Augmentative and Alternative Communication, 2015; Early Online: 1–22 © 2015 International Society for Augmentative and Alternative Communication ISSN 0743-4618 print/ISSN 1477-3848 online DOI: 10.3109/07434618.2015.1064163

TUTORIAL & SYNTHESIS ARTICLE

Early Intervention and AAC: What a Difference 30 Years Makes MARYANN ROMSKI1,2*, ROSE A. SEVCIK2, ANDREA BARTON-HULSEY2 & ANI S. WHITMORE2 Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

Departments of 1Communication and 2Psychology, Georgia State University, Atlanta, Georgia

Abstract This article provides an overview of early intervention and AAC over the 30-year period since the founding of the journal Augmentative and Alternative Communication in 1985. It discusses the global context for early intervention and addresses issues pertaining to young children from birth to 6 years of age. It provides a narrative review and synthesis of the evidence base in AAC and early intervention. Finally, it provides implications for practice and future research directions.

Keywords: Augmentative and alternative communication; Autism; Assistive technology; Early inter vention; Intellectual and developmental disabilities

for children whose speech comprehension skills may be limited, and replace or mitigate a child’s problem behaviors, such as screaming or hitting, with a conventional means of communication (Romski & Sevcik, 2005).

Introduction During the first years of life, communication is foundational to a child’s healthy development. When young children encounter either temporary or permanent difficulty learning to communicate via speech, they face many challenges because they are unable to convey basic necessities, wants, desires, knowledge, and emotions to their families, peers, teachers, and the community-at-large. These communication difficulties may be due to a broad range of reasons including autism spectrum disorder (ASD); cerebral palsy; dual sensory impairments; intellectual and developmental disabilities (IDD); genetic syndromes; multiple disabilities (including hearing impairment); traumatic brain injury (TBI) as a result of an accident; stroke; or, in rare instances, severe psychological trauma. Regardless of their cause, the children and their families need access to augmentative and alternative communication (AAC) services and supports early in life to support the development of language and communication skills. AAC services and support can play a number of different roles depending on the young child’s degree of disability and specific environmental needs. While the most obvious role is to provide another way to communicate while speech is emerging, AAC can also be used to augment existing speech and vocalizations to improve message intelligibility, provide an input mode as well as an output mode

A Global Perspective on Early Intervention Early intervention (EI) is the provision of services and supports to very young children and their families, either when the child has an identified disability or is at risk for one (Odom, Hanson, Blackman, & Kaul, 2003). The purpose of EI services and support is to facilitate the development of the child in the family in all areas, including communication and language. The provision of these services and supports as early as possible in the child’s life will then maximize the child’s inclusion and productivity in society over time as well as reduce stress on the family (Guralnick, 2000). United States (US) federal and state laws define EI as occurring from birth to 3 years of age because in the US there are mandated preschool educational services and supports that begin at 3 years of age for children with disabilities. In many other countries around the globe, EI services and supports extend until the age of 6 or 7 years old, when the child begins formal schooling. The World Health Organization (2012) defines early childhood as the time

Correspondence: MaryAnn Romski, Department of Communication, PO Box 5010, Georgia State University, Atlanta, GA 30302-5010, USA. E-mail: [email protected] (Received 10 September 2014; revised 14 June 2015; accepted 15 June 2015)

1

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

2

M. Romski et al.

that spans the pre-natal period to eight years of age. In the US, EI services and supports are typically provided in the child’s home though children may also receive services in a clinical setting. In some developed and developing countries, these services are more typically provided in a clinical setting or a combination of home and clinical settings. EI services and supports may include identification and assessment of developmental concerns as well as intervention to address specific areas of development including language and communication. Often, the population of children who receive EI services and supports are referred to as infants and young children and the services they receive are early childhood interventions (Guralnick, 2008). The International Society on Early Intervention (http://depts. washington.edu/isei) provides a global “framework and forum for professionals from around the world to communicate about advances in the field of early intervention.” Recently, nations around the globe have ratified the United Nations treaties known as the Convention on the Rights of Children (CRC) and the Convention on the Rights of Persons with Disabilities including infants and young children (CRPD). Stemming from the content of these treaties, Brown and Guralnick (2012) proposed 10 principles related to early intervention to guide families and professionals around the world including the principle that “. . . recommendations to families and intervention practices must be evidencebased.” What is the evidence base in AAC and early intervention?

Historical Perspective on AAC and Early Intervention Looking back 30 years to 1985 when the AAC journal was founded, the field was at a very different place in its thinking about what would be considered early intervention. The focus was on determining at what age the provision of AAC services should be considered. At that time, there were a variety of different perspectives about how AAC could be utilized, depending on the disability with which the child presented. For children with physical disabilities (primarily cerebral palsy), AAC was considered a viable intervention strategy during the preschool years, as evidenced by the three articles by Light, Collier, and Parnes (1985a, 1985b, 1985c) that appeared in the first volume of the AAC journal. In fact, as early as 1973, McDonald and Schultz published an article recommending and describing communication board use for children with cerebral palsy. The argument was that cerebral palsy was a motor disorder that resulted in dysarthria of speech and would create continuing difficulty with the production of intelligible speech throughout a child’s development. Thus, the use of AAC would help these children communicate their messages in a clear manner. For a child who was having difficulty using speech for communication but evidenced

an intellectual and developmental disability (IDD), rather than a clear physical disability that resulted in dysarthria, AAC services were truly the last resort. AAC was considered only after all other forms of speech and language therapy had been tried and the child failed to communicate via speech. At that time, both Chapman and Miller (1980) and Shane (1981) argued for developmental candidacy models that included a chronological age dimension when determining if AAC should be employed with a child. So the concept of early intervention as we know it today was considered within a very different framework as the AAC journal began publishing in 1985, depending on the child’s presenting disability. In the early 2000s, Cress and Marvin (2003) and Romski and Sevcik (2005) described the range of myths that had developed and influenced the use of AAC with young children over this period of time. The research being conducted and the resulting evidence base addressed a very distinct set of issues around whether or not there were pre-requisites for language development, whether or not AAC would hinder speech development, and what type of communication modes young children could use (Kangas & Lloyd, 1988; Romski & Sevcik, 1988). Fast forward to today, and AAC services and supports are now considered by many, but still not all parents and professionals, as a first line of communication intervention services and supports (Beukelman & Mirenda, 2013). In this paper, we examine how the field has evolved over the past 30 years and what evidence there is to support today’s perspective. First, we review data-based articles about AAC and early intervention for young children (birth to 3 and 4–6 years of age). Second, because the impetus for this invited article is the 30th anniversary of AAC, we weave into the review the contributions about early intervention from the journal over the last 30 years. Third, we discuss the quality of the evidence and identify important directions for future research. We conclude by discussing how this research can contribute to practice.

AAC Research with Infants and Young Children: Systematic Review of the Literature In order to characterize research related to early intervention and AAC, a systematic review of the literature was conducted (Greenhalgh & Peacock, 2005). A search of peer-reviewed journals spanned the 30-year period 1985–2014 and was conducted by two of the authors (ABH and ASW) with disagreements on the relevancy of a publication settled by the first two authors (MAR and RAS). The initial search began within the individual electronic database for Augmentative and Alternative Communication (AAC). Publications with face-value relevancy, based on the title, abstract, and inclusion of an early AAC intervention with children from birth to 6 years of age, were collected. While searching the publications found in AAC, any cited publications from Augmentative and Alternative Communication

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

Early Intervention and AAC peer-reviewed journals during the 30-year time period that appeared relevant were collected. Then both Google Scholar™ and the individual electronic journal databases of all of the citations retrieved in AAC were searched using the following search terms: “early intervention,” “augmentative and alternative communication,” “AAC,” and “AAC interventions.” Additionally, the fields of the name of the specific journal and years from 1985–2014 were set for each journal searched. In addition to AAC, 19 journals were included in the systematic review (see Supplementary Appendix A, to be found online at http:// informahealthcare.com/doi/abs/10.3109/07434618. 2015.1064163, for a list of the journals). The “snowball” search method was utilized in which a new journal was included in the search when a relevant citation was collected. Unless an identified publication did not meet the above inclusion criteria, there were no other exclusionary criteria employed because both empirical and narrative peer-reviewed publications, which used a variety of methodologies, were included in this review (Greenhalgh & Peacock, 2005). Search Results A total of 143 articles were identified through the search as relevant to the scope of the review and included articles that presented meta-analyses, surveys, non-experimental narrative reviews, and research reports that employed a range of methods (e.g., case studies to quasi-experimental designs and randomized clinical control trials). Of those publications, 73 articles (51%) were categorized as broadly addressing a range of topics either specific to AAC early intervention or inclusive of AAC and early intervention within the context of meta-analyses, surveys, and narrative reviews. Supplementary Appendix B (to be found online at http://informahealthcare.com/doi/abs/ 10.3109/07434618.2015.1064163) lists these articles categorized by the topics they discussed: Assessment, Family, future directions in research and intervention, intervention issues, language and communication development, personnel and partner training, issues in research methods, and speech development. In summary, these articles addressed a range of issues that are important to early intervention. They were heavily focused on early language development and the important topic of pre-requisites for using AAC and described the research reports available to refute the notion of prerequisites. None of those reports actually included very young children. They also addressed issues related to families but again did not include families of very young children. The remaining 70 articles (49%) were data based and included systematic methods with the number of participants ranging from 1–144. Of those 70 articles, 26 articles (37%) focused on infants and young children between the ages of birth to 3 years and 44 articles (63%) focused on children between 4 and 6 years of age (see Tables I and II for respective summaries of these © 2015 International Society for Augmentative and Alternative Communication

3

articles). Each table includes the number of participants and their mean age, the context, the study design, the outcome variables, the type of AAC system employed, and a brief summary of the results. Since its inception till the September 2014 issue, AAC published 74 articles that related partially or wholly to the broadly conceived topic of early intervention. These articles are integrated within the systematic review and can be found in Supplementary Appendix B and Tables I and II, to be found online at http://informahealthcare.com/doi/abs/10.3109/07 434618.2015.1064163 marked with an asterisk. Of particular note are two review papers published relatively recently that specifically addressed research on young children (Branson & Demchak, 2009; Light & Drager, 2007). Branson and Demchak conducted a systematic review of the literature about AAC use with infants and toddlers (birth to 3 years of age) across a 25-year time period. They identified 12 studies that reported improvements in the child’s communication after mostly unaided AAC interventions that focused on pre-linguistic skills with 7 of the 12 studies (58%) providing “conclusive” evidence. They found that AAC, including speech-generating devices (SGDs), can be effective though there was a heavy focus on the use of unaided AAC modes. Light and Drager’s paper provided a narrative review of AAC use by “young children with complex communication needs” focusing on multiple modes of communication, the impact of AAC on natural speech development, and the comparative effectiveness of AAC systems. They highlighted research on the design of technologies, including toys, to optimize their use for young children at various stages of development. They presented a set of AAC device design features (i.e., function, color/lights, shape/appearance, output, and personalization) and made developmentally appropriate recommendations for their modifications that have yet to be fully examined for use with children birth-to-6.

What is the Evidence about AAC and Early Intervention? A review of the 70 reports described in Tables I and II found that, not surprisingly, they addressed a broad range of related but distinctive topics, ranging from language and speech development to service delivery issues, with many reports addressing more than one topic. For purposes of discussion, we will highlight findings across studies that cluster around seven themes: (a) enhancing child communication and language development, (b) increasing child speech development, (c) evaluating assessment approaches, (d) using typical child development models, (e) exploring literacy development, (f) including families and communication partners, and (g) examining early AAC service delivery models.

1;3

57

4

1

1

4

Adamson, Romski, Bakeman, and Sevcik (2010)*

Barton, Sevcik, and Romski (2006)*

Bondy and Frost (1994)

Charlop-Christy, Carpenter, Le, LeBlanc, and Kellet (2002) Clibbens, Powell, and Atkinson (2002)

1

1

Iacono and Duncum (1995)*

Leech and Cress (2011)*

3;3

2;7

1;8

2;7

30

1

2;1

3

3;1

2;6

2

Hyppa Martin, Reichle, Dimian, and Chen (2013)

Dicarlo and Banajee (2000) Drager, Light, Speltz, Fallon, and Jeffries (2003)

3;7

1

Adamson and Dunbar (1991)

1;6

N

Citation

Mean age (years; months)

Case study; Intervention; Down syndrome Case study; Intervention

Case study; Angelman syndrome

Typical development

Intervention

Intervention; Parent training; Down syndrome

Case study; Intervention; Autism Case study; Intervention; Autism

Symbol learning

Case study; Intervention; Tracheostomy Intervention outcomes

Context

Design

Alternating treatment, multiple baseline design

Alternating treatments

Alternating treatments design

Group designexperimental; Random assignment

Multiple baseline

Retrospective analysis of pre-post group data

Multiple baseline

A-B design

Multiple probe design across treatment

Longitudinal observation of development RCT

Table I. Articles, by Topic and Year, Reporting Research with Children 0–3 years.

Speech development following low-tech AAC use

Vocabulary learning in three different SGD system layouts: taxonomic grid, schematic grid, schematic scene display Accuracy of requesting in gestural and graphic modes; frequency of requesting using vocalizations Effects of sign alone; effects of sign ⫹ SGD

Mother’s ability to use signs appropriate to child’s natural play interest to enhance joint attention Communicative initiations

Speech, socialcommunicative behaviors and problem behaviors

Use of pictures and spoken words

Symbols learned in comprehension and production

Symbol-infused joint engagement

Vocabulary and language growth

Outcome variables

(Continued)

Intervention using an SGD ⫹ sign was more effective than intervention using sign alone Use of signs and photograph prompts improved speech production Sign, SGD

Sign, photographs

Graphic mode of communication yielded greater accuracy when requesting than gesture mode

Communication initiations with SGD increased Children in the schematic scene display group performed better during learning sessions than children in the grid display groups

Mothers were able to use signs within a salient context for the child

Participants increased speech and social-communication; participants decreased problem behaviors

Introduction of an AAC system supported language development during temporary aphonia Symbol-infused joint engagement increased for all participants; level of joint engagement was related to the level of spoken language or augmented word use Three of four participants learned symbol meanings in comprehension and production; symbol iconicity did not play a critical role in learning PECS supported communication development and speech production

Results

Color photographs, gesture

SGD

SGD

Sign

PECS

PECS

Blissymbols and lexigrams

SGD

Sign, SGD

Type of AAC

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

4 M. Romski et al.

Augmentative and Alternative Communication

N

1

1

1

20

23

6

62

53

Citation

Letto, Bedrosian, and Skarakis Doyle (1994)*

Lüke (2014)

Mathisen, ArthurKelly, Kidd, and Nissen (2009)

McCarthy et al. (2006)*

Olin, Reichle, Johnson, and Monn (2010)

Olswang, Feuerstein, Lloyd Pinder, and Dowden (2013)

Romski et al. (2010)

Romski et al. (2011)

Table I. (Continued)

© 2015 International Society for Augmentative and Alternative Communication

2;5

2;5

1;5

2;5

2;7

3;8

2;6

2;6

Mean age (years; months)

Intervention; Family

Intervention

Assessment; Severe motor impairment

Typical development; Symbol learning

Typical development

Case study; Intervention;

Case study; Apraxia

Case study; Intervention; Cerebral palsy

Context

RCT

RCT

Retrospective analysis of pre-post group data

Random assignment to treatment condition; Pre-post assessment of performance Group design; Multiple probes across time

Pre-experimental; Pre-post assessment

A-B design

Longitudinal observation of development

Design

Parent perception of communication pre/post AAC intervention

Dynamic assessment to elicit triadic gaze; static assessment of triadic gaze; triadic gaze acquisition after intervention Child functional vocabulary, MLU, TTR, intelligibility, utterance rate, turns; parent MLU, turns

Changes in communication initiations, turns, complexity and generalization Mode of communication; speech intelligibility; consistency of speech; vocabulary and grammar development Standardized assessment; literacy development; SALT language transcript measures Learning of traditional scanning; learning of animated scanning with explicit feedback Learning of visual scene display (VSD) symbols; influence of practice on accuracy and speed of symbol location

Outcome variables

SGD

SGD

Eye gaze to object

SGD with a VSD

SGD

SGD with MINSPEAK

Gesture, SGD

Gesture, eye gaze to objects

Type of AAC

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

(Continued)

Children in Augmented Communication Input (ACI) and Augmented Communication Output (ACO) conditions used greater functional vocabulary than children in the spoken communication (SCI) condition; Children in ACI and ACO produced more speech Perceptions of severity of language difficulty decreased for ACI and ACO interventions and increased for children in SCI; Participation in ACI & ACO interventions improved parent’s perception of their child’s success

Participants 24 – 27 months of age were able to learn how to use VSDs within a short number of sessions; Participants 33–36 months of age were more accurate at initial introduction of VSD than younger participants Dynamic assessment is a valid tool to determine learning potential

Utterance length and intelligibility increased; gains in literacy awareness; inconclusive gains in phonological awareness Participants in the enhanced scanning condition improved performance accuracy across the sessions

SGD use enhanced communication and language development

Increased frequency of communication initiation with adult communication partner

Results

Early Intervention and AAC 5

60

20

6

41

4

Smith et al. (2011)

Stahmer and Ingersoll (2004)

Tait, Sigafoos, Woodyatt, O’Reilly and Lancioni (2004)

Whitmore, Romski, and Sevcik (2014)*

Wright, Kaiser, Reikowsky, and Roberts (2013)

2;8

2;1

2;5

2;5

2.3

2;5

1;5

Mean age (years; months)

Intervention; Autism

Intervention; Down syndrome

Intervention outcomes; Assessment

Intervention; Parent training

Intervention; Autism

Intervention; Family

Assessment

Context

RCT

Multiple baseline across participants

Multiple probe design across communication function RCT

Quasi-experimental; Pre-post assessment

RCT

Multiple probes across time; Longitudinal

Design

Note. RCT, randomized controlled trial; PECS, Picture Exchange Communication System *Published in Augmentative and Alternative Communication

36

41

Ross and Cress (2006)*

Yoder and Stone (2006)

N

Citation

Table I. (Continued)

Frequency of motor movements; target augmented word production; target spoken word production Use of signs following Enhanced Milieu Teaching (EMT) & Joint Attention Symbolic Play Engagement and Regulation (JSAPER) teaching strategies Effects of PECS vs. Responsive Education and Prelinguistic Milieu Therapy (RPMT); frequency of nonimitative spoken acts; number of different non-imitative words

Assessment discrepancies between the Battelle and MacArthur Communicative Development Inventory (MCDI) Parent stress and relationship to perspective of language development post augmented and spoken communication intervention Developmental change on the Bayley and Vineland; functional communication skills; functional play skills; PECS use Requesting, choice making, protesting, response to name

Outcome variables

PECS

Sign

SGD

Sign, eye gaze, graphic symbols, photographs

PECS

SGD

n/a

Type of AAC

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

PECS was more successful than RPMT at increasing the number of non-imitative communicative acts and number of non-imitative words used

EMT/JASPER intervention facilitated functional gains in sign production

Children in ACO increased use of upper-body motor movements; ACO may facilitate motor learning for augmented language production

Functional communication training (FCT) was effective

Parent perception of the severity of their child’s communication difficulties was partially mediated the relationship between the child’s expressive language and parental stress Standardized assessment scores improved, functional communication and play increased

Receptive language scores on the Battelle were greater than the cognitive and motor scores overall and greater than the MCDI ratings of receptive language

Results

6 M. Romski et al.

Augmentative and Alternative Communication

10

71

144

5

3

1

2

93

Barker, Akaba, Brady, and ThiemannBourque (2013)*

Binger and Light (2006)

Binger and Light (2007)

Binger et al. (2010)

Bornman, Alant, and Meiring (2001)

Brady (2000)*

Brady, ThiemannBorque, Fleming, and Matthews (2013)

N

Ball et al. (1999)

Authors

© 2015 International Society for Augmentative and Alternative Communication

4.2

5

6.5

5.5

4.1

3–5.9

4.1

4.7

Mean age (years; months)

Intervention

Intervention

Case study; Intervention; Apraxia

Intervention; Partner training

Intervention

Intervention

Service delivery; Teacher perspectives

Vocabulary needs; Typical development

Context

Design

Group pre-post comparison; latent variable modelling

Multiple probes across time

Multiple baseline

Single subject, multiple probe across participants

Single subject, multiple probe across participants

Survey data from SLPs

Multiple probes over time using surveys

Descriptive analysis; observational coding

Table II. Articles by Topic and Year Reporting Research with Children 4–6 Years of Age.

Training outcomes for educational assistants; rates of multi-symbol message production by students who use AAC Response to questions asked by mother; communication mode used by child; frequency of initiation attempts by child Comprehension of target vocabulary; use of SGD for requesting Number of different words produced; mode of words produced

Multi-symbol message production; effects of aided AAC modelling

Prevalence and characteristics of preschoolers who need AAC services

Frequency and type of generic talk produced by typically developing preschool children AAC use in preschool, use of AAC input in preschool, teacher support, peer support

Outcome variables

Sign, SGD

SGD

SGD

SGDs, PECS

3 SGDs, 2 communication boards

Gesture, signs, objects, picture communication board, SGD

Signs, PECS, SGDs

n/a

Type of AAC

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

(Continued)

Participants learned to request objects using their SGDs and showed increased comprehension of the requested objects Children who evidenced higher levels of symbolic skill and more adult input at home produced more words 1 year after AAC intervention

Digital voice output facilitated language and communication development in a child with developmental apraxia of speech

AAC input by peers of children who use AAC was associated with increased language growth; teacher prompting and questioning was associated with weaker language growth; teachers reported little training to support AAC use in preschool children 12% of special education preschoolers in PA required AAC services; children ranged in disability status, racial background, and required services from multiple professionals Four of the five participants learned how to use multi-symbol combinations and generalized the use of those symbols to new play contexts Education assistants were able to effectively learn how to use strategies to facilitate multisymbol use; child participants increased their use of multisymbol production

Almost half of the communication samples collected consisted of generic talk; vocabulary for generic talk on AAC devices is suggested

Results

Early Intervention and AAC 7

5

3

2

20

Clarke, Loganathan, and Swettenham (2012)

Douglas, McNaughton, and Light (2014)

Drager et al. (2006)

Fallon, Light and Paige (2001)

45

1

Charlop-Christy, Carpenter, Le, LeBlanc and Kellet (2002)

Fried-Oken and More (1992)*

26

N

Burroughs et al. (1990)

Authors

Table II. (Continued)

4.6

4.3

4.2

4.9

4.7

5.8

4.9

Mean age (years; months)

Group comparison to typical development; Vocabulary inventory

Vocabulary needs; Typical development

Intervention

Intervention; Partner training

Understanding of false belief; Cerebral palsy

Case study; Intervention; Autism

Symbol learning; Iconicity

Context

Group comparison of vocabulary data

Descriptive analysis using observation; language samples; content analysis; survey questionnaires

Multiple baseline across sets of vocabulary

Single-subject multiple probe design

Experimental task

Experimental cross over design; random assignment to group Multiple baseline

Design

Analysis of vocabulary for preschoolers with typical development; development and testing of a vocabulary selection questionnaire Parent inventory of vocabulary from typically developing children; parent inventory of vocabulary from children with CCN; language sample analysis

Acquisition of Rebus symbols vs. Blissymbols Effect of PECS on speech, socialcommunicative behaviors and problem behaviors Eye gaze toward correct window during task; utility of eye gaze methods to assess false belief task responses Number of communication opportunities provided by paraeducators after online instruction Symbol vocabulary; comprehension and production

Outcome variables

n/a

n/a

Line drawings on communication board

Gestures, signs, non-electronic communication boards

Eye gaze

PECS

Rebus symbols, Blissymbols

Type of AAC

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

(Continued)

Common words should be considered a good starting point for word selection, however low agreement across lists on common words suggests initial lexical selection is also highly individualized

Aided language modeling increased the participants’ symbol comprehension and production; gains were maintained; comprehension preceded production The vocabulary selection questionnaire developed was seen as appropriate and would be used in the future by SLPs working with children who require AAC

Online training can be effective in teaching paraeducators to support communication of young children with complex communication needs (CCN)

All children successfully used anticipatory eye gaze during the task; this response method has potential as a mode used in assessment

Participants were able to identify iconic Rebus symbols easier than Blissymbols from pre- to post-test Use of PECS resulted in increases in speech and social-communicative behaviors and decreases in problem behaviors

Results

8 M. Romski et al.

Augmentative and Alternative Communication

1

2

1

3

3

3

6

Harding et al. (2011)

Harris, Skarakis, Doyle, and Haff (1996)*

Hetzroni and Belfiore (2000)*

Johnston, McDonnell, Nelson, and Magnavito (2003)

Johnston, Nelson, Evans, and Palazolo (2003)*

Kent-Walsh, Binger, and Hasham (2010)

N

Goossens’ (1989)*

Authors

Table II. (Continued)

© 2015 International Society for Augmentative and Alternative Communication

6.2

4.9

4.9

4

5

6

6

Mean age (years; months)

Intervention; Storybook reading; Parent training

Intervention; Autism

Intervention

Intervention

Case study; Intervention

Intervention; Multisensory impairment

Case study; Intervention; ESL; Cerebral palsy

Context

Single subjectmultiple-probe across participants design

Single subjectmultiple-probe across participants design

Multiple baseline across participants

Single subject multiple-probe design

Multiple baseline

Single-subject multiple probe design

Longitudinal observation; diary of sessions & progress

Design

Segmentation and combination of grammar using symbols Blissymbol learning via interactive computer-assisted intervention Percent correct use of symbols; staff ratings of effectiveness of intervention Graphic symbol use; spoken language use; unprompted correct responses; effectiveness of intervention strategy; impact of intervention procedures; teacher perception of intervention effectiveness Parent instructional strategy use; turn-taking; production of new semantic concepts

Expressive language, comprehension, social interaction & behavior

Spontaneous communication; MLU; home vs clinic performance

Outcome variables

5 SGD; 1 nonelectronic communication board

PCS symbols

Picture communication symbols, single switch SGD

Blissymbols

SGD

Photographs

Eye gaze board

Type of AAC

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

(Continued)

Parents learned to implement the communication partner instructional strategy; children increased communicative turns and produced new sematic concepts

All participants demonstrated increases in percent correct use of symbolic communication; preschool staff had positive ratings of intervention effectiveness Participants learned means to request entrance into play groups and decreased off-task behavior; the intervention was considered socially valid using an acceptability survey for the school staff

Child evidenced emergent picture symbol communication and functional speech. It also provided a means to assess the child’s true developmental level Important factors when planning AAC intervention are the child’s cognitive ability, receptive language skills, and a collaborative team of service providers Positive effect of the intervention on both book reading and discourse contexts, with the greatest effect observed for book reading Participants were able to learn, maintain, and generalize Blissymbols presented during the intervention

Results

Early Intervention and AAC 9

8

Light, Collier, and Parnes (1985b)*

1

8

Light, Collier, and Parnes (1985a)*

Nunes and Hanline (2007)

5

Light, Binger, and Kelford Smith (1994)*

8

30

Light and Kelford Smith (1993)*

Light, Collier, and Parnes (1985c)*

14

N

Lerna, Esposito, Conson, and Massagli (2014)

Authors

Table II. (Continued)

4

5.9

5.9

5.9

4.4

3.7

5.7

Mean age (years; months)

Intervention; Autism; Family

Family

Family

Family

Group comparison to typical development; Literacy; Physical disabilities Literacy; Physical disabilities

Intervention; Autism

Context

Multiple baseline design

Descriptive; observational coding

Descriptive; observational coding

Descriptive; observational coding

Descriptive analysis; Observational coding

Group comparison of survey data

Experimental group design

Design

Child and parent rate of communication with familiar vs unfamiliar books; focus of interactions; mode and communicative behaviors of child Discourse patterns (communicative turns) of child and parent Range and frequency of communicative functions during free play with parent vs structured play with elicited communication Communication modes; functions of communication; relationship to discourse status (turn taking) with parent Strategies used by parents; child communication turns; imitative responses; modes of expression

Performance on standardized assessments of socialcommunicative abilities and behavior for PECS intervention vs conventional language therapy Home literacy experiences

Outcome variables

Graphic symbol communication board

Blissymbol communication board

Blissymbol communication board

Blissymbol communication board

Communication board with line drawings

n/a

PECS

Type of AAC

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

(Continued)

Children preferred unaided AAC modes, as compared to communication boards; communication mode preference was associated with conversation status and communicative function of the turn Participants increased frequency of communicative initiations and responses; parents increased use of intervention strategies

Parents produced more than twice as many communicative turns; children fulfilled half of their turn opportunities Children used fewer communicative functions during free play as compared to elicited communicative interactions with clinicians

Children who use AAC had less opportunity to use literacy materials and were less engaged in literacy activities Communication patterns were synchronous but asymmetrical with the mothers dominating interactions; few modes were available to the children; aided AAC was rarely incorporated

PECS group showed significant improvements on the ADOS, GMDS and VABS communication and social domains; cooperative play improved for PECS group

Results

10 M. Romski et al.

Augmentative and Alternative Communication

3

34

20

2

9

4

3

Peeters, Verhoeven, de Moor, van Balkom, and van Leeuwe (2009)

Pennington, and McConachie (1999)

Rosa-Lugo and Kent-Walsh (2008)

Rowland and Schweigert (1989)*

Schepis, Reid, Behrmann, and Sutton (1998)

Schwiegert and Rowland (1992)*

N

Olive et al. (2006)

Authors

Table II. (Continued)

© 2015 International Society for Augmentative and Alternative Communication

3.7

4

4.5-6

6.8

5.2

6

4.4

Mean age (years; months)

Intervention; Dual sensory impairment

Intervention; Autism

Intervention; Multisensory impairment

Intervention; Family; Literacy

Family; Physical disability

Literacy

Intervention; Autism

Context

Within session ABA design

Multiple probes across time within intervention routines

Pre-post measures; Daily observation during timed intervals

Single subjectmultiple-probe across participants

Observational coding; sequential analysis

Descriptive analysis of related variables

Multiple baseline with multiple probes across participants

Design

Effects of an SGD and naturalistic teaching procedures on communication interactions; SGD use, guided SGD use, gesture use, spoken nonword productions, spoken word productions Signaling attention; communicating a choice; microswitch use

Effects of Enhanced Milieu Teaching (EMT) and an SGD on requests during play Relationship between speech intelligibility, intelligence, home literacy experience (HLE), and reading skills from K to Grade 1 Form and function of child’s communication during mother-child interactions Strategies used by parents; child communication turns; production of new sematic concepts Tangible symbol acquisition

Outcome variables

Single message voice output switch

SGD

Tangible symbols

SGD

PCS, Blissymbols, Makaton

Eye gaze, gestures

SGD

Type of AAC

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

(Continued)

All participants were able to learn and maintain new communication skills

Mothers initiate communication more than they respond; children respond more than they initiate; children used more vocalizations and gesture than aided communication systems Parents increased use of intervention strategies; they generalized and maintained strategy use; children increased their use of communicative turns and produced new semantic concepts Participants showed a wide range in vocabulary gains of threedimensional symbols, twodimensional symbols, and the emergent use of manual signs SGD in combination with naturalistic teaching increased communication

Growth in all reading precursors from K to Grade 1; HLE impacts children’s early literacy development; influence of HLE and reading outcomes are mediated by reading precursors

All children increased number of requests using an SGD during play

Results

Early Intervention and AAC 11

10

15

28

10

1

Stephenson (2007)*

Thistle and Wilkinson (2009)

van der Schuit, Segers, van Balkom, and Verhoeven (2011)

van der Schuit, Segers, van Balkom, Stoep, and Verhoeven (2010)*

von Tetzchner et al. (2004)

2

3

Sigafoos, Didden, and O’Reilly (2003)*

von Tetzchner, Brekke, Sjøthun, and Grindheim (2005)*

1

N

Sevcik, Romski, and Adamson (2004)

Authors

Table II. (Continued)

5

3.5-6

4.1

4

4.6

5.3

6.7

4

Mean age (years; months)

Intervention; Descriptive

Case study; Descriptive; Autism

Intervention

Intervention

Typical development; Symbol learning

Symbol learning

Intervention

Case study; Intervention

Context

Naturalistic observation

Longitudinal observation of development

Pre-experimental; one-group pretest-posttest design

Experimental group design; quasirandom assignment Experimental control group design

Quasi-experimental design

Multiple baseline

Pre-experimental; pre-post comparison; diary study

Design

Greetings; borrowing and lending; managing rejection; developing the extensions of words and signs; narration

Reaction time to locate target line drawing Change in nonverbal cognition, receptive language, productive syntax, productive vocabulary Vocabulary development and multi-word utterances, receptive and expressive language Graphic symbol vocabulary acquisition

Role of digitized speech output on rates of requesting; rates of vocalizations Pairing spoken words to line drawings; pairing of line drawings to objects

Child engagement; utterances per minute; parent perception

Outcome variables

Printed words on eye gaze board; signs

Photographs, graphic symbols, signs

Sign, photographs, graphic symbols, SGDs

Gesture, sign, communication board, SGD

Line drawings of various colors

Line drawings

SGD

SGD

Type of AAC

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

Intervention significantly improved language skills of all participants; participants using speech prior to intervention showed the greatest improvement in receptive language and productive syntax Photographs and pictograms were learned as a means of communication without evidencing speech comprehension alone Results suggested the benefits of inclusive settings; children who use AAC and speak were able to engage in meaningful communicative interactions

Children in the intervention group using AAC showed greater learning gains in all areas than children in control group

System for Augmenting Language (SAL) intervention facilitated increased engagement and increased utterances per minute; resulted in positive parent perceptions Access to the preferred objects of the participants was related to consistent SGD use; SGD use did not prevent the production of vocalizations; SGD use may facilitate speech Children with intellectual disabilities found it difficult to match line drawings to objects when the color of the object did not match the color in the line drawing Children located line drawings with foreground color more quickly

Results

12 M. Romski et al.

Augmentative and Alternative Communication

Early Intervention and AAC

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

Enhancing Child Communication and Language Development A majority of the reviewed reports in Tables II and III focused on AAC interventions that promoted some aspect of early communication and language development. These reports provide substantial support that early AAC intervention enhances a child’s communication and language development, from single sign and symbol vocabulary increases for children 3 years old and under (e.g., Adamson & Dunbar, 1991; Barton, Sevcik, & Romski, 2006; Bondy & Frost, 1994; Lüke, 2014; Wright, Kaiser, Reikowsky, & Roberts, 2013) to multi-symbol utterances and grammatical development for the preschoolers (e.g., Binger & Light, 2007; Harris, Skarakis Doyle, & Haff, 1996). Other reports described the children’s communication skills, including their communicative turns and functions (Light et al., 1985a, 1985b, 1985c), communication initiations (Letto, Bedrosian, & Skarakis-Doyle, 1994; Dicarlo & Banajee, 2000), and parent-child communication interactions (Pennington & McConachie, 1999; Light, Binger, & Kelford Smith, 1994). Still other reports assessed the effects on vocabulary development of a range of AAC interventions, from milieu teaching (Olive, Davis, Chan, Lang, & Dickson, 2006; Wright et al., 2013) to augmented input (Drager et al., 2006) and computerized interventions (Barton et al., 2006; Hetzroni & Belfiore, 2000). Studies consistently reported that AAC use (i.e., Blissymbols, manual signs, PECS, Rebus, SGDs) is viable for supporting and increasing young children’s communication attempts and early language development. It is important to note that a number of reports addressed the successful use of PECS for young children with autism across the age ranges (Bondy & Frost, 1994; Charlop-Christy, Carpenter, Le, LeBlanc & Kellet, 2002; Lerna, Esposito, Conson, & Massagli, 2014; Stahmer & Ingersoll, 2004;Yoder & Stone, 2006). The evidence also spanned participants with a range of disabilities, from apraxia of speech (Bornman, Alant, & Meiring, 2001) or cerebral palsy (Goossens’, 1989) to intellectual disability (Sevcik, Romski, & Adamson, 2004; Stephenson, 2007) to dual sensory impairments (Harding, Lindsay, O’Brien, Dipper, & Wright, 2011; Rowland & Schwiegert, 1989; Schwiegert & Rowland, 1992) to autism (Johnston, Nelson, Evans, & Palazolo, 2003; Nunes & Hanline, 2007). The level of evidence available in these reports ranged from case studies to randomized control trials. Given the history of early intervention in our field, it is not surprising to have a number of case studies document the success of AAC with very young children. von Tetzchner and his colleagues (2004), for example, followed one preschooler with autism’s development of graphic symbols for communication longitudinally from 3;6 (years; months) to 6 years of age. With the exception of two relatively recent randomized control trials, the remainder of the studies employed either single subject designs or quasi-experimental © 2015 International Society for Augmentative and Alternative Communication

13

designs to answer their questions. The single subject designs, typically with multiple probes or multiple baselines across vocabulary or participants, investigated the effects of a range of intervention strategies, from aided language stimulation on vocabulary development (Drager et al., 2006) to naturalistic teaching on SGD use (Scheipis, Reid, Behrmann, & Sutton, 1998). The quasi-experimental designs typically employed pre-post measures to address questions about change over time. Using a pre-post design, Stahmer and Ingersoll (2004), for example, found that after PECS intervention within a naturalistic and inclusive setting, 20 children with autism under the age of 3, made gains in communication and functional play. Burroughs, Albritton, Eaton, and Montague (1990) used pre-post design and found that Rebus symbols were easier for preschoolers to learn than Blissymbols. The two randomized control trials compared AAC interventions with traditional approaches that targeted speech development. Both trials found that the AAC interventions produced stronger results than the traditional approach. Yoder and Stone (2006) found that children with autism who received the PECS intervention increased the number of communicative acts and non-imitative words they used as compared to children in the control intervention. Romski, Sevcik, Adamson, Smith, and Barker (2010) found that the toddlers who received the two augmented language interventions produced a substantially larger number of augmented and spoken words for the target vocabulary items than the children who received the spoken language intervention. The effects of parent-coached augmented language interventions also generalized to children’s engagement in child-parent interactions in ways that may facilitate additional language acquisition (Adamson, Romski, Bakeman, & Sevcik, 2010). Using secondary data analyses, Whitmore, Romski, and Sevcik (2014) explored the effects of this AAC intervention experience on toddlers’ gross motor development and concluded that children’s use of aided AAC may facilitate motor learning for augmented language production. It is striking to note that the majority of these studies measured expressive language skills. Only a few studies focused on receptive language skills and found that AAC interventions could have an effect on the children’s understanding of language. Brady (2000), for example, found that children who were taught to request also showed increased comprehension for the requested items. In a similar finding, Drager et al. (2006) reported that aided language modeling increased participants’ symbol comprehension skills and then their symbol production skills. Few studies compared outcomes across different AAC intervention approaches. In case studies, Hyppa Martin, Reichle, Dimian, and Chen (2013) found that graphic symbols resulted in more accurate communications than gestures, while Iacono and Duncum (1995) found the use of an SGD with signs was more effective than signs alone on the communication outcomes of a

14

M. Romski et al.

young child with Down syndrome. Beyond demonstrating an effect, one next step is to continue to examine how different approaches compare with each other. Such information will serve to refine our interventions and provide more definitive information about the utility of different interventions for children with distinct communication profiles than is currently available.

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

Increasing Child Speech Development The evidence strongly indicates that AAC does not hinder the development of speech at the very beginning stages of language acquisition. Reports describe specific gains in speech development in addition to the use of AAC (Charlop-Christy et al., 2002; Goossens, 1989; Leech & Cress, 2011; Romski et al., 2010; Scheipis, Reid, Behrmann, & Sutton, 1998; Stahmer & Ingersoll, 2004). These reports support findings in the literature about the emergence of speech skills later in development (Millar, Light, & Schlosser, 2006). It is difficult to say if other reports in Tables I and II did not find speech effects or if the studies did not measure speech production skills. It is an important distinction to be made and a critical measure to include in future investigations. For young children and their families, this outcome of AAC intervention is often very important. It is likely that some of the children who receive AAC services and supports at a very young age will go on to develop intelligible speech.

groups of typically developing children to provide a basis for how young children responded to the different types of AAC displays (i.e., visual scene versus grid displays, animation versus static displays, color versus black and white symbols). These studies provided evidence about how typically developing children as young as 2 years of age were able to utilize these types of displays; however, studies with young children who actually use SGDs have not yet been published. Sutton, Trudeau, Manford, Rios, and Poirier (2009) examined how 3- and 4-year-old children who were typically developing constructed simple utterances composed of graphic symbols. They found that using graphic symbols to convey simple utterances was a difficult task for these preschool children who were already using spoken language for communication. Their finding did not include an important comparison group, children who are using AAC for communication. Continuing with the trend seen in the birth-to-3 studies (i.e., using children with typical development for guidance), a few articles (Fallon, Light, & Paige, 2001; Fried-Oken & More, 1992; Ball, Marvin, Beukelman, Lasker, & Rupp, 1999) used surveys and language samples to assess the types of vocabulary words to which preschool children require access for communication. These studies provide a developmentally appropriate foundation for the selection of preschool AAC vocabulary. Exploring Literacy Development

Evaluating Assessment Approaches Among the reports were a number of assessment studies that focused on how young children responded to different assessment tools and strategies. Several reports noted that eye gaze shows promise as an assessment tool for children with severe motor impairments. Olswang, Feuerstein, Pinder, and Dowden (2013) reported that dynamic assessment was more successful at eliciting triadic gaze than static assessment techniques for very young children with severe motor impairment. Clarke, Doganathan, and Swettenham (2012) found that eye gaze was a successful tool for assessing false belief in children with cerebral palsy. Ross and Cress (2006) compared measures of receptive language and found the MacArthur Communication Development Inventory (MCDI citation) provided a more conservative estimate of children’s receptive language skills than the Battelle Developmental Inventory (Newborg, 1984). Additional research is needed to follow up on these findings. Using Typical Child Development Models A number of studies employed typically developing children to address questions about how very young children might respond to different aspects of AAC displays and tools. In the birth-to-3 studies, there were four studies (Drager, Light, Speltz, Fallon, & Jeffries, 2003; McCarthy et al., 2006; Thistle & Wilkinson, 2009; Olin, Reichle, Johnson, & Monn, 2010) that utilized

Even though only a modest number of articles focused on literacy development, the findings illustrated the importance of focusing attention on early literacy and reading skills during early intervention. Light et al. (1994) described the parent-child book reading interactions of preschoolers who used AAC and found that the parents dominated the exchanges and the children did not tend to use AAC during the interactions. Light and Kelford Smith (1993) found that the home literacy environments of children who used AAC did not provide as many opportunities for reading and were not as rich compared to those of typically developing children. In a case study, Mathisen, Arthur-Kelly, Kidd, and Nissen (2009) reported their almost 4-year-old participant, who used an SGD with MINSPEAK, made gains in literacy awareness but did not make comparable gains in phonological awareness. In a longitudinal study, Peeters, Verhoeven, de Moor, van Balkom, and van Leeuve (2009) surveyed the home literacy environments of 35 children with cerebral palsy. They found that the early home literacy activities of parents were related to both the phonemic awareness skills of the children and the children’s reading outcomes at the end of first grade. Including Families and Communicative Partners Communication with parents and caregivers is particularly important for young children. Although Supplementary Augmentative and Alternative Communication

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

Early Intervention and AAC Appendix to be found online at http://informahealthcare. com/doi/abs/10.3109/07434618.2015.1064163 A highlights a substantial number of papers that discuss family issues, none of the articles included a focus on children birth-to-6. Tables I and II suggest that there was strong evidence that parents and other communication partners (e.g., educational assistants) are able to learn strategies such as the use of manual signs and SGDs for communicating with young children who use AAC (Binger, Kent-Walsh, Ewing, & Taylor, 2010; Clibbens, Powell, & Atkinson, 2002; Douglas, McNaughton, & Light, 2014; Johnston, McDonnell, Nelson, & Magnavito, 2003; Kent-Walsh, Binger, & Hasham 2010; Nunes & Hanline, 2007; Romski et al., 2010; Rosa-Lugo & Kent-Walsh, 2008; Tait, Sigafoos, Woodyatt, O’Reilly & Lanconi, 2004) . In addition to teaching parents and other communication partners to communicate with their children, Romski, Sevcik, Adamson, Smith, Cheslock, and Bakeman (2011) found that parents’ perceptions of their child’s success became more positive after AAC intervention and Smith, Romski, Sevcik, Adamson, and Bakeman (2011) found that overall parent stress was not high prior to or following AAC language interventions. These findings indicate that parents and other communication partners can play an important role in their child’s communication intervention program. Additional research attention must be placed on the experiences of families of young children related to AAC interventions. Examining AAC Early Intervention Service Delivery Delivery of AAC early intervention services and supports is a critical topic to be addressed. The modest number of reports on this topic suggests that there is a great need for additional attention. Binger and Light (2006) surveyed 144 speech-language pathologists in the United States and found that approximately 12% of preschool children receiving special education services needed AAC services and supports. More recently, Barker, Akaba, Brady, and Thiemann-Bourque (2013) found that the 71 teachers they surveyed reported little training to support AAC use in their classrooms. They did find, however, that peer communication input was associated with increased child language growth, while teacher prompting and questioning was not. These studies offer a window into the need for early AAC intervention services and supports, as well as professional training requirements.

The Quality of Evidence and Future Research Priorities Overall, the past decade has seen a substantial increase in early AAC intervention experimental studies and provides optimism that there will be continuing focus on this very young population. The field has come a long way towards advancing our understanding about how early AAC intervention can improve outcomes for infants, toddlers, and young children. Particular © 2015 International Society for Augmentative and Alternative Communication

15

advancement has been made in the evidence about the positive effects of early AAC intervention on the communication, language, and speech development of young children. Studies employed a range of different methods and provided strong evidence that AAC is a viable intervention approach for supporting and increasing a young child’s communication attempts. Not surprisingly, many of the 24 case reports occurred early in the 30-year time period and provided a beginning point for understanding how AAC interventions worked for infants, toddlers, and preschool children with a range of different disabilities. The remaining 46 studies used single-subject designs with and without replication, quasi-experimental designs and, more recently, randomized control trials (RCTs; Romski, et al., 2010;Yoder & Stone, 2006) to assess the effects of early AAC intervention. The use of RCTs suggests that we can make relatively strong claims about the strength of the general findings from these reports. One caution is that the sample size in many of these studies is very small, suggesting difficulty with replication as well as the power of the effects. Another caution is that the reports cut across children with many different etiologies, from apraxia of speech to cerebral palsy to developmental delay to autism. Replication of the findings within each disorder will prove important in bolstering the conclusions we draw. While the field has made substantial gains in knowledge, these gains also highlight areas that deserve attention as we advance our understanding and improve outcomes. One area that deserves substantially more attention is the assessment of language and communication skills, including a substantive focus on speech and symbol comprehension skills that includes vocabulary as well as semantic relations and early grammatical forms. In very young children, it is often difficult to assess language understanding because the children have difficulty providing a consistent reliable response. Knowledge of receptive language skills is critical to understanding children’s language profiles. Using research with children who are developing typically as a model, the field might consider measurement strategies developed by Namy (2005). In 2014, AAC published two articles that led us into new directions for assessment. Brady, Anderson, Hahn, Obermeier, and Kapa (2014) utilized eye tracking research techniques to measure the receptive vocabulary skills of children with autism spectrum disorder and children with typical development. The typically developing children used differential eye gaze strategies across known and unknown words, while the children with autism showed more variability in their response patterns. They concluded that this technique holds promise as a means of assessment but needs additional investigation. Geytenbeek, Mokkink, Knol, Vermeulen, and Oostrom (2014) described a new instrument to assess comprehension of spoken language in young children with cerebral palsy and complex communication needs. This computerized instrument is currently

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

16

M. Romski et al.

available only in Dutch but holds much potential when it is translated into other languages. Given the chronological age of the children, many interventions targeted first words and single word vocabularies as the entry into the symbolic language system. The development of language interventions that target language skills beyond first word and single word vocabularies, however, is critical if we are to develop seamless language interventions that take a child through the stages of language development (Paul, 1997). Binger et al. (2010) have begun to address these issues by devising language interventions that target multi-symbol utterances. The next steps require investigators to link the development of single word vocabularies with semantic relations and early syntactic skills. This work must also address cross modal (auditory to visual) processing necessary to facilitate this transition for children learning to use signs and symbols as their primary means of communication. Understanding the role families play in the early use of AAC and the impact the use of AAC has on families is critical to the future success of AAC interventions with infants and young children. Table I describes a number of studies that surveyed families; however, they were not focused on the families of young children. The literature to date suggests that incorporating families and other communication partners into AAC intervention approaches is a very viable strategy. It is important, as well, to carefully examine family perspectives about their experiences with AAC interventions, in order to refine interventions to better serve the child within the family context. Another area that has been relatively silent to date when discussing very young children is the impact of multiple languages and cultures on the use of AAC. Aspects of these issues have been raised in the AAC field in general (e.g., Bunning, Gona, Newton, & Hartley, 2014). Going forward, it will be important to address the roles of more than one language and diverse cultures on the use of AAC for infants and young children. In addition, an issue that has not been addressed, but needs to be, is socio-economic status and its role in the implementation of interventions and AAC use in general. Understanding the long-term outcomes (in terms of speech and language development, educational opportunities, and overall development) for children who receive AAC from birth is essential. If our hypotheses about the importance of early intervention are correct, then we should see very different long-term outcomes in terms of societal inclusion, healthy development, and personal satisfaction than we saw for individuals whose AAC experience began later in development. It will be important to document these changes if the field is to continue to advance. And, finally, examining the integration of current and future technological advances into early AAC interventions is essential. Many of the studies reviewed in this paper employed gestures, manual signs, and some

communication boards. The rapid and dramatic revolution in new and emerging technologies offers opportunities for innovation that were not available even 5 years ago. Today, children who are typically developing are using technology at a very young age. Their parents and communication partners are using “apps” (applications) for a range of uses, including tele-support for AAC (Anderson, Balandin, Stancliffe, & Layfeld, 2014) and parent training. These technologies could make access more readily available for a larger subset of young children who may use AAC than was the case even a few short years ago. With this access comes a push to use the technology right off the shelf without pairing it with appropriate interventions. While the technology is to be embraced, it must be done with the caution that, by itself, technology is not the answer (Gosnell, Costello, & Shane, 2011). Thus, investigating access to emerging technologies at a very young age for children who may use AAC is an important area for further study. Replication of the successful findings reported in this paper with these new technologies will be important for the field as well. As Light and Drager (2007) indicated, the field must harness the power of technology to the benefit of the child’s development.

Implications of Research for Practice Overall, this review suggests that the field has amassed a strong evidence base that has developed from a reliance on case reports to an increase in experimental evidence such as single subject designs and randomized control trials. It provides a good deal of optimism about the effects of AAC early intervention on the development of language and communication skills in children who receive intervention from early in development. The implications of this research for practice are very positive and should be considered by the field. We will highlight four specific implications that must be integrated and implemented. First, and most importantly, the data strongly suggests that families and practitioners should be very confident in using AAC interventions with very young children early in their development. AAC interventions do not inhibit the development of speech; rather, they support the development of language and communication skills. This finding must be shared widely beyond the AAC community. Second, woven within a majority of the articles reviewed is the importance of providing AAC in the context of language and communication intervention. AAC provides the tools a young child can use to learn language, and the integration of these two areas is essential to long- term communication success for the child. Examination of existing oral language intervention strategies for integration with AAC is one route that may prove helpful. Enhanced milieu teaching (EMT) is one example (Olive et al., 2006; Wright et al., 2013). Augmentative and Alternative Communication

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

Early Intervention and AAC Third, the family plays a critical role in the development of language and communication skills for the young child. The reports presented suggest that parents and other communicative partners can use AAC strategies with their young children. While family participation is mandated in US early intervention programs, defining that role for AAC early interventions is essential to the long-term success of AAC. Family participation is also critical globally. Finally, as alluded to in a number of articles (e.g., Binger et al., 2012), professional education and training (both pre-service and in-service) is a very important component to ensure that the implications are integrated into practice. Pre-service educational programs across disciplines, including speech-language pathology, special education, and physical and occupational therapy, must ensure that training programs provide the most up-to-date information about the evidence for using AAC early in development. In-service educational programs across these disciplines must do the same to ensure that professionals trained a number of years ago have the most current information and intervention strategies at their disposal. In particular, it is essential that empirical data about early access and the role of AAC to augment existing vocalizations and speech development be disseminated broadly. Conclusions The field has come a very long way in its concept of AAC and early intervention. And, the AAC journal has contributed substantially to this development. AAC provided early in life can greatly enhance a child and his or her family’s lives. Infants, toddlers, and young children can have ways to communicate early in life when speech is physically compromised, slow to emerge, or absent. There is more substantial evidence about AAC use during the preschool years, but the evidence about children birth-to-3 is growing. We need to continue to disseminate these successes broadly so that clinicians and families understand the value of AAC early in life. We also need to continue to focus research energy on the development and fine-tuning of interventions and the measurement of their success across populations of children. The future looks bright as we continue to investigate the effects of providing AAC to infants and young children, taking into account the many roles AAC can play and the new and emerging technologies available today and in the future. Declaration of interest: The authors report no conflict of interests. The authors alone are responsible for the content and writing of the paper. References Adamson, L. B., & Dunbar, B. (1991). Communication development of young children with tracheostomies. Augmentative and Alternative Communication, 7, 275–283. © 2015 International Society for Augmentative and Alternative Communication

17

Adamson, L. B., Romski, M., Bakeman, R., & Sevcik, R. A. (2010). Augmented language intervention and the emergence of symbol-infused joint engagement. Journal of Speech, Language, and Hearing Research, 53, 1769–1773. doi:10.1044/10924388(2010/09-0208) Anderson, K., Balandin, S., Stancliffe, R., & Layfeld, C. (2014). Parents’ perspectives on tele-AAC support for families with a new speech generating device: Results from an Australian pilot study. Perspectives on Telepractice, 4, 52. doi:10.1044/teles4.2.52 Angelo, D. H. (2000). Impact of augmentative and alternative communication devices on families. Augmentative and Alternative Communication, 16, 37–47. Angelo, D. H., Jones, S. D., & Kokoska, S. M. (1995). Family perspective on augmentative and alternative communication: Families of young children. Augmentative and Alternative Communication, 11, 193–201. Bailey, R. L., Parette, H. P., Stoner, J. B., Angell, M. E., & Carroll, K. (2006). Family members’ perceptions of augmentative and alternative communication device use. Language, Speech, and Hearing Services in Schools, 37, 50–60. Retrieved from http:// www.ncbi.nlm.nih.gov/pubmed/16615749 Ball, L. J., Marvin, C. A., Beukelman, D. R., Lasker, J., & Rupp, D. (1999). Generic talk use by preschool children. Augmentative and Alternative Communication, 15, 145–155. Barker, R. M., Akaba, S., Brady, N. C., & Thiemann-Bourque, K. (2013). Support for AAC use in preschool, and growth in language skills, for young children with developmental disabilities. Augmentative and Alternative Communication, 29, 334–346. doi: 10.3109/07434618.2013.848933 Barton, A., Sevcik, R. A., & Romski, M. A. (2006). Exploring visual-graphic symbol acquisition by pre-school age children with developmental and language delays. Augmentative and Alternative Communication, 22, 10–20. doi:10.1080/07434610 500238206 Bedrosian, J. L. (1997). Language acquisition in young AAC system users: Issues and directions for future research. Augmentative and Alternative Communication, 13, 179–185. Bedrosian, J. L. (1999). Efficacy research issues in AAC : Interactive storybook reading. Augmentative and Alternative Communication, 15, 45–55. Berry, J. (1987). Strategies for involving parents in programs for young children using augmentative and alternative communication. Augmentative and Alternative Communication, 3, 90–93. Retrieved from http://informahealthcare.com/doi/abs/10.1080/074346187 12331274319 Beukelman, D., & Ansel, B. M. (1995). Research priorities in augmentative and alternative communication. Augmentative and Alternative Communication, 11, 131–134. Beukelman, D. R., & Mirenda, P. (2013). Augmentative and alternative communication: Supporting children and adults with complex communication needs (4th edn). Baltimore, MD: Brookes. Binger, C., Ball, L., Dietz, A., Kent-Walsh, J., Lasker, J., Lund, S., … & Quach, W. (2012). Personnel roles in the AAC assessment process. Augmentative and Alternative Communication, 28, 278–288. doi:10.3109/07434618.2012.716079 Binger, C., Berens, J., Kent-Walsh, J., & Taylor, S. (2008). The effects of aided AAC interventions on AAC use, speech, and symbolic gestures. Seminars in Speech and Language, 29, 101–111. doi:10.1055/s-2008-1079124. Binger, C., Kent-Walsh, J., Ewing, C., & Taylor, S. (2010). Teaching educational assistants to facilitate the multisymbol message productions of young students who require augmentative and alternative communication. American Journal of Speech-Language Pathology, 19, 108–120. doi:10.1044/1058-0360(2009/09-0015) Binger, C., & Light, J. (2006). Demographics of preschoolers who require AAC. Language, Speech, and Hearing Services in Schools, 37, 200–208. doi:10.1044/0161-1461(2006/022) Binger, C., & Light, J. (2007). The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication, 23, 30–43. doi:10.1080/07434610600807470

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

18

M. Romski et al.

Blischak, D., Lombardino, L., & Dyson, A. (2003). Use of speech-generating devices: In support of natural speech. Augmentative and Alternative Communication, 19, 29–35. doi:10.1080/0743461032000056478 Bondy, A. S., & Frost, L. A. (1994). The picture exchange communication system. Focus on Autism and Other Developmental Disabilities, 9, 1–19. doi:10.1177/108835769400900301 Bornman, J., Alant, E., & Meiring, E. (2001). The use of a digital voice output device to facilitate language development in a child with developmental apraxia of speech: A case study. Disability and Rehabilitation, 23(14), 623–634. Retrieved from http://www. ncbi.nlm.nih.gov/pubmed/11697460 Brady, N. C. (2000). Improved comprehension of object names following voice output communication aid use: Two case studies. Augmentative and Alternative Communication, 16, 197–204. Brady, N. C., Anderson, C. J., Hahn, L. J., Obermeier, S. M., & Kapa, L. L. (2014). Eye tracking as a measure of receptive vocabulary in children with autism spectrum disorders. Augmentative and Alternative Communication, 30, 147–159. Brady, N., & Fleming, K. (2012). Development of the Communication Complexity Scale. American Journal of Speech-Language Pathology, 21, 16–28. doi:10.1044/1058-0360(2011/10-0099) Brady, N., Skinner, D., Roberts, J., & Hennon, E. (2006). Communication in young children with fragile X syndrome: A qualitative study of mothers’ perspective. American Journal of Speech-Language Pathology, 15, 353–364. doi:10.1044/10580360(2006/033) Brady, N. C., Thiemann-Bourque, K., Fleming, K., & Matthews, K. (2013). Predicting language outcomes for children learning augmentative and alternative communication: Child and environmental factors. Journal of Speech, Language, and Hearing Research, 56, 1595–1612. doi:10.1044/1092-4388(2013/120102) Branson, D., & Demchak, M. (2009). The use of augmentative and alternative communication methods with infants and toddlers with disabilities: A research review. Augmentative and Alternative Communication, 25, 274–286. doi:10.3109/07434610903384529 Brown, S. E. & Guralnick, M. J. (2012). International human rights to early intervention for infants and young children with disabilities. Infants & Young Children, 25, 270–285. Bunning, K., Gona, J., Newton, C., & Hartley, S. (2014). Caregiver perceptions of children who have complex communication needs following a home-based intervention using augmentative and alternative communication in rural Kenya: An intervention note. Augmentative and Alternative Communication, 30, 344–356. Burroughs, J. A., Albritton, E. G., Eaton, B. B., & Montague, J. C. (1990). A comparative study of language delayed preschool children’s ability to recall symbols from two symbol systems. Augmentative and Alternative Communication, 6, 202–206. Calculator, S. N. (1997). Fostering early language acquisition and AAC use: Exploring reciprocal influences between children and their environments. Augmentative and Alternative Communication, 13, 149–157. Calculator, S. N. (2013). Parents’ reports of patterns of use and exposure to practices associated with AAC acceptance by individuals with Angelman syndrome. Augmentative and Alternative Communication, 29, 146–158. doi:10.3109/0743461 8.2013.784804 Cardon, T. A., Wilcox, M. J., & Campbell, P. H. (2011). Caregiver perspectives about assistive technology use with their young children with autism spectrum disorders. Infants & Young Children, 24, 153–173. Chapman, R. S., & Miller, J. F. (1981). Analyzing language and communication in the child. In R. L. Schiefelbusch (Ed.), Nonspeech language and communication analysis and intervention (pp. 159–196). Baltimore, MD: University Park Press. Charlop-Christy, M. H., Carpenter, M., Le, L., LeBlanc, L. A., & Kellet, K. (2002). Using the picture exchange communication system (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behavior,

and problem behavior. Journal of Applied Behavior Analysis, 35, 213–231. doi:10.1901/jaba.2002.35-213 Clarke, M. T., Loganathan, D., & Swettenham, J. (2012). Assessing true and false belief in young children with cerebral palsy through anticipatory gaze behaviours: A pilot study. Research in Developmental Disabilities, 33, 2058–2066. doi:10.1016/j. ridd.2012.05.009 Clibbens, J., Powell, G. G., & Atkinson, E. (2002). Strategies for achieving joint attention when signing to children with Down’s syndrome. International Journal of Language and Communication Disorders, 37, 309–323. doi:10.1080/1368282021013628 Cress, C. J., & Marvin, C. A. (2003). Common questions about AAC services in early intervention. Augmentative and Alternative Communication, 19, 254–272. doi:10.1080/0743461031000159 8242 Crystal, D. (1986). ISAAC in chains: The future of communication systems. Augmentative and Alternative Communication, 2, 140– 145. Dicarlo, C. F., & Banajee, M. (2000). Using voice output devices to increase initiations of young children with disabilities. Journal of Early Intervention, 23, 191–199. doi:10.1177/105381510002 30030801 Douglas, S. N., McNaughton, D., & Light, J. (2014). Online training for paraeducators to support the communication of young children. Journal of Early Intervention, 35, 223–242. doi:10.1177/1053815114526782 Drager, K. D. R., Light, J. C., Speltz, J.C., Fallon, K. A., & Jeffries, L. Z. (2003). The performance of typically developing 21/2 year olds on dynamic display AAC technologies with different system layouts and language organizations. Journal of Speech, Language and Hearing Research, 46, 298–312. Drager, K., Light, J., & McNaughton, D. (2010). Effects of AAC interventions on communication and language for young children with complex communication needs. Journal of Pediatric Rehabilitation Medicine, 3, 303–310. doi:10.3233/PRM-20100141 Drager, K., Postal, V. J., Carrolus, L., Castellano, M., Gagliano, C., & Glynn, J. (2006). The effect of aided language modeling on symbol comprehension and production in 2 preschoolers with autism. American Journal of Speech-Language Pathology, 15, 112– 125. doi:10.1044/1058-0360(2006/012) Dunst, C. J., & Wortman Lowe, L. (1986). From reflex to symbol: Describing, explaining, and fostering communicative competence. Augmentative and Alternative Communication, 2, 11–18. Fallon, K. A., Light, J. C., & Paige, T. K. (2001). Enhancing vocabulary selection for preschoolers who require augmentative and alternative communication (AAC). American Journal of SpeechLanguage Pathology, 10, 81–94. Finke, E. H., & Quinn, E. (2012). Perceptions of communication style and influences on intervention practices for young children with AAC needs. Augmentative and Alternative Communication, 28, 117–126. doi:10.3109/07434618.2012.677959 Flippin, M., Reszka, S., & Watson, L. R. (2010). Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: a meta-analysis. American Journal of Speech-Language Pathology, 19, 178–195. doi:10.1044/1058-0360(2010/09-0022) Fried-Oken, M., & More, L. (1992). An initial vocabulary for nonspeaking preschool children based on developmental and environmental language scores. Augmentative and Alternative Communication, 8, 41–56. Ganz, J. B., Davis, J. L., Lund, E. M., Goodwyn, F. D., & Simpson, R. L. (2012). Meta-analysis of PECS with individuals with ASD: Investigation of targeted versus non-targeted outcomes, participant characteristics, and implementation phase. Research in Developmental Disabilities, 33, 406–418. doi:10.1016/j. ridd.2011.09.023 Gerber, S., & Kraat, A. (1992). Use of a developmental model of language acquisition: Applications to children using AAC systems. Augmentative and Alternative Communication, 8, 19–32.

Augmentative and Alternative Communication

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

Early Intervention and AAC Gevarter, C., O’Reilly, M. F., Rojeski, L., Sammarco, N., Lang, R., Lancioni, G. E., & Sigafoos, J. (2013). Comparisons of intervention components within augmentative and alternative communication systems for individuals with developmental disabilities: A review of the literature. Research in Developmental Disabilities, 34, 4404–4414. doi:10.1016/j.ridd.2013.09.018 Geytenbeek, J. J., Mokkink, L. B., Knol, D. L., Vermeulen, R. J., & Oostrom, K. J. (2014). Reliability and validity of the C-BiLLT: A new instrument to assess comprehension of spoken language in young children with cerebral palsy and complex communication needs. Augmentative and Alternative Communication, 31, 1–15. do i:10.3109/07434618.2014.924992 Goossens’, C. (1989). Aided communication intervention before assessment: A case study of a child with cerebral palsy. Augmentative and Alternative Communication, 5, 14–26. Goossens’, C. A., & Crain, S. S. (1987). Overview of nonelectronic eyegaze communication techniques. Augmentative and Alternative Communication, 3, 77–89. Goldbart, J., & Marshall, J. (2004). “Pushes and Pulls” on the parents of children who use AAC. Augmentative and Alternative Communication, 20, 194–208. doi:10.1080/07434610400010960 Gosnell, J., Costello, J., & Shane, H. (2011). Using a clinical approach to answer “What communication apps should we use?” SIG 12 Perspectives on Augmentative and Alternative Communication, 20, 87–96. Granlund, M., Bjork-Akesson, E., Brodin, J., & Olsson, C. (1995). Communication intervention for persons with profound disabilities: A Swedish perspective. Augmentative and Alternative Communication, 11, 49–59. Granlund, M., Björck-Åkesson, E., Wilder, J., & Ylvén, R. (2008). AAC interventions for children in a family environment: Implementing evidence in practice. Augmentative and Alternative Communication, 24, 207–219. doi:10.1080/08990220802387935 Granlund, M., & Olsson, C. (1999). Efficacy of communication intervention for presymbolic communicators. Augmentative and Alternative Communication, 15, 25–37. Greenhalgh, T., & Peacock, R. (2005). Effectiveness and efficiency of search methods in systematic reviews of complex evidence: Audit of primary sources. The BMJ, 331, 1064–1065. Guralnick, M. J. (2000). Early childhood intervention: Evolution of a system. Focus on Autism and Other Developmental Disabilities, 15, 68–79. Guralnick, M. J. (2008) International perspectives on early intervention: A search for common ground. Journal of Early Intervention, 30, 90–101. Harding, C., Lindsay, G., O’Brien, A., Dipper, L., & Wright, J. (2011). Implementing AAC with children with profound and multiple learning disabilities: A study in rationale underpinning intervention. Journal of Research in Special Educational Needs, 11, 120–129. doi:10.1111/j.1471-3802.2010.01184.x Harris, L., Skarakis Doyle, E., & Haaf , R. (1996). Language treatment approach for users of AAC: Experimental single-subject investigation. Augmentative and Alternative Communication, 12, 230–243. Hetzroni, O. E., & Belfiore, P. J. (2000). Preschoolers with communication impairments play shrinking Kim: An interactive computer storytelling intervention for teaching Blissymbols. Augmentative and Alternative Communication, 16, 260–269. Hustad, K. C., Keppner, K., Schanz, A., & Berg, A. (2009). Augmentative and alternative communication for preschool children: Intervention goals and use of technology. Seminars in Speech and Language, 29, 83–91. Hyppa Martin, J., Reichle, J., Dimian, A., & Chen, M. (2013). Communication modality sampling for a toddler with Angelman syndrome. Language, Speech, and Hearing Services in Schools, 44, 327–336. doi:10.1044/0161-1461(2013/12-0108) Iacono, T., & Cameron, M. (2009). Australian speech-language pathologists’ perceptions and experiences of augmentative and alternative communication in early childhood intervention.

© 2015 International Society for Augmentative and Alternative Communication

19

Augmentative and Alternative Communication, 25, 236–49. doi:10.3109/07434610903322151 Iacono, T., Carter, M., & Hook, J. (1998). Identification of intentional communication in students with severe and multiple Disabilities. Augmentative and Alternative Communication, 14, 102–114. Iacono, T., & Duncum, J. E. (1995). Comparison of sign alone and in combination with an electronic communication device in early language intervention: Case study. Augmentative and Alternative Communication, 11, 249–259. Johnston, S. S., McDonnell, A. P., Nelson, C., & Magnavito, A. (2003). Teaching functional communication skills using augmentative and alternative communication in inclusive settings. Journal of Early Intervention, 25, 263–280. doi:10.1177/105381510302500403 Johnston, S., Nelson, C., Evans, J., & Palazolo, K. (2003). The use of visual supports in teaching young children with Autism Spectrum Disorder to initiate interactions. Augmentative and Alternative Communication, 19, 86–103. doi:10.1080/0743461031000112016 Johnston, S., Reichle, J., & Evans, J. (2004). Supporting augmentative and alternative communication use by beginning communicators with severe disabilities. American Journal of Speech-Language Pathology, 13, 20–30. Judge, S. (2002). Family-centered assistive technology assessment and intervention practices for early intervention. Infants & Young Children, 15, 60–68. Kangas, K. A., & Lloyd, L. L. (1988). Early cognitive skills as prerequisites to augmentative and alternative communication use: What are we waiting for? Augmentative and Alternative Communication, 4, 211–221. Kent-Walsh, J., Binger, C., & Hasham, Z. (2010). Effects of parent instruction on the symbolic communication of children using augmentative and alternative communication during storybook reading. American Journal of Speech-Language Pathology, 19, 97– 107. doi:10.1044/1058-0360(2010/09-0014) Kent-Walsh, J., & McNaughton, D. (2005). Communication partner instruction in AAC: Present practices and future directions. Augmentative and Alternative Communication, 21, 195–204. doi:10.1080/07434610400006646 Kling, A., Otr, L., Campbell, P. H., & Wilcox, J. (2010).Young children with physical disabilities. Infants & Young Children, 23, 169–183. Lancioni, G., O’Reilly, M., Cuvo, A., Singh, N., Sigafoos, J., & Didden, R. (2007). PECS and VOCAs to enable students with developmental disabilities to make requests: An overview of the literature. Research in Developmental Disabilities, 28, 468–488. Leech, E. R. B., & Cress, C. J. (2011). Indirect facilitation of speech in a late talking child by prompted production of picture symbols or signs. Augmentative and Alternative Communication, 27, 40–52. doi:10.3109/07434618.2010.550062 Letto, M., Bedrosian, J. L., & Skarakis-Doyle, E. (1994). Application of Vygotskian developmental theory to language acquisition in a young child with cerebral palsy. Augmentative and Alternative Communication, 10, 151–160. Lerna, A., Esposito, D., Conson, M., & Massagli, A. (2014). Longterm effects of PECS on social-communicative skills of children with autism spectrum disorders: A follow-up study. International Journal of Language & Communication Disorders, 49, 478–485. doi:10.1111/1460-6984.12079 Light, J. (1997a). “Communication is the essence of human life”: Reflections on communicative competence. Augmentative and Alternative Communication, 13, 61–70. Light, J. (1997b). “Let’s go star fishing”: Reflections on the contexts of language learning for children who use aided AAC. Augmentative and Alternative Communication, 13, 158–171. Light, J. C. (1999). Do augmentative and alternative communication interventions really make a difference?: The challenges of efficacy research. Augmentative and Alternative Communication, 15, 13–24. Light, J. C., Binger, C., & Kelford Smith, A. (1994). Story reading interactions between preschoolers who use AAC and their

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

20

M. Romski et al.

mothers. Augmentative and Alternative Communication, 10, 255–268. Light, J. C., Collier, B., & Parnes, P. (1985a). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part I – Discourse patterns. Augmentative and Alternative Communication, 1, 74–83. Light, J. C., Collier, B., & Parnes, P. (1985b). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part II – Communicative function. Augmentative and Alternative Communication, 1, 98–107. Light, J. C., Collier, B., & Parnes, P. (1985c). Communicative interaction between young nonspeaking physically disabled children and their primary caregivers: Part III – Modes of communication. Augmentative and Alternative Communication, 1, 125–133. Light, J., & Drager, K. (2007). AAC technologies for young children with complex communication needs: State of the science and future research directions. Augmentative and Alternative Communication, 23, 204–16. doi:10.1080/07434610701553635 Light, J. C., Drager, K. D., & Nemser, J. G. (2004). Enhancing the appeal of AAC technologies for young children: Lessons from the toy manufacturers. Augmentative and Alternative Communication, 20, 137–149. doi:10.1080/07434610410001699735 Light, J. C., & Kelford Smith, A. (1993). Home literacy experiences of preschoolers who use AAC systems and of their nondisabled peers. Augmentative and Alternative Communication, 9, 10–25. Light, J., & McNaughton, D. (2012). The changing face of augmentative and alternative communication: Past, present, and future challenges. Augmentative and Alternative Communication, 28, 197–204. doi:10.3109/07434618.2012.737024 Lüke, C. (2014). Impact of speech-generating devices on the language development of a child with childhood apraxia of speech: a case study. Disability and Rehabilitation: Assistive Technology, 0, 1–9. doi:10.3109/17483107.2014.913715 Lund, S. K., & Light, J. (2007). Long-term outcomes for individuals who use augmentative and alternative communication: Part III – contributing factors. Augmentative and Alternative Communication, 23, 323–335. doi:10.1080/02656730701189123 Mathisen, B., Arthur-Kelly, M., Kidd, J., & Nissen, C. (2009). Using MINSPEAK: A case study of a preschool child with complex communication needs. Disability and Rehabilitation: Assistive Technology, 4, 376–383. doi:10.1080/17483100902807112 McCarthy, J., Light, J., Drager, K., McNaughton, D., Grodzicki, L., Jones, J., … & Parkin, E. (2006). Re-designing scanning to reduce learning demands: the performance of typically developing 2-year-olds. Augmentative and Alternative Communication, 22, 269–283. doi:10.1080/00498250600718621 McDonald, E. & Schultz, A. (1973). Communication boards for cerebral-palsied children. Journal of Speech and Hearing Disorders, 38, 73–88. Millar, D., Light, J., & Schlosser, R. (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, Hearing Research, 49, 248–264. Mirenda, P. (1993). AAC: Bonding the uncertain mosaic. Augmentative and Alternative Communication, 9, 3–9. Mirenda, P., & Mathy-Laikko, P. (1989). Augmentative and alternative communication for persons with severe congenital communication disorders: An introduction. Augmentative and Alternative Communication, 5, 3–13. Namy, L. (2005). Symbol use and symbolic representation. Mahwah, NJ: Lawrence Erlbaum. Newborg, J. (1984). Battelle developmental inventory. Allen, TX: DLM Teaching Resources. Nunes, D., & Hanline, M. F. (2007). Enhancing the alternative and augmentative communication use of a child with autism through a parent implemented naturalistic intervention. International Journal of Disability, Development and Education, 54, 177–197. doi:10.1080/10349120701330495

Odom, S., Hanson, M., Blackman, J. A., & Kaul, S. (2003). Early intervention practices across the world. Baltimore, MD: Brookes. Olin, A. R., Reichle, J., Johnson, L., & Monn, E. (2010). Examining dynamic visual scene displays: implications for arranging and teaching symbol selection. American Journal of Speech-Language Pathology, 19, 284–297. doi:10.1044/1058-0360(2010/ 09-0001) Olive, M. L., Davis, T. N., Chan, J. M., Lang, R. B., & Dickson, S. M. (2006). The effects of enhanced milieu teaching and a voice output communication aid on the requesting of three children with autism. Journal of Autism and Developmental Disorders, 37, 1505–1513. Olswang, L. B., Feuerstein, J. L., Pinder, G. L., & Dowden, P. (2013). Validating dynamic assessment of triadic gaze for young children with severe disabilities. American Journal of Speech-Language Pathology, 22, 1–24. doi:10.1044/1058-0360(2012/12-0013). Parette, H. P., & Brotherson, M. J. (2004). Family-centered and culturally responsive assistive technology decision making. Infants & Young Children, 17, 355–367. Paul, R. (1997). Facilitating transitions in language development for children using AAC. Augmentative and Alternative Communication, 13, 141–148. Peeters, M.,Verhoeven, L., de Moor, J., van Balkom, H., & van Leeuwe, J. (2009). Home literacy predictors of early reading development in children with cerebral palsy. Research in Developmental Disabilities, 30, 445–461. Pennington, L., & McConachie, H. (1999). Mother – child interaction revisited: Communication with non-speaking physically disabled children. International Journal of Language & Communication Disorders, 34, 391–416. Pickl, G. (2011). Communication intervention in children with severe disabilities and multilingual backgrounds: Perceptions of pedagogues and parents. Augmentative and Alternative Communication, 27, 229–244. doi:10.3109/07434618.2011.630 021 Preston, D., & Carter, M. (2009). A review of the efficacy of the picture exchange communication system intervention. Journal of Autism and Developmental Disorders, 39, 1471–1486. doi:10.1007/ s10803-009-0763-y Romski, M. A., & Sevcik, R. A. (1988). Augmentative and alternative communication systems: Considerations for individuals with severe intellectual disabilities. Augmentative and Alternative Communication, 4, 83–93. Romski, M. A., & Sevcik, R. A. (1997). Augmentative and alternative communication for children with developmental disabilities. Mental Retardation and Developmental Disabilities Research Reviews, 3, 363–368. Romski, M., & Sevcik, R. A. (2005). Augmentative communication and early intervention: Myths and realities. Infants & Young Children, 18, 174–185. Romski, M. A., Sevcik, R. A., & Adamson, L. B. (1997). Framework for studying how children with developmental disabilities develop language through augmented means. Augmentative and Alternative Communication, 13, 172–178. Romski, M., Sevcik, R. A., Adamson, L. B., Smith, A., & Barker, R. M. (2010). Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents. Journal of Speech, Language and Hearing Research, 53, 350–365. Romski, M. A., Sevcik, R. A., Adamson, L. B., Smith, A., Cheslock, M., & Bakeman, R. (2011). Parent perceptions of the language development of toddlers with developmental delays before and after participation in parent-coached language interventions. American Journal of Speech-Language Pathology, 20, 111–119. doi:10.1044/1058-0360(2011/09-0087) Ross, B., & Cress, C. J. (2006). Comparison of standardized assessments for cognitive and receptive communication skills in young children with complex communication needs. Augmentative and Alternative Communication, 22, 100–111. doi:10.1080/07434610500389629

Augmentative and Alternative Communication

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

Early Intervention and AAC Rosa-Lugo, L. I., & Kent-Walsh, J. (2008). Effects of parent instruction on communicative turns of Latino children using augmentative and alternative communication during storybook reading. Communication Disorders Quarterly, 30, 49–61. Rowland, C., & Fried-Oken, M. (2010). Communication Matrix: A clinical and research assessment tool targeting children with severe communication disorders. Journal of Pediatric Rehabilitation Medicine, 3, 319–329. doi:10.3233/PRM2010-0144 Rowland, C., & Schweigert, P. (1989). Tangible symbols: Communication for individuals with multisensory impairments. Augmentative and Alternative Communication, 5, 226–234. Saito, Y., & Turnbull, A. (2007). Augmentative and alternative communication practice in the pursuit of family quality of life: A review of the literature. Research & Practice for Persons with Severe Disabilities, 32, 50–65. Schepis, M. M., Reid, D. H., Behrmann, M. M., & Sutton, K. A. (1998). Increasing communicative interactions of young children with autism using a voice output communication aid and naturalistic teaching. Journal of Applied Behavior Analysis, 31, 561–578. doi:10.1901/jaba.1998.31-561 Schlosser, R. W. (1999). Comparative efficacy of interventions in augmentative and alternative communication. Augmentative and Alternative Communication, 15, 56–68. Schlosser, R. (2003). Roles of speech output in augmentative and alternative communication: Narrative review. Augmentative and Alternative Communication, 19, 5–27. doi:10.1080/0743461032000056450 Schlosser, R. W., & Wendt, O. (2008). Effects of augmentative and alternative communication on speech production in children with autism: A systematic review. American Journal of SpeechLanguage Pathology, 17, 212–230. Schweigert, P., & Rowland, C. (1992). Early communication and microtechnology: Instructional sequence and case studies of children with severe multiple disabilities. Augmentative and Alternative Communication, 8, 273–286. Sevcik, R. A., Barton-Hulsey, A., & Romski, M. (2008). Early intervention, AAC, and transition to school for young children with significant spoken communication disorders and their families. Seminars in Speech and Language, 29, 92–100. doi:10.1055/s-2008-1079123. Sevcik, R., Romski, M., & Adamson, L. (2004). Research directions in augmentative and alternative communication for preschool children. Disability & Rehabilitation, 26, 1323–1329. doi:10.108 0/09638280412331280352 Shane, H. C. (1981). Decision making in early augmentative communication system use. In R. L. Schiefelbusch & D. D. Bricker (Eds), Early language: Acquisition and intervention (pp. 389–425). Baltimore, MD: University Park Press. Sigafoos, J., Didden, R., & O’Reilly, M. (2003). Effects of speech output on maintenance of requesting and frequency of vocalizations in three children with developmental disabilities. Augmentative and Alternative Communication, 19, 37–47. doi:10.1080/0743461032000056487 Simeonsson, R. J., Björck-Åkessön, E., & Lollar, D. J. (2012). Communication, disability, and the ICF-CY. Augmentative and Alternative Communication, 28, 3–10. doi:10.3109/07434618.20 11.653829 Smith, A. L., Romski, M. A., Sevcik, R. A., Adamson, L. B., & Bakeman, R. (2011). Parent stress and its relation to parent perceptions of communication following parent-coached language intervention. Journal of Early Intervention, 33, 135–150. doi:10.1177/1053815111405526 Snell, M. E., Caves, K., McLean, L., Mineo Mollica B., Mirenda, P., Paul-Brown, . . . & Yoder, D. E. (2003). Concerns regarding the application of restrictive “eligibility” policies to individuals who need communication services and supports: A response by the National Joint Committee for the Communication Needs of Persons with Severe Disabilities. Research & Practice for Persons with Severe Disabilities, 28, 70–78.

© 2015 International Society for Augmentative and Alternative Communication

21

Snell, M. E., Chen, L., Allaire, J. H., & Park, E. (2009). Communication breakdown at home and at school in young children with cerebral palsy and severe disabilities. Research & Practice for Persons with Severe Disabilities, 20, 25–36. Snell, M. E., Chen, L., & Hoover, K. (2006). Teaching augmentative and alternative communication to students with severe disabilities: A review of intervention research 1997–2003. Research & Practice for Persons with Severe Disabilities, 31, 203–214. Stahmer, A. C., & Ingersoll, B. (2004). Inclusive programming for toddlers with Autism Spectrum Disorders: Outcomes from the children’s toddler school. Journal of Positive Behavior Interventions, 6, 67–82. doi:10.1177/10983007040060020201 Starble, A., Hutchins, T., Favro, M. A., Prelock, P., & Bitner, B. (1994). Family-centered intervention and satisfaction with AAC device training. Communication Disorders Quarterly, 27, 47–54. Stephenson, J. (2007). The effect of color on the recognition and use of line drawings by children with severe intellectual disabilities. Augmentative and Alternative Communication, 23, 44–55. doi:10.1080/07434610600924457 Stephenson, J., & Linfoot, K. (1996). Pictures as communication symbols for students with severe intellectual disability. Augmentative and Alternative Communication, 12, 244–254. Sutton, A., Trudeau, N., Morford, J, Rios, M., & Poirier, M-A. (2010). Preschool-aged children have difficulty constructing and interpreting simple utterances composed of graphic symbols. Journal of Child Language, 37, 1–26. Tait, K., Sigafoos, J., Woodyatt, G., O’Reilly, M., & Lancioni, G. (2004). Evaluating parent use of functional communication training to replace and enhance prelinguistic behaviours in six children with developmental and physical disabilities. Disability and Rehabilitation, 26, 1241–1254. doi:10.1080/096382804123 31280253 Thistle, J. J., & Wilkinson, K. (2009). The effects of color cues on typically developing preschoolers’ speed of locating a target line drawing: Implications for augmentative and alternative communication. American Journal of Speech-Language Pathology, 18, 231–240. van der Meer, L., Sigafoos, J., O’Reilly, M. F., & Lancioni, G. E. (2011). Assessing preferences for AAC options in communication interventions for individuals with developmental disabilities: A review of the literature. Research in Developmental Disabilities, 32, 1422–1431. doi:10.1016/j.ridd.2011.02.003 van der Schuit, M., Segers, E., van Balkom, H., & Verhoeven, L. (2011). Early language intervention for children with intellectual disabilities: a neurocognitive perspective. Research in Developmental Disabilities, 32, 705–712. doi:10.1016/j.ridd. 2010.11.010 van der Schuit, M., Segers, E., van Balkom, H., Stoep, J., & Verhoeven, L. (2010). Immersive communication intervention for speaking and non-speaking children with intellectual disabilities. Augmentative and Alternative Communication, 26, 203–18. doi:10.3109/07434618.2010.505609 von Tetzchner, S., Brekke, K. M., Sjøthun, B., & Grindheim, E. (2005). Constructing preschool communities of learners that afford alternative language development. Augmentative and Alternative Communication, 21, 82–100. doi:10.1080/07434610500103541 von Tetzchner, S., Øvreeide, K. D., Jørgensen, K. K., Ormhaug, B. M., Oxholm, B., & Warme, R. (2004). Acquisition of graphic communication by a young girl without comprehension of spoken language. Disability and Rehabilitation, 26, 1335–1346. d oi:10.1080/09638280412331280370 Walker, V. L., & Snell, M. E. (2013). Effects of augmentative and alternative communication on challenging behavior: a meta-analysis. Augmentative and Alternative Communication, 29, 117–31. doi:10.3109/07434618.2013.785020 Whitmore, A. S., Romski, M. A., & Sevcik, R. A. (2014). Early augmented language intervention for children with developmental delays: Potential secondary motor outcomes. Augmentative and

22

M. Romski et al.

Augment Altern Commun Downloaded from informahealthcare.com by Nyu Medical Center on 07/28/15 For personal use only.

Alternative Communication, 30, 200–212. doi:10.3109/0743461 8.2014.940466 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 Research Reviews, 69, 58–69. doi:10.1002/mrdd World Health Organization (2012). Early childhood development and disability: A discussion paper. Geneva, Switzerland: World Health Organization. Wright, C. A., Kaiser, A. P., Reikowsky, D. I., & Roberts, M.Y. (2013). Effects of a naturalistic sign intervention on expressive language

of toddlers with Down syndrome. Journal of Speech, Language, and Hearing Research, 56, 994–1008. doi:10.1044/10924388(2012/12-0060) Yoder, P., & Stone, W. L. (2006). A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. Journal of Speech, Language, and Hearing Research, 49, 698–711. doi:10.1044/1092-4388(2006/051) Zangari, C., Lloyd, L. L., & Vicker, B. (1994). Augmentative and alternative communication: An historic perspective. Augmentative and Alternative Communication, 10, 27–59.

Supplementary Material Available Online Appendix A and B to be found online at http://informa healthcare.com/doi/abs/10.3109/07434618.2015. 1064163

Augmentative and Alternative Communication

Early Intervention and AAC: What a Difference 30 Years Makes.

This article provides an overview of early intervention and AAC over the 30-year period since the founding of the journal Augmentative and Alternative...
296KB Sizes 0 Downloads 10 Views