Augmentative and Alternative Communication’s Usage

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Abstract

This paper pertains to the topic of the use of augmentative and alternative communication (AAC) while providing special education interventions for children with disabilities in their early childhood. After supplying background information on special education, AAC, and the utilization of AAC in special education, a systematic literature review is conducted to find out which types of AAC can improve the quality of such interventions. Also, common themes (communication; AAC; teacher/parent training; and autism) were identified in the articles. It was discovered that nearly all AAC tools mentioned in the articles lead to improvements in children’s communication.

It is crucial to enhance the effectiveness of special education interventions for kids with disabilities during their early childhood to compensate for the developmental delays resulting from their impairments (Edyburn, Higgins, & Boone, 2005).

One way to do so is the use of innovative technologies for extensive utilization of augmentative and alternative communication (AAC). After providing some background on special education in early childhood, AAC, and the use of AAC in such education, this paper supplies the results of a systematic literature review and themes analysis conducted to find out what types of AAC can be used to enhance the effectiveness of special education interventions for kids in their early childhood. Based on these findings, recommendations are provided. Also, a discussion of the limitations of the study and its practical implications follows.

Background: Special Education in Early Childhood

Early childhood (that is, the period of one’s life when one is approximately 0 through 6 years old) is a period during which a person learns an immense amount of knowledge and skills which are necessary for adequate interaction with the surrounding world (Edyburn et al., 2005).

Disabilities and developmental delays experienced in this period mean that the child does not learn these skills properly, which had a considerable adverse impact on his or her further development – a lag, which, in most cases, is virtually impossible to compensate (Edyburn et al., 2005). For instance, children who are deaf or hard of hearing may not develop appropriate language skills, due to their inability to hear the communication of other people, at the age when typically developing children do so; as a result, their linguistic skills may remain impaired for their whole life (Lederberg, Schick, & Spencer, 2013).

Consequently, it is clear that detecting impairments and developmental delays in as early age as possible, and subsequently addressing them, is of paramount importance if the adverse impact of these impairments on the future life of the child is to be minimized (Boyd, Odom, Humphreys, & Sam, 2010; Edyburn et al., 2005). Also, it is pivotal to enhance the effectiveness of special education interventions aimed at addressing the negative effects of the impairments to better mitigate these effects.

Background: Augmentative and Alternative Communication (AAC)

It is stated that the term “augmentative and alternative communication,” commonly abbreviated as AAC, is utilized to refer to all the forms of communication, apart from oral speech, which can be employed to express one’s thoughts, desires, needs, and ideas (American Speech-Language-Hearing Association [ASLHA], n.d.). Therefore, the use of gestures, pictures, symbols, or writing with the purpose of communication with other individuals is all examples of AAC.

On the whole, AAC may provide a vast amount of opportunities to better communicate with other people. It should be pointed out that AAC is especially important in early childhood; even typically developing children who do not yet know how to speak need to be provided with AAC input to develop their language skills (Light & McNaughton, 2012b; Ruppar, Dymond, & Gaffney, 2011). Also, AAC is particularly useful for individuals who suffer from problems with their speech and language; these persons often rely on a wide array of AAC types to compensate for their lack of oral/verbal capabilities (ASLHA, n.d.).

Furthermore, it should be highlighted that the development of innovative technologies provides even more opportunities to use AAC, and people who have problems with language development are the group who may gain particularly strong benefits from these technologies and devices (Baxter, Enderby, Evans, & Judge, 2012). It is also clear that the implementation of such devices in special education can be particularly useful as well (Light & McNaughton, 2012b).

Using Assistive Technology and AAC in Early Childhood Services

From what has been said above, it should be clear that AAC is pivotal in the field of special education. There exist several reasons for this. Children who do have not yet learned their language skills need to be provided with AAC input to enable the development of these skills (Light & McNaughton, 2012b). Also, AAC allows for using a wide range of stimuli for engaging children in communication (for instance, children may react well to the body language of individuals, colorful images, and so on), which is important if their communication skills are to be developed (Light & McNaughton, 2012a).

In this respect, it is important to point out that innovative technologies provide an opportunity to use a wider array of AAC stimuli while interacting with children, including kids with disabilities and developmental problems (Baxter et al., 2012). Furthermore, the interactive interfaces of the modern technological devices may be able to cause a greater amount of interest in young children, consequently stimulating them to further engage in the perception of such stimuli, and, probably, in additional interaction with others (Light & McNaughton, 2012a). Because of these and many other reasons, it should be useful to employ assistive technologies to enhance the effectiveness of special education intervention provided for kids with impairments and developmental delays in their early childhood.

Purpose of the Study and Research Question

Therefore, the purpose of this paper is to investigate the use of AAC in early interventions in special education for individuals in their early childhood which have been documented in the research literature. Consequently, the research question the answer to which will be sought throughout this paper will be as follows: “What types of augmentative and alternative communication (AAC) can increase the quality of early intervention programs in special education?”

It should also be stressed that the need for such a study is determined by the importance of enhancing the quality of early special education interventions for children with special educational needs to mitigate the adverse impact of their disabilities or developmental delays (which may be severe even despite the special education interventions, especially in cases when disabilities are serious) and enable these children to better develop their skills, more easily integrate into the community of their peers, and, eventually, attain better life outcomes.

Methods and Data Sources

To find the articles for this study, the Education Resources Information Center (ERIC) via the EBSCOhost database was used at first; later, ERIC was used via the ProQuest database; and, finally, Google Scholar was utilized. Such keywords as “Young children AND Early childhood AND Augmentative and alternative communication,” “Young children AND Early intervention AND Augmentative and alternative communication,” “Toddlers AND Early intervention AND Augmentative and alternative communication” were utilized for search.

A large number of articles were found, and several criteria were employed to select the articles for the study. Namely, only articles not older than 2007, peer-reviewed, and closely related to the topic of the current study were selected. On the other hand, the materials which were not peer-reviewed articles, were not closely related to the topic, or were of apparently low quality, were excluded. On the whole, 11 articles were chosen for the review.

The articles were analyzed to identify the purposes of the reported studies; their designs and methods; the investigated sample; the AAC devices which were utilized; the variables or measures employed in the studies; and the findings or conclusions of the articles. All of these are summarized in the table below. Also, the articles were coded to identify the main themes (Saldana, 2009), to find common themes in these studies; the summarized results of this process are also supplied below.

Synthesis of Findings

The table below provides a synthesis of the results of the systematic literature review on the given topic.

#	Article	Study Design and Method	Participants	Type of AAC Device	Variables / Measures	Summary of Findings
1	Bruns & Mogharreban, 2008	Quantitative, descriptive. The authors utilized a questionnaire to gather the data about the perceptions of teachers; descriptive (and not inferential) statistics were employed to analyze the data.	Teachers from the Head Start program in Illinois. 89 teachers from 13 Head Start centers (located in 19 sites) were interrogated.	In the current study, no AAC devices were used, because only teachers were questioned to obtain their opinions.	The dependent variables included the perceptions of teachers about a) including young children in Head Start programs; b) the skills the teachers would require for this; and c) the teachers’ training needs.	The study examined the perceptions of Head Start teachers regarding the skills and professional development needs they would require to serve children with disabilities at an early age. On the whole, teachers supported the inclusion of young children with disabilities in Head Start programs. Approximately 90% of the teachers were convinced they would be able to provide an appropriate classroom environment for all children; however, only 72% of teachers stated they had sufficient knowledge of individualized education programs (IEP) to implement them. Many teachers (30%) said they required training when it came to dealing with behavioral issues; 11% wanted assistance with handling and positioning young children with disabilities. Also, many teachers desired training on adapting learning materials and the classroom to disabled children; on strategies for communicating with such children; on the assessment of these kids; and on dealing with their behavioral issues.
2	Carr & Felce, 2007	Quantitative, experimental. A PECS intervention was provided for the control group for 15 hours over 3 weeks. Three classroom observations recorded interactions between teachers and children in the experimental group. In the control group, two observations were conducted. Also, the effects of maturation were controlled for.	Young children with autism, aged 3 through 7. The experimental group consisted of 24 children.	Picture Exchange Communication System (PECS)	The independent variable was the provision of PECS intervention (intervention / no intervention). The dependent variables measured the recorded amount of communication between the teacher and the children (total child-to-adult interactions; child-to-adult linguistic communicative initiations; child-to-adult initiations with the response from the adult; total adult-to-child initiations with the opportunity of response from the child; adult-to-child initiations with a chance for child response + response from the kid; total adult initiations with no opportunity for child response).	Both communicative initiations by children, as well as a dyadic interaction between the kids and the teachers, were statistically significantly greater in the experimental group.
3	Cress, Moskal, & Hoffmann, 2008	Quantitative, correlational. The data was obtained from a 5-year longitudinal study, in which the communicative development of kids was explored. Visits lasting 2-3 hours were given to children and parents in their homes to examine the communicative and cognitive development of the kids.	27 children (18 male and 9 female) aged 12-27 months (mean: 17.5 months) with expressive communication impairments related to cerebral palsy; congenital conditions; acquired injury of the brain or brain disease; or neuromotor conditions.	General parent behavior/directiveness was assessed.	The study explored the relationship between the dependent variable – parent behaviors (such as contingency and directiveness (non-contingent prescriptions of attention or action by parents towards their children which are not caused by the kid’s current focus of attention)), and the independent variable – the skills of children (language and motor skills) which are associated with their disabilities.	After analyzing the data, the only statistically significant correlation was found between the amount of parent physical directiveness and the motor scores of the kids (r =.44, p =.023). However, no statistically significant correlations were detected between the parents’ physical directiveness and the children’s language scores, or the parents’ verbal directiveness and any of the three scores of children (motor, receptive language, or expressive scores). The authors conclude that the parents generally do not increase their directiveness towards children if the latter have disabilities.
4	Douglas, McNaughton, & Light, 2013	A single-subject multiple-probe design. Paraeducators were provided with training on communication strategies with children who have complex communication needs (CCN) such as autism or developmental delay. They were measured thrice: at the baseline, training, and maintenance phases.	Three dyads: a) Alice (20 years) and Adam (64 months old at the beginning of the research; autism); b) Betty (aged 21) and Bella (48 months old at the beginning of the research; developmental delay in cognitive and motor skills); c) Carol (aged 53) and Caleb (66 months old at the beginning of the research; gross motor delay and a developmental disability; profound hearing loss in the left ear, and moderate hearing loss in the right ear).	Various communication methods were used on children by educators within the PoWR strategy: a) provide opportunities for communication; b) wait for the communication of the child; c) respond to the kid’s communication.	The independent variable was the online training for paraeducators. The independent variables included: 1) the number of communication opportunities supplied by paraeducators for children with CCN; 2) the number of communication acts carried out by children with CCN in the process of play; 3) the number of responses of paraeducators to children with CNN in the process of play.	After the educators took part in training, they were found to supply the kids with a larger number of proper communication opportunities while engaging in play with the children they were providing services for. The kids also displayed an increase in the number of communication acts which they carried out. Finally, the number of responses of paraeducators to the kids made in the process of play (such as comments about the behaviors of children) also went up.
5	Kent-Walsh, Binger, & Hasham, 2010	Two single-subject, multiple-probe-across-participants study designs were employed to assess the effectiveness of providing training on using AAC devices for parents. The sessions of parents providing interventions for their children were recorded and transcribed.	Six parents, each with one child with complex communication needs. The parents had a) African American and b) European American background.	The ImPAACT (Improving Partner Applications of Augmentative Communication Techniques) program was used. Aided AAC symbols (e.g., images with “hot spots” which generate verbal output when the child touches the spot), grid displays, gestures, etc. were employed.	The independent variable was the training on using AAC devices, which was supplied for parents. The dependent variables were: a) for parents: the percentage accuracy of the implementation of the interaction strategy – that is, the percentage of steps appropriately carried out was assessed; b) for children: the overall quantity of communicative turns (comments or questions pertaining either to the book or to the experiences of kids which were related to the book) made by children during each of the ten-minute sessions of story-reading.	The parents were able to comprehend the methods for using the AAC devices during sessions; all the mothers utilized the interaction strategies with minimal accuracy of 90%. The number of communicative turns carried out by kids increased considerably. For instance, the ratio of the number of turns during the baseline session to the number of turns during the first intervention varied from 1:3 to 1:15 in different children. On the whole, the parents were able to comprehend and implement the proposed intervention with a high degree of accuracy; the number of communicative turns made by children increased greatly when the intervention was implemented.
6	Lorah et al., 2013	In this research, an experimental design (an alternating treatment design with an initial baseline) was utilized. A picture exchange device and a speech-generating device were compared to find out which device would be preferred by children with autism.	Five boys of pre-school age who were diagnosed with autism. Mean age = 4.5 years.	A picture exchange device; an iPad-based speech-generating device (SGD).	The independent variable was the use of the device (the picture exchange device; the SGD). The dependent measure was the mastery of the device. More specifically, the number of prompted and independent minds by children was recorded, and the percentage of independent minds was calculated.	The results of the study indicate that children with autism may prefer different alternative communication modalities: four children preferred using the SGD, and one child gave preference to utilizing the picture exchange device (although the proportion of independent manding was greater for children employing the SGD). It is concluded that the modality preference of a given child should be determined via assessment procedures.
7	Nunes & Hanline, 2007	A multiple baseline design across routines involving play and provision of care was used. Four naturalistic teaching strategies were taught to mothers so that the latter would implement a picture communication system when carrying out some home routines.	One boy with mild to moderate autism, aged 4.6 years, and his mother.	A visual-graphic system, namely, several picture communication systems that were utilized in teaching strategies implemented the process of carrying out two typical routines at home.	The communication turns of the child (initiation of communication and response); his imitative responses; and the modes of his expression (i.e. gestures/ manual signs, verbal/vocal, or augmentative system) were examined as dependent measures. As for the mother, the use of caregiver-teaching methods while carrying out the routines was recorded.	As a result of the study, the mother used two caregiver strategies across two different routines after the treatment (training for the mother); as for the other two strategies, no consistent changes in their use were observed. As for the boy, an increase in the frequency of initiations of communication, as well as in the frequency of his responses, was observed after the treatment.
8	Rosa-Lugo & Kent-Walsh, 2008	A single-subject, multiple-baseline-across-subjects design.	Two Latino parents with their children who use augmentative and alternative communication. The children were aged: 6 years and 8 months; 6 years 10 months.	An instructional program for parents was employed to teach parents to utilize a targeted interaction strategy.	The independent variable utilized in this study was the parent instructional program. The primary dependent variables in this research were a) the utilization of the targeted interaction strategy by parents; b) the communicative turns made by kinds in the process of storybook reading.	As a result of the treatment, both parents were able to meet the criterion for appropriate implementation of the targeted interaction strategy in the process of storybook reading; also, evidence was found to confirm both the generalized and the maintained utilization of the strategy. As for the offspring, both of them displayed a considerable increase in the number of communicative turns that were made, as well as in the expression of novel semantic concepts.
9	Rowland, 2011	The study provides information about the Communication Matrix, a tool that was developed for assessing the expressive communication of kids who have severe or multiple disabilities. It is based on the literature. Also, some data gained from using the Communication Matrix as an online assessment tool is discussed.	There were no direct participants in the study. The author provides data about 4 children the information on whom was gained via the Communication Matrix, as well as data obtained from children aged 2.0 to 5.11, whose main diagnosis was either deafblindness (N = 207), or autism (N = 426), or Down’s syndrome (N = 110).	The study did not employ AAC devices. Instead, the components of the communication of children with disabilities were assessed.	The study only provides information on the Communication Matrix; no dependent or independent variables are considered in the study itself.	The Communication Matrix tool is described in great detail, and it is stated that despite several limitations, this tool may allow for adequately assessing the communication methods utilized by children with disabilities and impairments, and the level of communicational development of these kids.
10	Sandberg & Liliedahl, 2008	The study explored if the asymmetry in communication which is characteristic of individuals using AAC and their communication partners employing the natural speech would also exist among non-vocal kids in their early childhood and the parents of these children. The communication was videotaped in semi-structured circumstances; for all the dyads, the same circumstances and materials were employed to permit comparison. The research was qualitative; the recordings were coded and rated by researchers.	Three mother-child dyads (the kids were aged from 2;5 to 3;4 years, had the developmental age of nearly 18 months and suffered from dysarthria); and three comparison parent-child dyads who had a matched developmental age, as well as matched gender.	No specific AAC device was employed; the children were presented with materials, and their interaction with their parents was recorded.	The dependent measurement was the amount of interaction between the mother and the child.	On the whole, it was found that the differences in the amount of communication between the focus group and the control group were rather minor, although the mothers in the focus dyads were more active than the mothers who were parts of the control dyads. It is concluded that parents need support to be able to detect and properly respond to the minor communication signals displayed by their offspring to better prompt kids to participate in active interaction. Simultaneously, it is stressed that children should be provided with the means to participate in the communication.
11	Trembath, Balandin, Togher, & Stancliffe, 2009	A qualitative study with a multiple baseline design. Typically developing peers of children with autism were taught to utilize peer-mediated naturalistic teaching, with and without the assistance of a speech-generating device (SGD).	Six typically developing children were taught to utilize the naturalistic teaching method; the method was used on three classmates with autism. The participants were recruited from three different pre-schools.	A peer-mediated naturalistic teaching method was used by classmates of the kids with autism; SGDs were used in some of the cases.	The dependent measurement was the number of communicative behaviors displayed by children with autism disorders.	All three kids with autism demonstrated an increase in the number of communicative behaviors immediately after the first use of the intervention, as well as during further interactions during mealtime with the peers who employed the method. Nevertheless, only one child with autism displayed a maintained increase in interaction later. It is concluded that utilizing peer-mediated naturalistic teaching in which SGDs are employed may be effective; suggestions on how to increase the maintenance of the results of the intervention are provided.

Common Themes

On the whole, the articles pertained to the topic of special education interventions for young children with impairments and developmental delays, so it is not surprising that the main theme in nearly all of them was related to improving the communication activities of children.

However, it should be noted that several articles concentrated on the provision of parents with training to enable them to supply something similar to special education interventions for their children on a more permanent basis (Kent-Walsh et al., 2010; Nunes & Hanline, 2007; Rosa-Lugo & Kent-Walsh, 2008; Sandberg & Liliedahl, 2008).

Generally speaking, training individuals to use certain communication strategies or employ methods similar to those utilized in special education interventions was an important theme in more than half of the articles. Apart from training parents, there was an investigation of what qualifications the teachers who may have to work with children with special needs have, and what training would they require to do so (Bruns & Mogharreban, 2008). Also, there was a study investigating the results of training peers of children with autism to communicate with the latter using specific strategies (Trembath et al., 2009). Thus, the theme of the training was essential in many of the reviewed studies.

AAC was an important theme; several articles stressed that using AAC, and innovative technologies to better implement AAC AAC, can be of major assistance when providing special education interventions for impaired children in early childhood (Lorah et al., 2013; Trembath et al., 2009). Carr and Felce (2007), e.g., utilized a Picture Exchange Communication System to elicit communicational acts from kids with autism.

Cress et al. (2008) measured non-verbal parents’ communication in association with children’s disability status. Douglas et al. (2013) investigated whether children would communicate more if strategies employing AAC were used on them. Kent-Walsh et al (2010) taught parents to utilize AAC. Lorah et al. (2013) checked which of the two chosen AAC devices children with autism would prefer. Nunes and Hanline (2007) taught the mother of a boy with autism to use a visual-graphic system. Rosa-Lugo and Kent-Walsh (2008) employed AAC in the process of storybook reading.

Also, a major theme in the articles was autism. Carr and Felce (2007), Douglas et al. (2013), Lorah et al. (2013), Nunes and Hanline (2007), Rowland (2011), and Trembath et al. (2009) all touched upon the topic of autism in some manner; usually, children with autism were included in the studies. This should not be surprising, for such children suffer from major problems when it comes to communication, so using AAC when working with them is justified.

Recommendations

From these findings, it is clear that increased use of AAC in early special education interventions for children with various impairments and developmental delays is of paramount importance if these children are to be provided with an opportunity to have the adverse impact of their disabilities and/or developmental delays mitigated. To answer the research question which was stated above, it should be noted that virtually all types of AAC discussed in the reviewed articles resulted in increased effectiveness of special education interventions.

Consequently, it can be recommended to teach parents of children with disabilities to use a variety of AAC tools in their communication with their offspring, for parents usually do not have knowledge in the sphere of special education, and may simply not know how to deal with their children with impairments without the guidance of special education professional. Also, the tools for special education intervention may often be recommended to be selected for each child individually; when possible, it may also be a viable strategy to let the child choose the device that they like best (for instance, a picture exchange device versus a speech-generating device, as discussed by Lorah et al. (2013)) to improve their outcomes.

Discussion

On the whole, it should be stressed that the current study revealed that numerous techniques may be used to improve the outcomes of early interventions in special education for children with disabilities or developmental delays and that even instructing and engaging peers of such children in communication may be beneficent for these kids. This implies that special education professionals should not only be able to use AAC techniques and devices themselves but also ought to teach others (for instance, parents or peers of children with disabilities or developmental delays) to appropriately utilize these as well. As for the limitations of the study, it should be pointed out that only a relatively small number of articles (11 articles) were analyzed, which probably does not permit for covering the majority of ways to use AAC in special education interventions for kids in their early childhood.

References

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