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>

Tying the Delivery of Activity Step Instructions to Step Performance: Evaluating a Basic Technology System with People with Special Needs

Objectives This study assessed a new technology system that automatically presented instructions for multistep activities to people with intellectual and sensory disabilities. The instructions were presented one at a time, and tied to the participants’ performance of the activity steps. That is, a new instruction occurred only after the participant had carried out the previous step. Methods The new system involved a Samsung Galaxy A10 with Android 10.0 operating system equipped with Amazon Alexa, MacroDroid, and Philips Hue applications and a Philips Hue indoor motion sensor. The assessment of the new system was carried out with seven participants who were exposed to two or three pairs of activities. They performed one activity of each pair with the new system and the other with a system presenting instructions at preset time intervals according to an alternating treatments design that included a cross-over phase. Results The mean percentage of correct responses tended to be higher with the new system than with the control system. Paired t-tests carried out to compare the sessions with the new system with the sessions with the control system of each participant showed that the differences in correct responses between the two sets of sessions were statistically significant for all participants. Conclusions The new system may represent a useful (advantageous) tool for supporting people like those involved in this study in the performance of multistep activities.

Model Teachers or Model Students? A Comparison of Video Modelling Interventions for Improving Reading Fluency and Comprehension in Children with Autism

Video modelling (VM) interventions have been used to improve the fluency of individuals with learning disabilities and reading difficulties; this study aimed to replicate these findings with autism spectrum disorder (ASD) students. Four children with ASD (aged between 8 and 15) experienced two VM interventions, across 10 sessions, during an alternating treatments design: VM using a teacher model, and feedforward video self-modelling (FFVSM) where the student acted as the model. For two participants, FFVSM was found to be an effective intervention but overall, results for both interventions were inconsistent with previous research. Talking Mats Interviews were used to include these individuals within the social validation process of behavioural research.

Equating and Assigning Targets in the Adapted Alternating Treatments Design: Review of Special Education Journals

The current review examined the prevalence of the adapted alternating treatments design (AATD) across 22 special education journals and methods to equate and assign target sets to experimental conditions in the AATD. Since the seminal description of the design in 1985, a total of 49 articles were published using the AATD across 12 of the reviewed journals. The most prominent methods of equating target sets differed from prior reviews of behavior-analytic journals, likely due to the preponderance of response chains being targeted in special education research using the AATD. The majority of articles describe at least one method for equating target sets, although multiple methods were common. Additional methodological strengths in this literature included methods to reduce potential bias when assigning target sets to experimental conditions and counterbalancing target sets across participants. Considerations for practitioners and researchers when using the AATD are described.

Comparing the Minimum Celeration Line and the Beat Your Personal Best Goal-Setting Approaches During the Mathematical Practice of Students Diagnosed with Autism

This study compared two goal-setting approaches found in the Precision Teaching literature, namely the minimum celeration line and the beat your personal best during the mathematical practice of three male students diagnosed with autism, aged 8–9. An adapted alternating treatments design with a control condition was embedded in a concurrent multiple baseline across participants design. Each approach was randomly allocated to either the multiplication/division (×÷) table of 18 or 19, while no approach was allocated to the ×÷14 table that acted as a control. Instruction utilized number families and consisted of (a) untimed practice, (b) frequency-building, (c) performance criteria, (d) graphing, and (e) a token economy. Upon practice completion, an assessment of maintenance, endurance, stability, and application (MESA) was conducted. Participants improved with both conditions and maintained their performance well, while improvements with the control condition were weak. The beat your personal best approach was highlighted as slightly more effective in terms of average performance and more efficient in terms of timings needed to achieve criterion. No differences were identified in terms of learning rate (i.e., celeration) or performance on the MESA. More research is warranted to identify which goal-setting procedure is more appropriate for students in special education.

A Comparison of iPad-Assisted and Flash Card-Assisted Instruction for Learners With Autism

Using electronic tablets to present flash cards for teaching skills is becoming common among practitioners. However, no published study compared the effectiveness of the electronic tablet-based flash cards to paper flash cards for teaching receptive labeling skills. The purpose of this study was to compare the efficacy of the iPad-based and paper flash cards for teaching receptive labeling to learners with autism. An adapted alternating treatments design was used. Participants included one preschool student with autism and one elementary school student with autism. Findings indicated that iPad-assisted instruction resulted in a slightly faster acquisition and slightly lower levels of prompts for both participants. No differences were found in the generalization and maintenance of the skills between the two instructional mediums. Mixed results were found for challenging behaviors associated with each intervention. Implications and suggestions for future research are discussed.

Interdependent Group Rewards: Rewarding On-Task Behavior Versus Academic Performance in an Eighth-Grade Classroom Serving Students With Emotional and Behavioral Disorders

An alternating treatments design was used to evaluate and compare the effects of two interdependent group contingencies on the academic performance, on-task behavior, and disruptive behavior of eighth-grade students in a social studies class. All students were enrolled in a self-contained alternative school for students with behavior problems. Delivering rewards contingent upon participants’ average percent correct enhanced on-task behavior and percent correct on independent seatwork assignments; however, delivering rewards contingent upon participants’ on-task behavior yielded more consistent and larger increases in percent correct and on-task behavior. Neither group contingency resulted in consistent or meaningful changes in disruptive behavior. Theoretical and applied implications related to direct and indirect effects of interdependent group rewards are discussed along with directions for future research.

The Effect of Computer-Assisted Instruction on Challenging Behavior and Academic Engagement

Students with intellectual and developmental disabilities (IDD) require intensive supports, including those that target behavior, to make progress on literacy goals. In this study, we investigated whether computer-assisted instruction (CAI) may be one effective method to decrease challenging behavior and increase academic engagement. Participants were three students with IDD (7 to 9 years old) who engaged in challenging behaviors during instruction. We used a single-case alternating treatments design to compare levels of challenging behavior and academic engagement during paper-based and CAI (i.e., tablet computer-based) literacy instruction. Results indicated that CAI was associated with decreased challenging behavior and increased academic engagement for two of three participants. In addition, the CAI condition corresponded with higher scores on academic performance assessments for one participant. Although teacher and student measures of social validity were positive, there was limited evidence that results maintained. These findings are described in relation to their limitations, future directions for research, and impact on practitioners.

Review of Methods to Equate Target Sets in the Adapted Alternating Treatments Design

The adapted alternating treatments design is a commonly used experimental design in skill acquisition research. This design allows for the evaluation of two or more independent variables on responding to unique target sets. Equating target sets is necessary to ensure a valid comparison of the independent variables. To date, there is little guidance on best practice when equating target sets and it is unclear how researchers have done so previously. We reviewed the reported methods used to equate target sets in articles published using the adapted alternating treatments design in five behavior-analytic journals. Just over half of the studies published using the adapted alternating treatments design reported any method to equate target sets and the methods varied considerably. Alternative methods, such as random assignment, were prevalent. Considerations for best practice and avenues for future research are discussed.