Evaluating and Enhancing Communication Skills in Four Adolescents with Profound and Multiple Disabilities

<p>Individuals with profound and multiple disability (PMD) experience more than one type of disability, typically severe to profound intellectual disability and significant motoric impairment. These complex impairments negatively affect many aspects of the person’s functioning, such as daily living, academic, and social skills. Persons with PMD will often experience fluctuating levels of awareness, and often have such severe communication deficits that they rely on the use prelinguistic behaviours (PLBs) to communicate. It is often difficult for those working with these individuals to identify preferences and behavioural states indicative of engagement and motivation. As a result, these individuals often experience social isolation and a lower quality of life. The purpose of this research project was to evaluate the overall level of functioning and communicative abilities of four adolescents with PMD and identify instructional procedures that might enhance their natural method of communication, such that they are more readily understood. This was achieved through assessment and intervention based methods. First, the repertoire of forms and functions of specific PLBs in four participants with PMD were identified. Then, circumstances under which behaviours indicative of alertness and engagement were assessed. Next, the author validated the function of specific PLBs used to request the continuation or access to preferred stimuli. Subsequently, three intervention case studies were implemented to strengthen and/or enhance the PLB requesting behaviours of three participants using microswitch technology and individualised instructional strategies. Results suggested that individuals with PMD can and do demonstrate consistent PLBs used to request access to preferred stimuli. Specific PLBs of three participants were strengthened and/or enhanced, with two of these participants able to use a microswitch to activate a speech generating device to produce a communicative request. Implications of these results are discussed in terms of the overall outcomes for each participant and the challenges of implementing a whole communication assessment and intervention approach for this population of learners.</p>

Evaluating and Enhancing Communication Skills in Four Adolescents with Profound and Multiple Disabilities

<p>Individuals with profound and multiple disability (PMD) experience more than one type of disability, typically severe to profound intellectual disability and significant motoric impairment. These complex impairments negatively affect many aspects of the person’s functioning, such as daily living, academic, and social skills. Persons with PMD will often experience fluctuating levels of awareness, and often have such severe communication deficits that they rely on the use prelinguistic behaviours (PLBs) to communicate. It is often difficult for those working with these individuals to identify preferences and behavioural states indicative of engagement and motivation. As a result, these individuals often experience social isolation and a lower quality of life. The purpose of this research project was to evaluate the overall level of functioning and communicative abilities of four adolescents with PMD and identify instructional procedures that might enhance their natural method of communication, such that they are more readily understood. This was achieved through assessment and intervention based methods. First, the repertoire of forms and functions of specific PLBs in four participants with PMD were identified. Then, circumstances under which behaviours indicative of alertness and engagement were assessed. Next, the author validated the function of specific PLBs used to request the continuation or access to preferred stimuli. Subsequently, three intervention case studies were implemented to strengthen and/or enhance the PLB requesting behaviours of three participants using microswitch technology and individualised instructional strategies. Results suggested that individuals with PMD can and do demonstrate consistent PLBs used to request access to preferred stimuli. Specific PLBs of three participants were strengthened and/or enhanced, with two of these participants able to use a microswitch to activate a speech generating device to produce a communicative request. Implications of these results are discussed in terms of the overall outcomes for each participant and the challenges of implementing a whole communication assessment and intervention approach for this population of learners.</p>

Teaching a Multi-Step Requesting Sequence to Two Adolescents with Autism Using an iPod-based Speech Generating Device

<p>Many children with autism fail to develop speech and are therefore candidates for the use of speech-generating devices (SGDs). However, existing studies are limited because they have tended to focus only on teaching an initial single-step requesting sequence. This thesis aimed to extend the existing literature by evaluating intervention procedures for teaching two adolescents with autism to perform multistep requesting sequences that required navigating across two screen pages (Intervention 1). Intervention 2 focused on teaching the adolescents to turn on and unlock the screen of the SGD prior to initiating the previously learnt multi-step requesting sequence. Both interventions made use of response prompting, prompt fading, and differential reinforcement procedures and were evaluated using the multiple-baseline across subjects design. Results showed that both interventions were effective in teaching these adolescents to use the iPod Touch(R) to make a sequence of requests. The results of the present study suggest that adolescents with autism can successfully learn to use an iPod Touch(R) to independently perform multi-step requesting sequences.</p>

Teaching a Multi-Step Requesting Sequence to Two Adolescents with Autism Using an iPod-based Speech Generating Device

<p>Many children with autism fail to develop speech and are therefore candidates for the use of speech-generating devices (SGDs). However, existing studies are limited because they have tended to focus only on teaching an initial single-step requesting sequence. This thesis aimed to extend the existing literature by evaluating intervention procedures for teaching two adolescents with autism to perform multistep requesting sequences that required navigating across two screen pages (Intervention 1). Intervention 2 focused on teaching the adolescents to turn on and unlock the screen of the SGD prior to initiating the previously learnt multi-step requesting sequence. Both interventions made use of response prompting, prompt fading, and differential reinforcement procedures and were evaluated using the multiple-baseline across subjects design. Results showed that both interventions were effective in teaching these adolescents to use the iPod Touch(R) to make a sequence of requests. The results of the present study suggest that adolescents with autism can successfully learn to use an iPod Touch(R) to independently perform multi-step requesting sequences.</p>

Effects of a Systematic Augmentative and Alternative Communication Intervention Using a Speech-Generating Device on Multistep Requesting and Generic Small Talk for Children With Severe Autism Spectrum Disorder

Purpose The purpose of this study was to determine the effects of augmentative and alternative communication (AAC) intervention using a speech-generating device (SGD) on acquisition, maintenance, and generalization of multistep requesting and generic small talk in three children with severe autism spectrum disorder (ASD) between the ages of 7 and 13 years. Method A multiple-baseline design across participants combined with a posttreatment multiple-generalization-probe design was used to assess acquisition, generalization, and maintenance of target communicative behaviors with the experimenter and the participants' familiar communication partners (FCPs). Intervention was composed of systematic instruction in the use of an SGD using least-to-most prompting, constant time delay, error correction, and reinforcement. Results Visual analysis established a strong functional relationship between the independent variable and the two dependent variables (i.e., requesting preferred activities, engaging in generic small talk) for all three participants. Effect size indicator analyses corroborated these findings, indicating strong effects for performing multistep requesting and medium effects for engaging in generic small talk. All participants were able to generalize the acquired communicative behaviors to request new and untrained snacks and activities and engage in generic small talk with FCPs who were not part of the training. Maintenance of acquired communicative behaviors was demonstrated 3 weeks post completion of intervention. Conclusion This study provides preliminary evidence that AAC intervention using an SGD and incorporating least-to-most prompting, constant time delay, error correction, and reinforcement is effective in terms of multistep requesting and generic small talk behaviors in children with severe ASD. Supplemental Material https://doi.org/10.23641/asha.16663630

Expanding Availability of Speech-Generating Device Evaluation and Treatment to People With Amyotrophic Lateral Sclerosis (pALS) Through Telepractice: Perspectives of pALS and Communication Partners

Purpose To examine the experiences of people with ALS (pALS) and their communication partners (cALS) regarding receiving speech-generating device (SGD) evaluation and treatment via telepractice. Method Eight pALS along with a primary cALS participated in telepractice SGD evaluation and treatment with an augmentative and alternative communication (AAC) specialist and representatives from multiple SGD vendors. Participants were interviewed postevaluation and post-SGD training to examine their experiences. Mixed methods data were collected through Likert scale responses and qualitative interviews. Results Telepractice SGD evaluation and training were feasible and resulted in all pALS receiving SGDs they were able to use to communicate. In both Likert rating items and qualitative interviews, participants rated the telepractice experience very highly in terms of giving them access to AAC services via an AAC specialist that they would not have otherwise been able to access, and doing so in a format that was possible given their limitations in mobility, endurance, and caregiver availability. Suggestions for improving the telepractice experience were provided. Conclusions Telepractice should be considered as an option to provide vital SGD services to patients who are geographically remote, mobility impaired, unable to leave their home, experience fatigue with travel, or otherwise would not have access to these specialized services. Telepractice allows patients to preserve their time and energy for the assessment and treatment sessions, resulting in perhaps deeper and more frequent engagement in evaluation and training. Telepractice could serve as an alternative to outpatient, in-person evaluations, or be utilized in conjunction with in-person appointments. Supplemental Material https://doi.org/10.23641/asha.15094257

Evaluating acquisition, preference and discrimination in requesting skills between picture exchange and iPad®-based speech generating device across preschoolers

This study compared a picture exchange (PE) system and an iPad®-based speech generating device (SGD) when teaching requesting skills to preschoolers with developmental disabilities and limited functional speech. A multiple baseline design with counterbalancing the order of two instruction conditions across participants was applied to compare the acquisition rate, followed by a concurrent operant arrangement to examine participants’ preference for these two augmentative and alternative communication (AAC) systems. Discrimination of two picture symbols presented via the priority AAC system was also probed using a concurrent operant arrangement. Results indicated that two of three participants required less sessions to reach mastery for the iPad®-based instruction condition. All participants showed a clear preference for the iPad®-based SGD and were able to discriminate between two picture symbols presented simultaneously on the iPad®-based SGD when making requests. This study highlights practice implications in terms of describing a systematic approach that could be employed when identifying a priority AAC system for learners with developmental disabilities and limited functional speech.