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Autism Spectrum Disorders and AAC
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Volume Editors: Pat Mirenda Ph.D., BCBA-D, Teresa Iacono Ph.D. Series Editors: David R. Beukelman Ph.D., Joe Reichle Ph.D. Chapter Authors: Michael Arthur-Kelly, Racheal Arthur-Kelly, Andy Bondy Ph.D., Teena Caithness, Mark Carter Ph.D., Hsu-Min Chaing Ph.D., Kathryn Drager Ph.D., Karen A. Erickson Ph.D., Sheridan Forster, Lori Frost, Vanessa Green Ph.D., Teresa Iacono Ph.D., Hilary Johnson, Cheryl M. Jorgensen Ph.D., David A. Koppenhaver Ph.D., Rajinder Koul Ph.D., Giulio Lancioni Ph.D., Amy C. Laurent, Janice C. Light Ph.D., Michael McSheehan, Diane Millar Ph.D., CCC-SLP, Pat Mirenda Ph.D., BCBA-D, Mark F. O'Reilly Ph.D., Barry M. Prizant Ph.D., CCC-SLP, Joe Reichle Ph.D., MaryAnn Romski Ph.D., Charity Mary Rowland, Emily Rubin M.S., CCC-SLP, Patrick J. Rydell, Ralf Schlosser Ph.D., Rose A. Sevcik Ph.D., Jeff Sigafoos Ph.D., Oliver Wendt Ph.D., Krista M. Wilkinson, Amy R. Williams Author: Rae M. Sonnenmeier Ph.D.
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For children, adolescents, and adults with autism, AAC can have a tremendous positive impact on communication, social skills, and behavior. Now there's a comprehensive, up-to-date research volume that shows professionals what today's most effective AAC methods are—and why they're a perfect fit with a variety of learning approaches that work for people with autism.
Pat Mirenda—a leading authority on AAC and autism—and Teresa Iacono partner with more than 30 other experts to give readers the most current, in-depth information on a wide range of AAC methods and technologies. Through clear and compelling examinations of the latest research studies, professionals supporting people with autism will discover how these evidence-based AAC interventions can be used to
- promote children's natural speech and language development
- expand literacy skills
- modify challenging behavior
- build young children's social interaction skills
- encourage students' full membership and participation in inclusive classrooms
- give children socially appropriate ways to express needs and preferences
- replace unconventional communicative acts with more conventional ones
- help adolescents and adults develop strong social networks within their community
Readers will also get clarification of the common characteristics of effective AAC interventions and insight into the future research required to make AAC technologies more meaningful and motivating.
Essential for educators, SLPs, OTs, PTs, and other direct service providers, this new addition to the renowned Augmentative and Alternative Communication series will give readers a complete understanding of today's diverse AAC options—knowledge they'll use to help people with autism develop the communication and social skills they need to succeed.
Help people with autism benefit from
- speech generating devices
- visual schedules and other types of visual supports
- peer-mediated interventions
- manual signing and gestures
- graphic symbols
- written supports
- and more!
Practically Speaking is part of the Augmentative and Alternative Communication Series.
Reviews
Review: Focus on Autism and Other Developmental Disabilities
"An essential addition to the professional and personal libraries of all those who work with and care for individuals in the autism spectrum...provides current research in a distinctively robust, yet reader-friendly format [and] honestly present[s] the gnawing questions and slowly emerging answers in this new and exciting field."
Review: The Midwest Book Review
"A necessity for educators dealing with … special needs people … Belongs in any collection on autism."
Review: Research and Practice for Persons with Severe Disabilities
"A wonderful resource...Presents the most recent research about AAC systems and begins to bridge the gap between AAC and ASD."
Review by: David McNaughton, The Pennsylvania State University, University Park
"A current, comprehensive, and reader friendly text."
Review by: Steven F. Warren, Professor of Applied Behavioral Science, University of Kansas
"Thorough and timely . . . represents the most comprehensive, up-to-date source of cutting edge knowledge that presently exists. I strongly recommend this text to parents, practitioners and researchers."
Review by: Sarah W. Blackstone, President, ACI, Monterey, CA
"At last. A book that thoroughly reviews the efficacy of using a range of AAC strategies, techniques and technologies to support communication and language for people on the autism spectrum. This is exactly what ALL practitioners, researchers, family members, administrators, advocates and funders need."
Review by: Daniel Openden, Southwest Autism Research & Resource Center (SARRC) & Arizona State University
"A comprehensive resource that integrates AAC research, assessments, interventions, and related issues that are specific to individuals with ASD."
Series Preface
Series Editors, Editorial Advisor, and Editorial Advisory Board
Volume Preface
About the Editors
Contributors
Acknowledgments
I: Overview and Assessment
1. Introduction to AAC for Individuals with Autism Spectrum Disorders
Pat Mirenda
2: Assessment Issues
Teresa Iacono and Teena Caithness
II: Communication Modalities
3: Presymbolic Communicators with Autism Spectrum Disorders
Charity M. Rowland
4: Research on the Use of Manual Signs and Graphic Symbols in Autism Spectrum Disorders: A Systematic Review
Oliver Wendt
Appendix A: Overview and Appraisal of Studies Involving Manual Signs and Gestures
Appendix B: Overview and Appraisal of Studies Involving Graphic Symbols
5: Speech Output and Speech-Generating Devices in Autism Spectrum Disorders
Ralf W. Schlosser, Jeff Sigafoos, & Rajinder K. Koul
6: Effects of AAC on the Natural Speech Development of Individuals with Autism Spectrum Disorders
Diane C. Millar
III: AAC Interventions
7: AAC and the SCERTS® Model: Incorporating AAC within a Comprehensive, Multidisciplinary Educational Program
Emily Rubin, Amy C. Laurent, Barry M. Prizant, & Amy M. Wetherby
8: The System for Augmenting Language: Implications for Young Children with Autism Spectrum Disorders
MaryAnn Romski, Rose A. Sevcik, Ashlyn Smith, R. Micheal Barker, Stephanie Folan, & Andrea Barton-Hulsey
9: Using AAC Technologies to Build Social Interaction with Young Children with Autism Spectrum Disorders
Kathryn D.R. Drager, Janice C. Light, & Erinn H. Finke
10: The Picture Exchange Communication System: Clinical and Research Applications
Andy Bondy & Lori Frost
11: A Picture Is Worth a Thousand Words: Using Visual Supports for Augmented Input with Individuals with Autism Spectrum Disorders
Pat Mirenda & Kenneth E. Brown
12: Functional Communication Training and Choice-Making Interventions for the Treatment of Problem Behavior in Individuals with Autism Spectrum Disorders
Jeff Sigafoos, Mark F. O'Reilly, & Giulio E. Lancioni
13: The Role of Aided AAC in Replacing Unconventional Communicative Acts with More Conventional Ones
Krista M. Wilkinson & Joe Reichle
IV: AAC-Related Issues
14: Literacy in Individuals with Autism Spectrum Disorders Who Use AAC
David A. Koppenhaver & Karen A. Erickson
15: Membership, Participation, and Learning in General Education Classrooms for Students with Autism Spectrum Disorders Who Use AAC
Michael McSheehan, Rae M. Sonnenmeier, & Cheryl M. Jorgensen
Appendix: Beyond Access Model Best Practices
16: Supporting the Participation of Adolescents and Adults with Complex Communication Needs
Teresa Iacono, Hilary Johnson, & Sheridan Forster
Index
Excerpted from Autism Spectrum Disorders and AAC
Edited by Pat Mirenda, Ph.D., & Teresa Iacono, Ph.D. ©2009. Brookes Publishing. All rights reserved.
EVIDENCE-BASED PRACTICE
A relatively recent development in the field of AAC is an increased
emphasis on evidence-based practice (EBP) for assessment, intervention
planning, and implementation. EBP is “the integration of best and current
research evidence with clinical/educational expertise and relevant
stakeholder perspectives to facilitate decisions for assessment and intervention
that are deemed effective and efficient for a given stakeholder”
(Schlosser & Raghavendra, 2003, p. 263). EBP does not mean that either
clinical reasoning or the perspectives of individuals who use AAC and
their families are discounted during the AAC assessment or decisionmaking
processes. Rather, in addition to these important elements, a
third component—current research evidence—is added to the mix.
The EBP process, described by Schlosser and Raghavendra (2003),
can be used to make decisions about the intervention components that
are most likely to lead to positive outcomes for a given individual. The
six steps of this process are
- Ask a well-built question, such as “Should we use manual signing
or should we use graphic symbols to teach requesting to this adolescent
with autism?” or “Should we use an SGD to teach social
interaction skills to this child with Rett syndrome?”
- Select evidence sources (e.g., textbooks, research databases,
journals).
- Search the literature.
- Examine the evidence systematically.
- Apply the evidence to make decisions on behalf of the specific individual
who requires AAC.
- Evaluate the outcome of the decision over time.
One of the practical outcomes of the emphasis on EBP has been the
generation of a number of integrative reviews of AAC research. In such
reviews, authors examine research related to a specific type of AAC
intervention (e.g., SGDs) with a specific population (e.g., children with
ASDs), using either statistical or narrative techniques. They also provide
summary statements regarding, for example, the benefits that have
been shown to result from the use of a specific intervention or the optimum
conditions for generating positive outcomes. Many authors in this
book have used this process or a variation thereof to integrate existing
research on specific aspects of AAC. In addition, integrative reviews on
AAC for individuals with ASDs have addressed topics such as manual signing (Goldstein, 2002; Mirenda, 2001, 2003b; Wendt, Schlosser, &
Lloyd, 2005), graphic symbols (Mirenda, 2001, 2003b; Wendt et al.,
2005), SGDs and computers with speech output (Schlosser & Blischak,
2001; Wendt et al., 2005), functional communication training (Bopp,
Brown, & Mirenda, 2004; Wendt et al., 2005), and visual schedules that
use graphic symbols (Bopp et al., 2004).
Decision making that incorporates research evidence is important
when designing AAC interventions for individuals with ASDs for a
number of reasons. First, these individuals constitute an extremely heterogeneous
group with regard to the social, cognitive, motivational,
and motor abilities that underlie successful communication. Thus,
AAC decisions must be made on the basis of individual skill and preference
profiles, rather than on the basis of an ASD diagnosis alone.
Researchers have therefore examined strategies for incorporating the
modality preferences of individuals with ASDs into the decisionmaking
process (Sigafoos, O’Reilly, Ganz, Lancioni, & Schlosser, 2005;
Son, Sigafoos, O’Reilly, & Lancioni, 2006).
Second, the field of ASDs in general is “littered with the debris of
dead ends, crushed hopes, ineffective treatments, and false starts”
(Schreibman, 2005, p. 7). With regard to AAC, this was highlighted in
1970s by the wholesale adoption of total communication as “the
answer” for all individuals with ASDs who were unable to speak; in
the 1990s, a similar furor focused on facilitated communication. The
tendency of many professionals and families to adopt the latest fad
intervention, regardless of the quantity or quality of research evidence
to support it, can be counteracted by the adoption of an EBP approach
to decision making.
Third, for professionals in the field, EBPs are guaranteed to keep
us humble by making us aware of just how much we still have to learn.
The fact is that we do not know even more than we do know about
AAC for individuals with ASD. We do not know how to select the combination
of AAC modalities that will result in optimal communication
for each individual; how to design comprehensive AAC instructional
interventions that truly build on each person’s abilities and strengths;
or how to maximally support social, language, and literacy development
through AAC. If it is indeed true that with humility comes wisdom,
the systematic examination of research evidence for decision
making is essential for the field to move forward.
CONUNDRUMS AND CONTROVERSIES
The Merriam-Webster Online Dictionary (2007) defines a conundrum as
“an intricate and difficult problem.” In the field of AAC, as in all other fields of scientific endeavor, a number of conundrums have come and
gone over the years, while several have lingered and are still active
today. Many of the currently controversial issues as they pertain to
individuals with ASDs are examined in individual chapters of this
book, including the use of SGDs for individuals with ASDs (Chapter 5)
and how various AAC modalities affect the likelihood of speech production
(Chapter 6). Additional chapters examine the use and effectiveness
of both behavioral and social/developmental instructional
approaches, including the Picture Exchange Communication System
(Chapter 10; see also Frost & Bondy, 2002); the Social Communication,
Emotional Regulation, and Transactional Support (SCERTS®) Model
(Chapter 8; see also Prizant, Wetherby, Rubin, Laurent, & Rydell, 2005a,
2005b); and various aided language models (Chapters 7 and 9). Chapters
on the use of AAC techniques for problem behavior (Chapters 12
and 13), literacy development (Chapter 14), and inclusive education
(Chapter 15) also address conundrums that confront and challenge
many families and AAC professionals who support individuals with
ASDs. This chapter explores three additional controversial issues: 1)
integrating AAC with other early intervention approaches for young
children with ASDs, 2) deciding whether or not AAC is appropriate
and choosing individualized AAC techniques, and 3) critically reexamining
conventional assumptions about ASDs as they apply to AAC.
Early Intervention and AAC
The importance of early intervention for young children with ASDs
is not a matter for debate. In a comprehensive, evidence-based report,
the U.S. National Research Council (NRC) Committee on Educational
Interventions for Children with Autism (2001) strongly recommended
that entry into intervention programs should begin as soon as an ASD
diagnosis is seriously considered, rather than waiting until it is confirmed.
The NRC Committee also concurred that “active engagement in
intensive instructional programming” (p. 219) should be provided to
children at least up to age 8 years for a minimum of 25 hours per week
on a year-round basis, and should consist of “repeated, planned teaching
opportunities” (p. 219) conducted in both one-to-one and very small
group sessions. They also recommended that emphasis be placed on the
use of evidence-based instructional techniques in six main instructional
areas: 1) functional, spontaneous communication using speech and/or
AAC; 2) developmentally appropriate social skills with parents and
peers; 3) play skills with peers; 4) various goals for cognitive development,
with emphasis on generalization; 5) positive behavior supports
for problem behaviors; and 6) functional academic skills, as appropriate.
The NRC Committee (2001) acknowledged that a wide range of
instructional approaches may be used to accomplish these goals. These
approaches include structured teaching based on the principles of
applied behavior analysis such as discrete trial teaching (Smith, 2001),
incidental teaching (McGee, Morrier, & Daly, 1999), applied verbal
behavior (Sundberg & Partington, 1998), and pivotal response training
(Koegel & Koegel, 2006). They also include social/developmental
approaches such as the Developmental, Individual-Difference,
Relationship-Based (DIR) model (Greenspan & Weider, 1999) and the
SCERTS Model (Prizant et al., 2005a, 2005b). Although the NRC Committee
did not recommend a specific curriculum or approach, they
stressed the importance of goal-directed, evidence-based, individualized
programs that meet the needs of both children with ASDs and
their families.
Because of these recommendations, immediately after receiving a
diagnosis for their child, families are faced with the daunting task of
deciding what to do for their child with ASD and how best to do it.
Some of their decisions may affect the extent to which AAC techniques
of various types will be accepted and used (e.g., in an applied verbal
behavior approach, manual signing may be accepted but graphic symbols
may not be; see Mirenda, 2003b; Sundberg, 1993). Even when there
is agreement about the techniques to implement, AAC practitioners
will almost always need to work with other professionals whose views
may be quite divergent from (and perhaps even incompatible with)
their own. The potential for controversy is considerable and the potential
for conflict is high; therefore, the ability to negotiate and collaborate
is required of all involved.
To AAC or Not to AAC?
If the goal of an AAC system is to “enable individuals to efficiently and
effectively engage in a variety of interactions and participate in activities
of their choice” (Beukelman & Mirenda, 2005, p. 8), it is critical that
AAC interventions be maximally individualized. This principle raises
a number of contentious issues, the first and foremost of which is that
many parents of young children (and some practitioners as well) are
reluctant to implement AAC interventions out of concern that they will
prevent speech production (Cress & Marvin, 2003). Despite credible
research evidence to the contrary (Chapter 6; see also Millar, Light, &
Schlosser, 2006), this reluctance continues to limit the extent to which
individuals who can benefit from AAC have access to it. In addition,
AAC is no less immune to “one-size-fits-all” thinking than is any other
type of educational intervention. Some practitioners who ascribe to this way of thinking institute one or more AAC techniques with everyone
whose social-communication interactions are lacking, regardless of
whether AAC is actually required. Other practitioners espouse the
superiority of a particular instructional technique over all others,
regardless of the abilities and preferences of individuals with ASDs or
their families. Still others may always prescribe the specific AAC
modality with which they have experience, rather than considering the
entire range of available options. For example, some practitioners
claim that manual signing is the best AAC technique for all individuals
with ASDs, based largely on theoretical arguments rather than on
empirical evidence (Mirenda, 2003b). Regardless, this one-size-fits-all
thinking invariably limits the communication options that are available
to individuals with ASDs and can be avoided by adopting the general
EBP approach that was described in a previous section of this chapter.
(Mis)conceptions About ASDs and AAC
Research has called into question at least two of the assumptions that
most people accept about ASDs in general: 1) motor impairments are
not part of the disorder and 2) in most cases, intellectual disability is.
Mirenda (2008) noted that these two assumptions directly affect both
the design and the goals of AAC interventions for many individuals
with ASDs. Alternative access or instructional supports are rarely provided
to compensate for the types of motor planning or coordination
problems that appear to be more common than previously thought
(e.g., Dziuk et al., 2007; Hardan, Kilpatrick, Keshavan, & Minshew,
2003; Ming, Brimacombe, & Wagner, 2007; Minshew, Sung, Jones, &
Furman, 2004). AAC goals are often focused solely on basic requesting
skills, under the assumption that most individuals with ASDs will be
unable to acquire a broad range of communicative functions because of
limited cognitive capacity. Edelson (2006) and others (e.g., Dawson,
Soulières, Gernsbacher, & Mottron, 2007), however, have provided
empirical evidence to challenge the conventional presumption that
intellectual disability usually co-occurs with ASDs. In addition, some
researchers have started to demonstrate that individuals with ASDs
can become much more communicatively competent through the use
of AAC than might be expected in the presence of intellectual disability
(e.g., Light et al., 2005). Given all of this, Mirenda (2008) urged AAC
clinicians and researchers to “question what we think we know about
people with ASD in general and how we support those individuals
whose speech does not develop to communicate through AAC in
particular.” It remains to be seen whether the AAC community will
take up this challenge both to reconceptualize ASDs in general and to
design innovative AAC interventions that push traditional boundaries
and presume the potential for competence.
CONCLUSION
Decision making related to AAC interventions for individuals with
ASDs is a complex and challenging endeavor. Because of the wide heterogeneity
of this population, decisions about appropriate AAC techniques
cannot and should not be made in the abstract; rather, they must
be made for specific learners, in specific contexts, to meet specific needs
(Beukelman & Mirenda, 2005). It is clear that that the success or failure
of any AAC intervention is not simply a matter of choosing symbols or
devices; instructional variables are also critically important. Indeed,
when AAC fails to result in spontaneous, functional communication,
this failure usually reflects limitations in the procedures and methods
used for instruction rather than an inherent problem with AAC itself.
In the end, the combination of research-based modality selection, excellent
instruction, and goodness-of-fit (Bailey et al., 1990) with regard to
environments, communication partners, and communication needs are
all needed to maximize the possibility of successful communication for
individuals with ASDs.
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By Naseef, Robert |
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By Thompson, Travis |
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By Kluth, Paula |
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