/input method combinations to copy text or engage in a scripted interactive communication task. The printed outputs were analyzed for the number of words generated and the number of errors made. Analyses of the Ss' printed outputs, produced following short-term training, showed that the input selection method was a significant factor in text input rate for both text copying and interactive communication. The specific electronic communication device had little or no significant effect on rate or accuracy when the input selection method was the same. Error types and frequencies of their occurrence were similar for both text copying and interactive communication tasks.

Taylor, R. and T. Iacono (2003). "AAC and scripting activities to facilitate communication and play." Advances in Speech Language Pathology 5(2): 79-93.
Many children with developmental disability have limited skills in both play and communication. In this study, the effects of a naturalistic intervention approach to play and symbolic communication was investigated within a single-subject multiple baseline design. The intervention involved scripting play activities and modelling vocabulary in speech and the augmentative and alternative communication (AAC) modality of sign. An additional intervention phase was introduced, wherein the AAC intervention was expanded to include an electronic communication device. The results indicated that modelling and scripted play activities resulted in increases in symbolic play, while changes in types of functional play were evident, while its frequency was somewhat erratic across baseline and intervention phases. Improvements in communication were more evident when a multimodal AAC approach was used in modelling than when sign was used alone.

Thunberg, G., E. Ahlsén, et al. (2007). "Children with autistic spectrum disorders and speech-generating devices: communication in different activities at home." Clinical Linguistics & Phonetics 21(6): 457-479.
The communication of four children with autistic spectrum disorder was investigated when they were supplied with a speech-generating device (SGD) in three different activities in their home environment: mealtime, story reading and "sharing experiences of the preschool day". An activity based communication analysis, in which collective and individual background factors for the activities were outlined, was used as a basis for the discussion of linguistic coding data derived from video-recordings made before and during SGD intervention. The coded communicative behaviours were engagement in activity, role in turn-taking, communicative form, function and effectiveness. An increase in communicative effectiveness was more noticeable when the SGDs could be used to fulfil goals and roles within the activity. The instruction to the parents to use the SGDs in their communication with the child had an important influence on the activities.

Thunberg, G., A. D. Sandberg, et al. (2009). "Speech-generating devices used at home by children with autism spectrum disorders: A preliminary assessment." Focus on autism and other developmental disabilities 24(2): 104-114.
Three children diagnosed within the autism spectrum between the ages of 5 and 7 years at different stages of communication development were supplied with speech-generating devices (SGDs) in their homes. The parents were taught to introduce the SGDs into home routines and the effects were evaluated naturalistically. Videotapes recorded by the parents before and during SGD use were coded with respect to communication effectiveness, mode, role in turn taking, and engagement in activity. Findings varied among the children and activities, but an increased level of communication effectiveness was seen during SGD use for all children. Variations of outcome among the three children and factors of importance for effective SGD use in the homes of children with autism spectrum disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)

Trembath, D., S. Balandin, et al. (2009). "Peer-mediated teaching and augmentative and alternative communication for preschool-aged children with autism." Journal of Intellectual & Developmental Disability 34(2): 173-186.
BACKGROUND: The aim of this study was to assess the effectiveness of two communication interventions for preschool-aged children with autism. METHOD: Six typically developing peers were taught to implement peer-mediated naturalistic teaching, with and without a speech generating device (SGD), during play sessions with 3 classmates with autism in three preschools. Generalisation probes were conducted during mealtimes at the preschools. A multiple baseline design was used to assess the outcomes of the two intervention conditions. RESULTS: All 3 children with autism increased their communicative behaviours immediately following the introduction of the two interventions, and generalised these increases to mealtime interactions with their peers. However, only 1 child maintained these increases in communication. CONCLUSION: These results provide preliminary evidence for the effectiveness of combining peer-mediated naturalistic teaching with the use of SGDs for preschool-aged children with autism. Suggestions for improving the maintenance of intervention effects are provided.