Erinn H. Finke

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication.

AIMS AND OBJECTIVES To systematically review the research regarding communication between nurses and patients with complex communication needs (CCN). The research was reviewed with respect to the following themes: (a) the importance of communication; (b) the barriers to effective communication; (c) the supports needed for effective communication; and (d) recommendations for improving the effectiveness of communication between nurses and patients with CCN. Augmentative and alternative communication (AAC) strategies that can be used by nurses to facilitate more effective communication with patients with CCN are discussed. BACKGROUND Effective nurse-patient communication is critical to efficient care provision. Difficulties in communication between nurses and patients arise when patients are unable to speak. This problem is further complicated because nurses typically receive little or no training in how to use AAC to communicate with patients with CCN. DESIGN Systematic review. METHOD This paper reviewed the published research focusing on the perspectives of nurses, patients with CCN and their caregivers regarding the challenges to effective communication between nurses and patients with CCN. Further, specific strategies (i.e., using AAC) that nurses can use to improve and facilitate communication with patients with CCN are provided. CONCLUSIONS Communication between nurses and patients is critical to providing and receiving quality care. Nurses and patients have reported concern and frustration when communication is not adequate. Using AAC strategies will help nurses and patients better communicate with each other when speech is not an option. RELEVANCE TO CLINICAL PRACTICE Communication with all patients is very important to the provision of quality nursing care. Communication cannot always be achieved using the speech modality. Nurses need to have tools and skills that will allow them to communicate with all of their patients whether or not they can speak.

“All Children Can and Should Have the Opportunity to Learn”: General Education Teachers' Perspectives on Including Children with Autism Spectrum Disorder who Require AAC

A qualitative online focus group methodology was used to investigate the experiences of five elementary school teachers (grades K-5) who had included in their general education classrooms children with autism spectrum disorders (ASD) who required augmentative and alternative communication (AAC). Information was obtained from the participants in the following areas: (a) the benefits of educational inclusion, (b) the negative impacts of educational inclusion, (c) the challenges of educational inclusion, (d) the supports for educational inclusion, and (e) recommendations for other teachers and individuals involved in the inclusion process. Participants primarily chose to focus on inclusion as a beneficial practice for all involved, but did describe a few barriers and challenges of inclusion. The results are discussed as they relate to these themes and with reference to published literature. Recommendations for future directions are also presented.

Perceptions of Communication Style and Influences on Intervention Practices for Young Children with AAC Needs

The current study was designed to determine whether SLP perceptions of communication style (passive or active) affect their intervention planning and decision making for young children who require augmentative and alternative communication (AAC). A second goal was to determine whether SLPs who work with young children who use AAC target goals in intervention that promote and/or maintain an active communication style. An original survey was designed for the study. The SLP participants were asked to provide information about the design of AAC systems and the communicative opportunities made available to young children with AAC needs. Participants were recruited through email and were asked to respond to a Web-based survey. Eighty-nine preschool SLPs practicing in 20 states across the United States responded to the survey. Results indicated that many of the SLPs classified young children with AAC needs they have worked with as passive communicators. Furthermore, the SLPs reported differences in their intervention practices for children with AAC needs whom they considered active and passive communicators. The return rate for participants was small, and it is difficult to generalize the results. However, it appears that more emphasis needs to be placed on providing interventions that target communication skills that young children who use AAC need in order to be active communicators and to participate fully in their natural contexts.

Friendship: Operationalizing the Intangible to Improve Friendship-Based Outcomes for Individuals With Autism Spectrum Disorder

Purpose Individuals with autism spectrum disorder (ASD) have social deficits that affect making and maintaining friends. Many empirically tested methods to address these social deficits are available, yet difficulties related to the establishment and maintenance of authentic friendships persist. Method This viewpoint article (a) briefly reviews the current state of the science relative to social and friendship skills training for individuals with ASD, (b) considers the potential links (or lack thereof) between current social and friendship skill interventions for individuals with ASD and outcomes related to making and maintaining friends, (c) examines how friendship-related outcomes might be maximized, and (d) proposes a framework for intervention planning that may promote these valued outcomes. Results There are several key concepts to consider in planning intervention targeting friendship as an outcome. These concepts include (a) equal status, (b) mutually motivating and authentic opportunities for interaction, and (c) frequent opportunities for interaction. Conclusions There are many aspects about friendship development that cannot be controlled or contrived. Much is still to be learned about the achievement of better friendships for individuals with ASD. Reconceptualizing the way we design intervention may promote better outcomes for individuals on the autism spectrum.

Decision Making of Parents of Children with Autism Spectrum Disorder Concerning Augmentative and Alternative Communication in Hungary.

A qualitative interview methodology was used to investigate the perspectives of 10 Hungarian parents of children with autism spectrum disorder (ASD) concerning their decision-making processes undertaken to make communication intervention decisions for their children. Six themes were identified from the data: (a) sources of information, (b) interventions to support communication, (c) intervention outcomes, (d) reasons for adding or discontinuing interventions, (e) desired interventions, and (f) decision-making processes. Parents in Hungary used a variety of sources to find information about communication interventions and had differing expectations of these interventions. They expressed a variety of reasons for adding or discontinuing communication interventions. Additional results are discussed as they relate to the themes and with reference to published literature. Limitations to this research are presented, and several priorities for further research directions are offered.

Effects of a Least-to-Most Prompting Procedure on Multisymbol Message Production in Children With Autism Spectrum Disorder Who Use Augmentative and Alternative Communication

Purpose In this study, we investigated the efficacy of a least-to-most (LTM) prompting procedure (Ault & Griffen, 2013; MacDuff, Krantz, & McClannahan, 2001; Neitzel & Wolery, 2009) for increasing use of multisymbol messages in school-age children with autism spectrum disorder (ASD) who use augmentative and alternative communication (AAC) during a storybook reading activity. Method In the study, we used a single-subject, multiple-probe research design across participants (Kazdin, 1982) with 6 children (ages 8-12) with ASD and who used AAC systems for communication. There were 4 phases in this investigation: (a) baseline, (b) intervention, (c) generalization, and (d) maintenance. Results All participants exhibited a positive increase in multisymbol message production almost immediately upon introduction of the LTM prompting procedure. Conclusions The results of the investigation contribute important information on the efficacy of the LTM prompting procedure for teaching use of multisymbol messages to school-age children with ASD who use AAC.

Parental Intention to Support Video Game Play by Children With Autism Spectrum Disorder: An Application of the Theory of Planned Behavior

PURPOSE The purpose of this study was to determine parental attitudes regarding engagement with video games by their children with autism spectrum disorder (ASD) and whether attitudes vary based on ASD symptom severity. METHOD Online survey methodology was used to gather information from parents of children with ASD between the ages of 8 and 12 years. The finalized data set included 152 cases. Descriptive statistics and frequency analyses were used to examine participant demographics and video game play. Descriptive and inferential statistics were used to evaluate questions on the theory of planned behavior. Regression analyses determined the predictive ability of the theory of planned behavior constructs, and t tests provided additional descriptive information about between-group differences. RESULTS Children with ASD play video games. There are no significant differences in the time, intensity, or types of games played based on severity of ASD symptoms (mild vs. moderate). Parents of children with ASD had positive attitudes about video game play. CONCLUSIONS Parents of children with ASD appear to support video game play. On average, parents indicated video game play was positive for their children with ASD, particularly if they believed the games were having a positive impact on their childs development.

The Experience of Military Families with Children with Autism Spectrum Disorders During Relocation and Separation

Military families with a child with autism spectrum disorder (ASD) are underrepresented in the literature. In order to provide appropriate services, research must be done to determine the needs of these families. A qualitative methodology was used to interview military spouses with children with ASD about their experiences with therapeutic services. Overall, results indicate military families with a child with ASD experience challenges associated with both the military lifestyle and having a child with special needs. Due to their membership in two groups prone to support limitations and therapeutic service accessibility issues, military families with a child with ASD may be at additional risk for high levels of stress and difficulty obtaining and maintaining ASD related services.

Intelligibility of children's speech in digitized speech

The current investigation examined the intelligibility of digitized speech recorded from typically developing child speakers, ages 4, 5, 6, and 7 years, and reproduced on an augmentative and alternative communication (AAC) device with digitized speech output. The study used a between group design. Forty adults were asked to transcribe 120 words spoken by child speakers in one of the age groups, and presented on an AAC device with digitized speech output. The dependent variable was intelligibility (percent of words correctly identified) of the children’s speech. Overall, the intelligibility of children’s speech increases with the age of the child speaker. However, there was a lot of individual variation in the intelligibility of children’s voices. There was no clear cut-off age, although the speech of some young children may not be sufficiently intelligible on an AAC device that uses digitized speech. Clinicians and parents choosing child speakers for AAC devices with digitized speech are cautioned to carefully consider the speakers used for recording digitized speech output and the characteristics of the speech of the individual speaker. Future research directions are discussed.

Social Referencing Gaze Behavior During a Videogame Task: Eye Tracking Evidence from Children With and Without ASD

The purpose of this study was to understand the social referencing behaviors of children with and without autism spectrum disorder (ASD) while visually attending to a videogame stimulus depicting both the face of the videogame player and the videogame play action. Videogames appear to offer a uniquely well-suited environment for the emergence of friendships, but it is not known if children with and without ASD attend to and play videogames similarly. Eyetracking technology was used to investigate visual attention of participants matched based on chronological age. Parametric and nonparametric statistical analyses were used and results indicated the groups did not differ on percentage of time spent visually attending to any of the areas of interest, with one possible exception.