Running Head: AUGMENTATIVE AND ALTERNATE COMMUNICATION FOR AUTISM Augmentative and Alternate Communication for Autism Jennifer A. McIntyre Widener University Introduction This literature review is to help educators review research on assistive technology andA\how it relates to the lives of students who have disabilities. The focus of this literature review is to explore what AAC is, how it benefits students who have autism, and current research on AAC .
Autism is a spectrum disorder, meaning that there is a large range of people who fall into different parts of the spectrum (from high functioning all the way to low functioning).
Some people on the autism spectrum have limited or no verbal ability to communicate. Assistive technology has opened that dark doors and sheds light on the ability for these people to share their knowledge, thoughts, beliefs, values, etc. with the world.
Assistive technology is any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.
Assistive technology service is directly assisting an individual with a disability in the selection, acquisition, or use of an assistive technology device (P. L. 100-407, Sec. 3 1988).
Autism, a lifelong disability, is a spectrum disorder that is identified in the Individuals with Disabilities Education Act (IDEA, 2004) as a developmental disability significantly affecting verbal and nonverbal communication and social interaction, usually evident before age 3 that adversely affects a child’s educational performance. Other characteristics often associated with ASD are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.
The term does not apply if a child’s educational performance is adversely affected because the child has an emotional disturbance. Autism is also identified in the Diagnostic and Statistical Manual of Mental Disorders, DSM- IV (APA, 1994) as a pervasive developmental disorder characterized by perceptual, cognitive, and social differences. The DSM-IV classified Autism as a disorder within a broader group of pervasive developmental disorder (PDD) which includes Autism, Childhood Disintegrated Disorder (CDD), Rett’s Disorder, Asperger’s Disorder, and Pervasive Developmental Discover Not Otherwise Specified (PDD-NOS).
Practitioners and education professionals frequently use the term Autism Spectrum Disorder (ASD) when referring to any or all of these disorders. Most parents of children with autism first begin to be concerned that something is not quite right in their child’s development because of early delays or regressions in the development of speech (Short & Schopler, 1988).
Problems with communication, in terms of both understanding and expression, are often said to be one of the main causes of the severe behavior problems that are common among persons with severe autism and mental retardation (Carr et al. , 1999). The lack of meaningful, spontaneous speech by age five has been associated with poor adult outcomes (Billstedt, 2007; Billstedt, Gillberg, & Gillberg, 2005; Howlin, Goode, Hutton, & Rutter, 2004; Shea & Mesibov, 2005). Certainly, communication and communication problems are at the heart of what ASD is all about.
Broadly speaking, a diagnosis or referral for assessment for autism is made when an individual possess characteristics in these three areas: qualitative impairment in social interaction, qualitative impairments in communication, and restrictive, repetitive, and stereotyped patterns of behavior in interests and activities (Haq, Countuer 2004; Ozonoff, South, & Miller, 2000). While all people who have autism have various forms of communication and language difficulties, there is a considerable range among individuals who have this diagnosis.
According to the United States Department of Health and Human Services, “The word “autism” has its origin in the Greek word “Self”. Children who have autism are often self-absorbed and seem to exist in a private world, where they are unable to successfully communicate and interact with others” (2011). Children who have autism may have difficulty developing language skills and understanding what others say to them. They also have difficulty communicating non-verbally, such as through hand gestures, eye contact, and acial expression. Not every child with Autism Spectrum Disorder will have a language problem. A child’s ability to communicate will depend on his or her intellectual social development. Some children who have Autism Spectrum Disorder may be unable to speak. Others may have rich vocabularies and will be able to talk about topics in great detail. Most children who have ASD have little or no problem pronouncing words. However, the majority has difficulty using language effectively (U. S. Department of Health and Human Services, 2011).
Approximately 50% of individuals with autism do not develop functional language and many of those exhibit abnormalities in usage (Scott, Clack, and Bradley, 2000). From these findings, it is evident that communication interventions are crucial concepts that should be involved in any program, while working with students who have Autism Spectrum Disorder. A large majority of these candidates would be eligible to use assistive technology such as augmentative and alternative communication systems (AAC).
Augmentative and alternative communication systems will either supplement the candidates existing speech or be their primary means of communication (Mirenda, 2003). What is Augmentative and Alternative Communication (AAC)? The American Speech-Language-Hearing Association defines AAC as an area of clinical practice that attempts to compensate (either temporarily or permanently) for the impairment and disability patterns of individuals with severe expressive communication disorders (i. e. , the severe impairments in speech-language, reading and writing).
AAC incorporates the individual’s full communication abilities and may include any existing speech or vocalizations, gestures, manual signs, and aided communication. AAC is truly multimodal, permitting individuals to use every mode possible to communicate. The ability to use AAC devices may change over time, although sometimes very slowly, and the AAC system chosen today may not be the best system tomorrow. In any case, an AAC system is an integrated group of four components used by an individual to enhance communication.
These four components are symbols, aids, techniques, and/or strategies (Heller, 2004; Turnbell 2005). “There are 2 main types of AAC systems: unaided and aided. Unaided AAC systems include pointing, facial gestures, sign language, eye gaze and gestures. We all use these methods of communication everyday but people who have difficulty communicating rely more heavily on these forms. ” (Koegel 2010). Aided AAC consists of additional types of equipment that assist the person in communication. This equipment can range from no technology to high technology.
A form of no tech can be a communication board/book that consists of pictures, symbols, words, letters or numbers. A person who uses a communication board/book points to or looks at the desired picture, word etc. to express their wants/needs.? ?A form of low tech can be simple switches, such as a One Step, Step by Step, Tech/Talk etc. The communicator touches the switch with their hand or a part of the body that can easily access the switch. Once activated the low tech device then speaks what it has been programmed to say.? A high tech device such as DynaVox, Mercury etc. is designed with synthetic speech output and can look similar to a laptop computer. These devices allow people to communicate and have conversations with others. They are programmed with pictures, symbols, letters, words, phrases and can be accessed with the method that is best for the communicator (direct select, scanning, head mouse, joystick etc. ) (Koegel, 2010). Traditionally, AAC interventions for people with autism have focused on the use of unaided communication (e. g. gestures and signs).
However, since many individuals with ASD experience difficulty generating spontaneous communication, combining signs to communicate more complex information, and communicating with those who don’t know signs, aided communication is being explored more for this population. While unaided communication systems may be more portable, aided systems offer some advantages specifically for people with autism because they are intelligible to a wide range of partners and they play to the visual-spatial strength by using pictures or symbols (Beck, 2002). History
Believe it or not, AAC origins have been traced back to the ancient Greek and Roman times. They mainly used a manual alphabet and would have the individuals point to the letters one by one to form words. The most commonly recorded people that this form of communication was used on were the deaf and the mute. History and old drawings have shown that the Native Americans also used this form of communication as an alternate for people in their tribes that could not speak (Buekelman & Miranda, 2002, pg-30-32). A French physician who worked in a hospital in the 1920’s invented the first formal communication board. He needed a way to ommunicate with his patients to see what kind of pain they were in, if they had any questions, how they were feelings, etc. He came up with a chart that displayed smiley faces ranked from 1 to 10 of pain. He also invented a communication board that had letters and words on it, so that the patients could point to letters and words to express their feelings and communicate. This communication board was later adapted into the field of special education, which has recently significantly incorporated more and more assistive technology, like communication boards into the field within the last decade (Tezchner & Martinsen, 2000, 9. 5). These low-tech communication boards have increased to high tech communication boards today; both are commonly used for people who have autism to help them communicate. Research Benefits of Augmentative and Alternative Communication Systems Typically developing children attain speech and language skills early in development. These skills allow social interaction, conceptual development, expression of needs and wants, and see the later progress of language and literacy skills (Light & Drager, 2000).
In school aged children with severe communication impairments, like autism, who had shown no advancement in their communication within the last two years, longitudinal studies have demonstrated that the use of Augmentative and Alternative Communication systems improved both communication and vocabulary in student participants (Seviek, Romski, & Adamonson, 1999). Similarly, the “rich multimodal means of communication enabled their participants to both successfully and effectively communicate with adults” (Seviek, Romski, & Adamonson, 1999).
Their increased vocabulary enabled participants to engage with a different circle of communication partners, which in turn had potential to extend their vocabulary and communication competence. These communication systems give students who have autism the ability to feel like their voice is being heard, which increases self-esteem and self-worth. (Seviek, Romski, & Adamonson, 1999). Their research also involved 15 early childhood students who had autism. Seviek, Romeski, & Adamonson, followed these students for 15 years through their educational journeys in all inclusive classroom settings.
All of these students used some form of Augmentative or Alternative Communication Systems (ACC). Over half of the participants and their families reported parental satisfaction with the level of inclusion of the child with ASD, and with his or her classmates. One general education teacher wrote, “the other students will often work together and include the child with autism; they may share ideas, or sometimes even discuss things off topic while they are working. I find this allows the students to build friendships in the classroom” (Miller et al. , 1991).
These participants also felt that increased opportunities for social interaction with typically developing peers provided positive role models and examples for appropriate classroom behavior. One non-verbal student in a general education classroom was given a Dynavox and other general education students helped him program it. The teachers also enjoyed watching their students with ASD grow socially. Only four participants complained of noises that disrupted their non-disabled students in the classroom (Miller et al. , 1991). Incorporating AAC in the Classroom and Home Setting
The selection of a particular AAC system for a specific child is best made through a collaborative team decision-making process. The team actively involves family members and typically includes teachers, childcare providers, administrators, AAC technicians, physicians, and speech and language, occupational, and physical therapists (Blackstone & Hunt Berg, 2003). To begin the process of obtaining an AAC device, the individual must receive a communication assessment. Since communication devices come in so many different shapes and sizes and offer so many functions, receiving a proper evaluation is essential prior to selecting a device.
Licensed Speech Language Pathologists, Assistive Technology Specialists, or Rehabilitation Engineers that are experienced in AAC perform these assessments. During the assessment, the therapist will try different communication devices with a patient and will also evaluate other important factors such as hearing, eyesight, and motor function. The goal of the evaluation is to match a device to the person’s wants, needs, and capabilities. (Blackstone & Hunt Berg, 2003). Light, Beukelman, and Reichle (2003) identified four areas of competence that are required for effective use of AAC and an alternative mode of communication. Linguistic competence refers to the degree of receptive and expressive language development and knowledge of the linguistic code that is intended for use on the AAC system. Use of an alphabet board, in which the AAC user spells out words and sentences by pointing to individuals letters in sequence, for example, requires a higher level of linguistic competence that selecting line drawings (e. g. , a line drawing of a cookie) to communicate basic wants and needs. Operational competence refers to the skills required to use the AAC system or device.
Social competence refers to social skills that are involved in communication, such as skills in initiating, maintaining, and terminating communicative interactions in a socially, culturally, and contextually appropriate manner. Strategic competence refers to special skills that are unique to AAC-based communication, such as the ability to gain the listener’s attention prior to selecting a symbol on a communication board, adjusting the rate of symbol selection to the listener’s speech of comprehension, and repairing communicative breakdowns by combining gestures with graphic-mode communication. ”
Language intervention programs are most effective when they take place in the child’s natural language-learning settings (for example, in the home, school, or community) and when the child’s family is actively involved (Wetherby & Prizant 1996; National Research Council 2001). Most parents and child care providers who have had little or no experience with AAC systems need professional guidance—usually from a speech therapist—to begin using a system. Soon they become competent and creative in the use and continued development of the system. When using AAC systems at home, it is critical that families maintain their typical routines.
The professional can help families incorporate the systems into their usual activities. ACC systems can also be adapted and grow with the child (i. e. : more words can be added, voice speaker can be activated, etc. ) (Wetherby & Prizant 1996; National Research Council 2001). Efficacy of Research Koegeal (2010) in summarizing recent study findings, reported that current research shows that non- or minimally-verbal students with autism can increase their verbal imitation, word production, and spontaneous utterances if intervention programs are begun early (before age 5) with communication oards/ assistive technology (p. 72). Koegeal (2010) also mentions, AAC systems have been employed with individuals with autism across several decades. However, as in other domains of behavioral intervention, relatively few studies of treatment efficacy have been performed. In the majority of published investigations, the number of participants has been small, and the treatment group has typically comprised individuals with severe disabilities, only some of whom fall within the diagnostic category of autism. ” (p. 139).
Summarizing all the research on communication boards, there have been many single studies collected, however; none have been large enough to get solid data from. The research gap found by Koegeal is also noted by Olgetree & Harn (2001). Ogletree & Harn (2001) noted that, “although AAC has found its way into various communication interventions for persons with autism, the dearth of literature specific to this application is astounding” (p. 138). Some individuals benefit from communication boards that have autism, while others do not.
However, the teachers, families, and other professionals who have been able to communicate with individuals who have autism (through communication boards) have unlocked the isolation that autism causes and have found the ability to communicate with these individuals who may have been written off as unintelligent or never had an outlet to communicate and display their thoughts, feelings, attitudes, knowledge, etc. AAC “Myths” Many people are under the impression that AAC either stops or hinders further speech development.
Parents have the reasonable fear that AAC systems will unmotivate their child’s willingness to want to speak and further gain social skills. However, literature suggests the opposite of parents, teachers, and practitioners fears. Miller et al. , (1991), for example, reported that manual signs had been taught to 80% of the 46 young children with Autism (mean chronological age 3 years, 11 months) that they surveyed. The families of these children also reported that they discontinued the use of the manual signs when the child began talking or when the child’s speech became easier to understand. Miller et al. 1991, also reported that when sign vocabularies were included, the initial vocabularies of a group of children with autism were not significantly different from those of mental-age–matched typically developing children. Conclusion: Overall, the field of Augmentative and Alternative Communication Systems for autism is fairly new. However, the field is rapidly growing and more and more research is being conducted each year, due to interest in functional communication. Wilkinson and Henning (2007) highlighted several recent technological advances in the field that aim to expand access to AAC.
One such advance involves the development of scanning strategies that aim to maximize the ability of individuals to access AAC symbols on aided devices, such as a electronic communication board with synthesized speech output. The different requirements associated with accessing fixed (display does not change into another display unless the overlay is removed) versus dynamic displays (e. g. , the selection of the “apple” symbol opens up the fruits or food display) continues to receive empirical attention and is bound to result in greater understanding which displays are appropriate for what kinds of user characteristics.
Further research also indicated that the field of assistive technology is rapidly expanding and what our society believes in “high-tech” today, will be the “low-teach of tomorrow. While AAC is intended to enable communication in the absence of speech, the effects of various AAC systems for the user and his/her communication partners is an under-researched area. There is however, a growing interest on the effects of AAC-based communication of the behavior of communicative partners, particularly with respect to identifying partner behaviors that may facilitate communicative interactions involving people who use AAC (Aston, n. . ). The progression in the field of assistive technology shows that many great advances are still yet to be made. This means that students who have autism will have more opportunities to express their feelings, thoughts, ideas, opinions, etc. with the world and expand their fully into the environment. References American Psychiatric Association (1994). Diagnostic and statistical manual for mental disorders (4th ed). Washington, DC: Author. Aston, M. T. , (n. d). Measuring the effect of explicit modeling toiIncrease of mean length of utterances of augmentative alternative communication.
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