Kathryn D. R. Drager

AAC technologies for young children with complex communication needs: State of the science and future research directions

Augmentative and alternative communication (AAC) technologies offer the potential to provide children who have complex communication needs with access to the magic and power of communication. This paper is intended to (a) summarize the research related to AAC technologies for young children who have complex communication needs; and (b) define priorities for future research to improve AAC technologies and interventions for children with complex communication needs. With the realization of improved AAC technologies, young children with complex communication needs will have better tools to maximize their development of communication, language, and literacy skills, and attain their full potential.

Performance of Typically Developing Four- and Five-Year-Old Children with AAC Systems using Different Language Organization Techniques

In this paper, the results of two studies designed to investigate the learning demands of four different approaches to the layout and organization of language in electronic augmentative and alternative communication (AAC) systems are presented: taxonomic grid, schematic grid, schematic scene, and iconic encoding techniques. A total of 80 typically developing children participated in the two studies: 40 four-year-olds (Study 1) and 40 five-year-olds (Study 2). Ten children in each study were randomly assigned to each of the four system organization conditions. The children were introduced to target vocabulary items (24 items for the 4-year-olds and 30 for the 5-year-olds) in a series of four learning and testing sessions. Half of the vocabulary items were concrete concepts and half were abstract concepts. Results of the studies indicated that the 4-year-old and 5-year-old children were more accurate locating target vocabulary in the three dynamic display conditions (taxonomic grid, schematic grid, schematic scene) than in the iconic encoding condition. On initial exposure to the systems, the iconic encoding technique was not at all transparent to the children; the other three systems were only moderately transparent. All but one of the 4-year-old children and all of the 5-year-old children demonstrated gains in accuracy across the learning sessions; gains were significantly greater for the three dynamic display conditions than for the iconic encoding condition. The children were more accurate with the concrete vocabulary items than the abstract ones. There was some, albeit limited, evidence that the children generalized to facilitate learning of novel vocabulary items. Results are discussed with reference to the literature. Implications for practice and directions for future research are also discussed.

Considerations for the Composition of Visual Scene Displays: Potential Contributions of Information from Visual and Cognitive Sciences

Aided augmentative and alternative (AAC) interventions have been demonstrated to facilitate a variety of communication outcomes in persons with intellectual disabilities. Most aided AAC systems rely on a visual modality. When the medium for communication is visual, it seems likely that the effectiveness of intervention depends in part on the effectiveness and efficiency with which the information presented in the display can be perceived, identified, and extracted by communicators and their partners. Understanding of visual-cognitive processing – that is, how a user attends, perceives, and makes sense of the visual information on the display – therefore seems critical to designing effective aided AAC interventions. In this Forum Note, we discuss characteristics of one particular type of aided AAC display, that is, Visual Scene Displays (VSDs) as they may relate to user visual and cognitive processing. We consider three specific ways in which bodies of knowledge drawn from the visual cognitive sciences may be relevant to the composition of VSDs, with the understanding the direct research with children with complex communication needs is necessary to verify or refute our speculations.

Enhancing the Appeal of AAC Technologies for Young Children: Lessons from the Toy Manufacturers

If augmentative and alternative communication (AAC) systems are highly appealing, they may be more likely to be used by children with complex communication needs, may enhance self-esteem, and may facilitate interactions with other children. To date, there has been little attention to design features that might increase the appeal of AAC systems. Reported in this paper is an exploratory study that compared features of AAC technology with those of popular toys for young children, with a view to identifying potential designs that might improve the appeal of the AAC systems. The toys and AAC systems were systematically analyzed with respect to the following features: color, materials, shape, size, weight, movement or action, sound or voices, lights, and themes. Results indicated that there are significant contrasts between the design features of popular toys and those of AAC systems. These differences are discussed with suggestions for potential design modifications for AAC technologies to increase their appeal.

“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.

Re-designing scanning to reduce learning demands: The performance of typically developing 2-year-olds

Children with severe motor impairments who cannot use direct selection are typically introduced to scanning as a means of accessing assistive technology. Unfortunately, it is difficult for young children to learn to scan because the design of current scanning techniques does not always make explicit the offer of items from the selection array; furthermore, it does not provide explicit feedback after activation of the switch to select the target item. In the current study, scanning was redesigned to reduce learning demands by making both the offer of items and the feedback upon selection more explicit through the use of animation realized through HTML and speech output with appropriate intonation. Twenty typically developing 2-year-olds without disabilities were randomly assigned to use either traditional scanning or enhanced scanning to select target items from an array of three items. The 2-year-olds did not learn to use traditional scanning across three sessions. Their performance in Session 3 did not differ from that in Session 1; they did not exceed chance levels of accuracy in either session (mean accuracy of 20% for Sessions 1 and 3). In contrast, the children in the enhanced scanning condition demonstrated improvements in accuracy across the three 10 – 20-min sessions (mean accuracies of 22 and 48% for Sessions 1 and 3, respectively). There were no reliable differences between the childrens performances with the two scanning techniques for Session 1; however, by Session 3, the children were more than twice as accurate using the enhanced scanning technique compared to the traditional design. Results suggest that by redesigning scanning, we may be able to reduce some of the learning demands and thereby reduce some of the instructional time required for children to attain mastery. Clinical implications, limitations, and directions for future research and development are discussed.

Effects of AAC interventions on communication and language for young children with complex communication needs

Children with complex communication needs (CCN) who require augmentative and alternative communication (AAC) are at considerable risk in many aspects of their development: (a) functional communication skills, (b) speech development, (c) language development, (d) cognitive/conceptual development, (e) literacy development, (f) social participation, (g) access to education, and (h) overall quality of life. Early intervention is critical to address these areas and provide successful and functional outcomes. AAC offers the potential to enhance communication, language, and learning for children with significant communication disabilities. This paper provides an overview of the effects of AAC interventions on communication, behavior, language, and speech outcomes for young children with CCN for pediatricians and other medical and rehabilitation professionals. Future research directions to maximize the communication development of young children with CCN are also discussed.

Comparison of correct responses and response latency for fixed and dynamic displays: performance of a learner with severe developmental disabilities

The relative efficiency of three types of graphic symbol displays was examined for an experienced augmentative system user. The learner matched photographs to symbols in displays that included fixed (all symbols appearing on one page), dynamic active (each symbol on one page electronically linked to a second page), and dynamic passive (two pages of symbols linked by a “go to” symbol). Accuracy and response time were measures used to determine if one type of symbol display was easier to learn and/or use than another. Response time was the fastest and accuracy was the greatest for the fixed and dynamic active display types. Differences between the three display types became more apparent after the addition of distractor symbols. The limitations of the findings of this single participant investigation are discussed along with implications for future research.

Operational Demands of AAC Mobile Technology Applications on Programming Vocabulary and Engagement During Professional and Child Interactions

ABSTRACT Typically, the vocabulary in augmentative and alternative communication (AAC) technologies is pre-programmed by manufacturers or by parents and professionals outside of daily interactions. Because vocabulary needs are difficult to predict, young children who use aided AAC often do not have access to vocabulary concepts as the need and interest arises in their daily interactions, limiting their vocabulary acquisition and use. Ideally, parents and professionals would be able to add vocabulary to AAC technologies “just-in-time” as required during daily interactions. This study compared the effects of two AAC applications for mobile technologies: GoTalk Now (which required more programming steps) and EasyVSD (which required fewer programming steps) on the number of visual scene displays (VSDs) and hotspots created in 10-min interactions between eight professionals and preschool-aged children with typical development. The results indicated that, although all of the professionals were able to create VSDs and add vocabulary during interactions with the children, they created more VSDs and hotspots with the app with fewer programming steps than with the one with more steps, and child engagement and programming participation levels were high with both apps, but higher levels for both variables were observed with the app with fewer programming steps than with the one with more steps. These results suggest that apps with fewer programming steps may reduce operational demands and better support professionals to (a) respond to the child’s input, (b) use just-in-time programming during interactions, (c) provide access to more vocabulary, and (d) increase participation.

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.