Cynthia J. Cress

Common Questions about AAC Services in Early Intervention

Children and adults with developmental delays have benefited from the use of augmentative and alternative communication (AAC) systems to develop language skills necessary for more generative and functional communication. Beginning communicators however, have historically been considered too young or too pre-linguistic and therefore have not been introduced to AAC systems until behaviors, thought to be prerequisites, have been noted. Recent research and theories about early communication development have challenged this traditional practice and broadened the scope of what is considered to be AAC. Practitioners and parents unfamiliar with early AAC options may not recognize possible applications of communication strategies used with typically developing children and older persons with developmental disabilities. AAC is applicable at all ages for learning communication roles and behaviors as well as for functional communication for persons who do not yet demonstrate clear referential symbol use. This article addresses nine questions that are frequently asked about early introduction of AAC systems to children under 3 years of age. Rationales and strategies are provided that can assist early interventionists and parents in considering AAC options for children at risk for being unintelligible or non-speaking.

AAC strategies for people with primary progressive aphasia without dementia: two case studies

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

Development and Standardization of a Test to Measure the Emotional and Behavioral Strengths of Preschool Children

The purpose of the present study was to document the development and standardization of the Preschool Behavioral and Emotional Rating Scale and to examine its factor structure, internal consistency, and criterion validity. Data from a nationally representative sample (N = 1,471) of preschool children with and without disabilities were collected. An exploratory factor analysis identified four factors: Emotional Regulation, School Readiness, Social Confidence, and Family Involvement. The subscales and total instrument appear remarkably stable and consistent (.838 to .983). Age differences across 3-, 4-, and 5-year olds were small in magnitude, although girls were rated as possessing significantly more strengths than boys. Preschool children with disabilities were seen as having less emotional and behavioral strength than their peers without disabilities. The limitations and future research needs are discussed.

Parent Directiveness in Free Play with Young Children with Physical Impairments.

Children with disabilities are reported to experience a high degree of directive parent interaction compared to typically developing children because of poor communicative or task skills. This study examines relationships between parent behaviors (directiveness and contingency) and child skills (language and motor) for children with physical or neuromotor impairments at risk for being nonspeaking during undirected incidental play. The only correlation between parent behavior and child developmental status was between physical directiveness and child motor scores. Previous reports of high directiveness that increase with degree of disability might be attributable to task instructions during object play, in which high physical directiveness would be required for this population.

visiBabble for reinforcement of early vocalization

The visiBabble system processes infant vocalizations in real-time. It responds to the infants syllable-like productions with brightly colored animations and records the acoustic-phonetic analysis. The system reinforces the production of syllabic utterances that are associated with later language and cognitive development. We report here on the development of the visiBabble prototype and field-testing of the system.

Comparison of standardized assessments for cognitive and receptive communication skills in young children with complex communication needs

This study compared estimates of receptive language development for children with complex communication needs to estimates of related skill domains. Subscores of the Battelle Developmental Inventory were compared with each other and the MacArthur Communication Developmental Inventory for 41 children with severe expressive impairments over a period of 18 months, beginning at ages 12 – 24 months. Across all ages studied, children with severe expressive impairments had better receptive language scores than expected for either their cognitive or overall developmental age equivalence scores. While receptive language measures were correlated with each other and age, scores for receptive language skills on the MacArthur were consistently more stringent than for the Battelle for this population. Implications for clinical application of these measures for children with expressive impairments are discussed.

Indirect facilitation of speech in a late talking child by prompted production of picture symbols or signs.

The present study investigated the effectiveness of prompted nonspoken language production using two low-tech AAC strategies (i.e., picture symbols and sign language) at indirectly facilitating speech productions in a young child with expressive language delays (“late talker”). A single subject, multiple baseline design was used. Results indicated that prompting either sign or picture-symbol production improved the childs speech output for target words without any direct prompts to speak, but that the two AAC strategies did not differ from one another in effectiveness at indirectly eliciting speech. The improvements associated with both strategies suggest that AAC can be a viable intervention tool to address improved speech in children with expressive delays. The AAC intervention had a clear and rapid effect on the childs spoken word productions, although the child did not produce signs or symbols to criterion for most of the target words before producing them in speech.

Contingent Interactions Between Parents and Young Children With Severe Expressive Communication Impairments

Parents and their children with severe expressive impairments may have limited successful communicative exchanges due to each partner’s difficulty in recognizing and responding to communicative behaviors of the other. This study examined the communicative functions and modes of communication that received contingent responses in 20 dyads of parents and young children with severe expressive impairments. Parents responded more often to children’s nonvocal behaviors and adult-directed behaviors than vocal behaviors and non-adult-directed behaviors (i.e., child gestures or vocal behaviors that were not conveyed toward the direction of the adult). The children responded more often to parent communication about goal-directed than non-goal-directed tasks. Implications of these results for communication intervention are discussed.

Preschool Behavioral and Emotional Rating Scale (PreBERS): Test-Retest and Inter-Rater Reliability for Children with Disabilities

This article reports three studies that evaluated the test-retest and inter-rater reliability of the Preschool Behavioral and Emotional Rating Scale (PreBERS) (Epstein & Synhorst, 2009). First, teachers rated 63 children receiving school services for disability on the PreBERS, with two ratings one month apart. Second, paraprofessionals rated the same children on the PreBERS, with two ratings one month apart. Third, teacher and paraprofessional ratings were compared for inter-rater reliability between these observers. Correlations were large to very large in each of these studies, indicating that the PreBERS is a stable measure across time and raters. Recommendations for use of the PreBERS with preschool children with disabilities as well as directions for future research are discussed.

Mastery motivation in children with complex communication needs: longitudinal data analysis

Abstract This study compared longitudinal changes in mastery motivation during parent-child free play for 37 children with complex communication needs. Mastery motivation manifests as a willingness to work hard at tasks that are challenging, which is an important quality to overcoming the challenges involved in successful expressive communication using AAC. Unprompted parent-child play episodes were identified in three assessment sessions over an 18-month period and coded for nine categories of mastery motivation in social and object play. All of the object-oriented mastery motivation categories and one social mastery motivation category showed an influence of motor skills after controlling for receptive language. Object play elicited significantly more of all of the object-focused mastery motivation categories than social play, and social play elicited more of one type of social-focused mastery motivation behavior than object play. Mastery motivation variables did not differ significantly over time for children. Potential physical and interpersonal influences on mastery motivation for parents and children with complex communication needs are discussed, including broadening the procedures and definitions of mastery motivation beyond object-oriented measurements for children with complex communication needs.