Repercussão da implementação do Picture Exchange Communication System – PECS no índice de sobrecarga de mães de crianças com Transtorno do Espectro do Autismo

RESUMO Objetivo O objetivo deste estudo foi analisar a repercussão da implementação do PECS no índice de sobrecarga de mães de crianças com Transtorno do Espectro do Autismo (TEA). Método Trata-se de um estudo longitudinal (CEP 0403/2017). A amostra foi constituída por 20 díades mães-crianças com TEA. As mães tinham em média, 41 anos e 5 meses e as crianças, 7 anos e 2 meses. Quinze crianças eram do gênero masculino e cinco, do feminino. Foi aplicada a versão brasileira da escala Burden Interview cujo objetivo é a verificação do nível de sobrecarga dos cuidadores. Para análise dos comportamentos não-adaptativos aplicou-se o Autism Behavior Checklist (ABC) e para análise do repertório lexical: os Testes de Vocabulário Auditivo e Expressivo. O Programa de Implementação do PECS foi composto por 24 sessões de terapia fonoaudiológica individual com a presença ativa das mães. Ao final do Programa todas as crianças e suas respectivas mães foram reavaliadas com parte dos instrumentos utilizados na fase inicial do estudo. Resultados Houve tendência de redução dos índices de sobrecarga materna após a implementação do PECS. Notamos diminuição significativa dos comportamentos não-adaptativos e aumento dos índices de vocabulário expressivo e auditivo das crianças no momento final do estudo. Não observamos correlação significativa entre os índices de sobrecarga com a idade, escolaridade e quociente intelectual das crianças; nem com a escolaridade e nível socioeconômico materno. Conclusão Foi possível analisar a repercussão da implementação do PECS na sobrecarga de mães de crianças com TEA assistidas pelo Programa.

Comparing acquisition, preference, maintenance, and social validity of manual sign, picture exchange, and speech-generating devices as AAC options for children with developmental disabilities

<p>Background: Communication deficit is a defining characteristic of children with autism spectrum disorder (ASD) and other developmental delays/disabilities (DD). In many cases the degree of communication impairment is severe. For example, approximately 25% of children diagnosed with ASD fail to develop sufficient speech to meet their everyday communication needs. In the absence of speech, these children are often taught to use augmentative and alternative communication (AAC). Three main AAC options have been taught to children with DD. These are (a) manual sign (MS), (b) picture exchange systems (PE), in which the child exchanges a picture card to communicate, and (c) speech-generating device (SGD). Debate persists in the literature as to which of these three options is best suited to address the communication intervention needs of children with DD. With the rapid developments in technology, subsequently, more high-tech devices are being introduced to the field of AAC. Studies have compared these three AAC options, but the literature has not yet compared these three options in terms of long-term maintenance of communication skills and social validity of the AAC systems. Objective: The studies in this thesis focused on (a) comparing acquisition and maintenance of a requesting skill that was taught with each of the three AAC options (MS, PE, and SGD), (b) assessing the participant’s preference of using each of the three AAC options, and (c) assessing stakeholders’ perceptions of each AAC option in terms of perceived (a) intelligibility, (b) ease of acquisition, (c) effectiveness/acceptability, and d) preference. Method: In Study 1, four children with DD were taught to use MS, PE, and SGD to request continuation of toy play (i.e., to request more). This experimental study was implemented using a single-subject alternating-treatment design which was divided into four phases (i.e., baseline, intervention, post-intervention, and follow-up). The effects of intervention on acquisition of the requesting response with each option were evaluated using an alternating-treatments design across participants design. Acquisition and maintenance at 12 to 18 months was compared across the three AAC options in an alternating treatments design. The participants’ preference for using each of the three AAC options was also assessed at regular intervals during the study using a choice-making paradigm. For Study 2, a non-experimental quantitative design was applied. Data were collected using an anonymous five-point Likert-scaled survey that consisted of 11 questions. 104 undergraduate students were shown a video of a person communicating with each AAC option (MS, PE, and SGD in different video clips) then asked to rate each AAC option in terms of perceived (a) intelligibility, (b) ease of acquisition, (c) effectiveness/acceptability, and (d) their preference. Results: Study 1. With intervention, three of the four participants learned to use each of the three AAC options, but one child only learned to use the PE option. Trials to criterion across children ranged from 22 to 28 trials for the SGD, from 12 to 60 trials for PE option, and from 21 to 64 trials for MS option. For the three participants who reached criterion with all three AAC options, maintenance results were best for PE and the SGD. Preference assessments showed that participants most often chose the SGD, suggesting a preference for using that option. For Study 2, the undergraduate students, mean ratings for perceived intelligibility and effectiveness/acceptability were significantly higher for the SGD. The SGD and MS options were rated as being more preferred over PE. PE was rated significantly higher on perceived ease of acquisition. Conclusion: The children’s high level of proficiency in using the most frequently selected AAC system (i.e., the SGD) suggest that incorporating the child’s preference for AAC system might be valuable to avoid the risk of device abandonment. Additionally, data from the social validation assessment suggests that the SGD was perceived to have greater social validity than MS and PE. The combination of these findings adds to the existing literature in supporting the use of the SGD as a promising AAC option for children with DD. Findings on acquisition rates, long-term follow-up, and preference for AAC systems extend previous research with respect to incorporating longer-term follow-up data on the child’s proficiency of and preference across AAC options. Additionally, the social validation results provide a contribution to the field of AAC intervention in relation to how the wider community perceives these three AAC options. Future research might compare several AAC systems when teaching more elaborate communication skills (e.g., social interaction) and exploring factors that might impact one’s perception of a certain AAC systems.</p>

Comparing acquisition, preference, maintenance, and social validity of manual sign, picture exchange, and speech-generating devices as AAC options for children with developmental disabilities

<p>Background: Communication deficit is a defining characteristic of children with autism spectrum disorder (ASD) and other developmental delays/disabilities (DD). In many cases the degree of communication impairment is severe. For example, approximately 25% of children diagnosed with ASD fail to develop sufficient speech to meet their everyday communication needs. In the absence of speech, these children are often taught to use augmentative and alternative communication (AAC). Three main AAC options have been taught to children with DD. These are (a) manual sign (MS), (b) picture exchange systems (PE), in which the child exchanges a picture card to communicate, and (c) speech-generating device (SGD). Debate persists in the literature as to which of these three options is best suited to address the communication intervention needs of children with DD. With the rapid developments in technology, subsequently, more high-tech devices are being introduced to the field of AAC. Studies have compared these three AAC options, but the literature has not yet compared these three options in terms of long-term maintenance of communication skills and social validity of the AAC systems. Objective: The studies in this thesis focused on (a) comparing acquisition and maintenance of a requesting skill that was taught with each of the three AAC options (MS, PE, and SGD), (b) assessing the participant’s preference of using each of the three AAC options, and (c) assessing stakeholders’ perceptions of each AAC option in terms of perceived (a) intelligibility, (b) ease of acquisition, (c) effectiveness/acceptability, and d) preference. Method: In Study 1, four children with DD were taught to use MS, PE, and SGD to request continuation of toy play (i.e., to request more). This experimental study was implemented using a single-subject alternating-treatment design which was divided into four phases (i.e., baseline, intervention, post-intervention, and follow-up). The effects of intervention on acquisition of the requesting response with each option were evaluated using an alternating-treatments design across participants design. Acquisition and maintenance at 12 to 18 months was compared across the three AAC options in an alternating treatments design. The participants’ preference for using each of the three AAC options was also assessed at regular intervals during the study using a choice-making paradigm. For Study 2, a non-experimental quantitative design was applied. Data were collected using an anonymous five-point Likert-scaled survey that consisted of 11 questions. 104 undergraduate students were shown a video of a person communicating with each AAC option (MS, PE, and SGD in different video clips) then asked to rate each AAC option in terms of perceived (a) intelligibility, (b) ease of acquisition, (c) effectiveness/acceptability, and (d) their preference. Results: Study 1. With intervention, three of the four participants learned to use each of the three AAC options, but one child only learned to use the PE option. Trials to criterion across children ranged from 22 to 28 trials for the SGD, from 12 to 60 trials for PE option, and from 21 to 64 trials for MS option. For the three participants who reached criterion with all three AAC options, maintenance results were best for PE and the SGD. Preference assessments showed that participants most often chose the SGD, suggesting a preference for using that option. For Study 2, the undergraduate students, mean ratings for perceived intelligibility and effectiveness/acceptability were significantly higher for the SGD. The SGD and MS options were rated as being more preferred over PE. PE was rated significantly higher on perceived ease of acquisition. Conclusion: The children’s high level of proficiency in using the most frequently selected AAC system (i.e., the SGD) suggest that incorporating the child’s preference for AAC system might be valuable to avoid the risk of device abandonment. Additionally, data from the social validation assessment suggests that the SGD was perceived to have greater social validity than MS and PE. The combination of these findings adds to the existing literature in supporting the use of the SGD as a promising AAC option for children with DD. Findings on acquisition rates, long-term follow-up, and preference for AAC systems extend previous research with respect to incorporating longer-term follow-up data on the child’s proficiency of and preference across AAC options. Additionally, the social validation results provide a contribution to the field of AAC intervention in relation to how the wider community perceives these three AAC options. Future research might compare several AAC systems when teaching more elaborate communication skills (e.g., social interaction) and exploring factors that might impact one’s perception of a certain AAC systems.</p>

Comparing Tangible Symbols, Picture Exchange and a Direct Selection Response when Teaching Requesting to Two Children with Autism Spectrum Disorder

<p>Children diagnosed with Autism Spectrum Disorder (ASD) who fail to develop functional speech are candidates for augmentative and alternative communication (AAC) systems. One of the primary intentions of AAC is to provide an alternative method of communicating in the absence of speech (Mirenda, 2003). In order to select the most beneficial AAC system for a user, in regards to the ease of acquisition and successfully communicating with AAC systems, it is considered important to undertake research comparing various AAC systems and to assess users’ preferences for using one system over another. Empirical evidence from previous studies comparing AAC indicates that users often learn to use AAC systems with varying degrees of proficiency and at various acquisition rates. Additionally, assessing users’ preferences for different AAC systems has been shown to influence acquisition rates and long term maintenance of AAC systems and is suggested to be an important component when carrying out AAC intervention. In the present study a tangible symbol (TS) communication system was compared, in terms of acquisition rates and preference, with Picture Exchange (PE) and an additional direct selection (DS) method of gaining access to desired stimuli in two young boys with ASD. Two male participants diagnosed with ASD were taught via systematic instructional procedures to request/gain access to the continuation of preferred cartoon movies by using TS, PE, and DS. Additionally, preference assessments were implemented during intervention and follow-up phases to determine whether the participants showed a preference for using one of these three requesting/access methods over the other two, and whether any such preferences remained stable throughout follow-up sessions. Results indicated that both participants successfully learned to request each of the six cartoon movies using each of the three methods. Specifically, acquisition rates for TS and PE were comparable across both participants, and overall both participants preferred to request using the TS. During intervention sessions, one participant preferred to use DS, however this preference changed during follow-up where he chose to use TS more overall. These data suggest that TS is a viable AAC option for children with ASD who do not speak, and can be learned to a high proficiency after receiving systematic teaching procedures as used in the present study.</p>

Comparing Tangible Symbols, Picture Exchange and a Direct Selection Response when Teaching Requesting to Two Children with Autism Spectrum Disorder

<p>Children diagnosed with Autism Spectrum Disorder (ASD) who fail to develop functional speech are candidates for augmentative and alternative communication (AAC) systems. One of the primary intentions of AAC is to provide an alternative method of communicating in the absence of speech (Mirenda, 2003). In order to select the most beneficial AAC system for a user, in regards to the ease of acquisition and successfully communicating with AAC systems, it is considered important to undertake research comparing various AAC systems and to assess users’ preferences for using one system over another. Empirical evidence from previous studies comparing AAC indicates that users often learn to use AAC systems with varying degrees of proficiency and at various acquisition rates. Additionally, assessing users’ preferences for different AAC systems has been shown to influence acquisition rates and long term maintenance of AAC systems and is suggested to be an important component when carrying out AAC intervention. In the present study a tangible symbol (TS) communication system was compared, in terms of acquisition rates and preference, with Picture Exchange (PE) and an additional direct selection (DS) method of gaining access to desired stimuli in two young boys with ASD. Two male participants diagnosed with ASD were taught via systematic instructional procedures to request/gain access to the continuation of preferred cartoon movies by using TS, PE, and DS. Additionally, preference assessments were implemented during intervention and follow-up phases to determine whether the participants showed a preference for using one of these three requesting/access methods over the other two, and whether any such preferences remained stable throughout follow-up sessions. Results indicated that both participants successfully learned to request each of the six cartoon movies using each of the three methods. Specifically, acquisition rates for TS and PE were comparable across both participants, and overall both participants preferred to request using the TS. During intervention sessions, one participant preferred to use DS, however this preference changed during follow-up where he chose to use TS more overall. These data suggest that TS is a viable AAC option for children with ASD who do not speak, and can be learned to a high proficiency after receiving systematic teaching procedures as used in the present study.</p>

Comparison and Preference: Manual Signing, Picture Exchange, and Speech-Generating Devices as Communication Modes for Children with Developmental Disabilities

<p>Children with autism spectrum disorder (ASD) and related developmental disabilities (DD), who do not speak or have very limited spoken language, are often candidates for augmentative and alternative communication (AAC). Three common modes of AAC are manual signing (MS), picture exchange (PE), and speech-generating devices (SGDs). Studies suggest that children with ASD and other DD might demonstrate comparable proficiency in learning to use each of these communication systems. Because there may not be one single mode of AAC that appears to be most readily taught to, and learnt by, these children, decisions regarding which AAC mode to implement might need to be based upon an assessment of the individual's preferences for using different AAC systems. Giving students the opportunity to self-select their most preferred AAC mode could also be viewed as one way of promoting self-determination in AAC intervention and this in turn might significantly influence progress in learning to communicate and maintenance of newly acquired AAC skills. The three empirical intervention studies that are presented in the present thesis each made use of systematic instructional procedures, based upon the principles of applied behaviour analysis (ABA), to teach children with ASD and other DD to request (mand) preferred items using MS, PE, and SGD. A key aspect of the studies was the assessment of each child's preference for using one of the three AAC modes via a structured choice-making protocol. This choice-making protocol was designed to determine whether children made greater progress, showed increased communication ability, and continued to use AAC during follow-up sessions when their preferences for different AAC options were assessed and incorporated into the intervention process. Utilising single-case research methodology (combined multiple-baseline and alternating-treatments designs), a total of 12 participants (9 boys, 3 girls, aged 4 to 13 years) received interventions that were designed to compare acquisition, maintenance, and preference for MS, PE, and SGD. Overall, the results of the three studies demonstrated that seven of the 12 (58%) participants learnt to use, and reached criterion, for use of each AAC option. Five participants did not reach criterion for MS. Two participants did not reach criterion for PE and one of these participants did not reach criterion for SGD. Eight of the 12 (67%) participants appeared to show a preference for using the SGD. Preference for using PE was demonstrated by three out of eight (38%) participants (PE was only assessed in Studies 2 and 3). Finally, one out of the 12 (8%) participants appeared to show a preference for using MS. These data suggest greater proficiency and better maintenance when children used their preferred communication option. These findings highlight some potentially positive effects of enabling some degree of self-determination with respect to aspects of the use of AAC systems in communication intervention. Given the encouraging intervention outcomes for the present series of three studies, future research and practice should continue to seek ways of increasing opportunities for self-determination in AAC and related interventions for individuals with ASD/DD.</p>

Comparison and Preference: Manual Signing, Picture Exchange, and Speech-Generating Devices as Communication Modes for Children with Developmental Disabilities

<p>Children with autism spectrum disorder (ASD) and related developmental disabilities (DD), who do not speak or have very limited spoken language, are often candidates for augmentative and alternative communication (AAC). Three common modes of AAC are manual signing (MS), picture exchange (PE), and speech-generating devices (SGDs). Studies suggest that children with ASD and other DD might demonstrate comparable proficiency in learning to use each of these communication systems. Because there may not be one single mode of AAC that appears to be most readily taught to, and learnt by, these children, decisions regarding which AAC mode to implement might need to be based upon an assessment of the individual's preferences for using different AAC systems. Giving students the opportunity to self-select their most preferred AAC mode could also be viewed as one way of promoting self-determination in AAC intervention and this in turn might significantly influence progress in learning to communicate and maintenance of newly acquired AAC skills. The three empirical intervention studies that are presented in the present thesis each made use of systematic instructional procedures, based upon the principles of applied behaviour analysis (ABA), to teach children with ASD and other DD to request (mand) preferred items using MS, PE, and SGD. A key aspect of the studies was the assessment of each child's preference for using one of the three AAC modes via a structured choice-making protocol. This choice-making protocol was designed to determine whether children made greater progress, showed increased communication ability, and continued to use AAC during follow-up sessions when their preferences for different AAC options were assessed and incorporated into the intervention process. Utilising single-case research methodology (combined multiple-baseline and alternating-treatments designs), a total of 12 participants (9 boys, 3 girls, aged 4 to 13 years) received interventions that were designed to compare acquisition, maintenance, and preference for MS, PE, and SGD. Overall, the results of the three studies demonstrated that seven of the 12 (58%) participants learnt to use, and reached criterion, for use of each AAC option. Five participants did not reach criterion for MS. Two participants did not reach criterion for PE and one of these participants did not reach criterion for SGD. Eight of the 12 (67%) participants appeared to show a preference for using the SGD. Preference for using PE was demonstrated by three out of eight (38%) participants (PE was only assessed in Studies 2 and 3). Finally, one out of the 12 (8%) participants appeared to show a preference for using MS. These data suggest greater proficiency and better maintenance when children used their preferred communication option. These findings highlight some potentially positive effects of enabling some degree of self-determination with respect to aspects of the use of AAC systems in communication intervention. Given the encouraging intervention outcomes for the present series of three studies, future research and practice should continue to seek ways of increasing opportunities for self-determination in AAC and related interventions for individuals with ASD/DD.</p>