Teaching Alphabet Recognition and Letter Sound Correspondence Using a 4 Blocks of Literacy Model for Children with Complex Communication Needs (CCN): Illustrated with a Single Case Study

There are numerous hurdles to literacy acquisition for students with severe and multiple disabilities, such as intellectual disability, complex communication needs including physical disability and autism. However, there is substantial body of research that suggests that these children can gain literacy skills, develop communication and language with effective literacy education, and with the support of assistive and augmentative alternative communication systems. The study describes an ongoing intervention for teaching alphabet recognition and letter-sound correspondence using the 4 blocks of literacy model with a 5.7 year old girl with multiple disabilities who use augmentative alternative communication systems for communication. Emergent literacy instruction for improving alphabet recognition and letter sound correspondence was taught applying the principles of the 4 blocks “Working with words” and “Shared book reading” over a period of eight months. Improvement noticed in alphabet recognition and letter sound correspondence was investigated. Emergent literacy instruction using 4 blocks of literacy model was proved to be an effective method in gaining the alphabet principles and phonics skills. The study provides insights to the rehabilitation professionals and budding therapists on how to implement emergent literacy instructions and strategies to be considered for children with complex communication needs. Key words: Emergent Literacy, Complex Communication Needs, Augmentative Alternative Communication, Multiple Disabilities, 4 Blocks of Literacy Model.

Adolescents on the Autism Spectrum: Music Therapists’ Work with Speech-Language Pathologists

Adolescents on the autism spectrum may experience challenges with multiple domains of communication that impact their quality of life. Both music therapists and speech-language pathologists (SLPs) implement activities to address these challenges. Empirical evidence suggests that incorporating music into treatment can be an effective way to improve communication. The purpose of this article is to provide suggestions for music therapists assisting adolescents on the autism spectrum to improve their communication skills and ways to collaborate with SLPs in doing so. In this paper, we discuss interprofessional collaborative models (e.g., interdisciplinary, transdisciplinary) and competencies (e.g., coordination, adaptability), as well as music-based clinical experiences that appeal to adolescents, and target improvement of communication skills for learners with complex communication needs.

Selecting Communicative Interventions Targets for School-Aged participants with ASD and ID: A Single-Case Experimental Design Meta-analysis

Objective: This meta-analysis reviews the literature on communication modes, communicative functions, and types of augmentative and alternative communication (AAC) interventions for school-age participants with autism spectrum disorders and/or intellectual disabilities who experience complex communication needs. Considering potential differences related to outcomes that were targeted for intervention could help identify the most effective means of individualizing AAC interventions. Methods: We performed a systematic literature search using Academic Search Ultimate, ERIC, PsycINFO, Web of Science, and Proquest Dissertations & Theses Global to retrieve research conducted between 1978 and the beginning of 2020. Studies included in the synthesis are (a) in English; (b) has one or more participants with an intellectual delay, developmental disability(ies); (c) reported the results of an augmentative and alternative communication (AAC) intervention to supplement or replace conventional speech for people with complex communication needs; (d) was a SCED; (e) measured social-communicative outcomes. We synthesized results across studies using multi-level meta-analyses of two case-level effect size metrics, Tau and log response ratio. We conducted moderator analyses using meta-regression with robust variance estimation.Results: Across 114 included studies with 330 participants and 767 effect size, overall Tau effects were moderate, Tau = 0.72, 95% CI [0.67, 0.77], and heterogeneous. For the subset of data series where log response ratio could be estimated, the overall average effect was LRR = 1.86, 95% CI [1.58, 2.13], and effects were highly heterogeneous. There were few statistically significant differences found between moderator categories, which included communication mode, communicative function, and type of AAC implemented.Conclusions: This meta-analysis highlights the potential differences related to outcomes that were targeted for AAC interventions for individuals with ASD and IDD. AAC intervention has been shown to improve communication outcomes in this population. However, there was a lack of sufficient data to analyze for some potential moderators such as insufficient descriptive information on participant characteristics. This is likely due to the heterogeneity of the participants and implementation factors; however, these factors were frequently underreported by original study authors which disallowed systematic analysis. That said, there is a need for more detailed participant characteristic descriptions in original research reports to support future aggregation across the literature. Sponsorship: We received funding for the review from the Institute of Education Sciences.Protocol: The review protocol was registered in the PROSPERO system (CRD42018112428).

Complex Communication Needs of a Child with Dandy-Walker Syndrome and Mucopolysaccharidosis Type II Case Study

There exist few publications describing the cases of children diagnosed with two rare diseases. Most of them are medical case studies. The purpose of the research was to describe the complex communication needs of a child and the resulting needs in the area of me as a person and in the home, social, educational, therapeutic and medical environment. The research involved a boy in early school age diagnosed with the Dandy-Walker syndrome and mucopolysaccharidosis type II (Hunter syndrome). The research was embedded in qualitative orientation using an individual case study. The research was conducted over a period of four years (2016 to 2020). The complex communication needs diagnosed in the boy triggered the following needs in the area of “me as a person”: to notice the effects of one’s actions, to have a sense of being a member of a group, to engage in activities that will help develop one’s own competencies and gain experience, and to be included in group activities. The research suggests that all of the above mentioned needs exist in the home and social environment area. In terms of education, it was determined that there is no need for a teaching assistant/aide who would know alternative methods of communication and could adapt the classroom to multimodal communication and train other persons. In terms of therapy, there was no need to create a controlled space in an institution, as therapy, the same as education, takes place in the boy’s home. In terms of medical care, Adam has all the above mentioned needs.

Augmentative and Alternative Communication in an Elementary School Setting: A Case Study

Purpose: Although there is a strong evidence base supporting the use of augmentative and alternative communication (AAC) in school settings, the research-to-practice gap in this area remains a concern. Few studies have examined how AAC systems are implemented in school settings and whether these systems adequately promote communicative competence for students with complex communication needs. The aim of this case study was to better understand the ways in which elementary-age students with complex communication needs used AAC throughout daily routines. Method: Observations of five students, four receiving services under the category of autism and one under intellectual disability, in school settings were conducted to document the communication function, type of AAC systems used, and the times and activities during which AAC systems were accessible. In addition, supplemental interviews were conducted to understand the rationale for AAC implementation from the perspective of the special education teacher and speech-language pathologist. Results: Overall, findings from the observations and interviews indicated that a variety of AAC modes were utilized. Interactions represented a range of communicative functions, with the exception of social closeness, and were primarily observed during academic activities. However, there were some discrepancies between observations and interview data. Conclusions: Although these findings provide insight into how students with complex communication needs may use AAC in elementary school settings, more research is needed to explore AAC use across a range of students, classrooms, and schools. We present specific future research directions, along with implications and recommendations for AAC teams and researchers.

Supporting Peer Interactions for Students With Complex Communication Needs in Inclusive Settings: Paraeducator Roles

Purpose: This clinical focus article presents a review of literature supporting the importance of fostering positive peer interactions for students with complex communication needs (CCN). A resulting template is included to help guide educational teams, including speech-language pathologists (SLPs), in planning for paraeducator training specific to supporting peer interactions for children with CCN. This clinical focus article summarizes the current literature available on inclusion and peer relationships for students with CCN in general education classrooms and paraeducator roles and training. The World Health Organization's International Classification of Functioning, Disability and Health for Children and Youth framework was consulted to help establish considerations relevant to paraeducator training. With many demands on the time of SLPs throughout the school day, paraeducators may offer an often untapped resource to help support positive peer relationships for students with CCN. Conclusions: This clinical focus article provides an overview of challenges that may impede positive peer relationships from developing in inclusive classroom settings, including ones related to (a) the student with CCN, (b) the peers, (c) the augmentative and alternative communication systems, or (d) the environment. The readers will be provided with a template to guide educational teams and SLPs in collaborating with paraeducators to foster positive peer interactions, including the following steps: (1) define goals for the student with CCN and determine supports required from paraeducators, (2) determine content of training for paraeducators, (3) choose an effective instructional approach, (4) establish a feasible training format, and (5) implement the paraeducator training and evaluate outcomes to ensure benefits for students with CCN and their peers.

Caregivers Acceptance of Using Semantic Communication Boards for teaching Children with Complex Communication Needs

Alternative Communication Boards (ACB) are used to compensate for the difficulties faced by people with complex communication needs. These boards facilitate the construction of telegraphic phrases through visual cues, using colors and pictograms to represent the grammatical class and the meaning of the words, respectively. In this paper, we present the combination of three essential materials to construct a semantic ACB. In this context, a Semantic ACB is a communication board that uses a semantic script to guide the message authoring. The proposal was evaluated using the Technology Acceptance Model (TAM) as a basis. The results demonstrate that caregivers are more interested in a semantic ACB that is useful than in one that is easy to use.

Promoting Social Equality in Inclusive Education: Mapping the Experience of Parents of Children who Rely on Augmentative and Alternative Communication

Inclusive education aims for equal opportunities to be provided to all children regardless of their socioeconomic background, genre, or disability. There are various technological tools that can support the inclusive education of students with complex communication needs. Despite the fact that the parents’ roles in supporting pupils with disabilities is vital, to date, there has been a lack of research investigating the roles of Cypriot parents of these children. The research aim was to explore the experiences of parents on the island who support students with complex communication needs, regarding how they perceive their roles as parents. In-depth interviews were conducted with six parents of children aged five to twelve years. Data were analysed based on thematic analysis. The findings show that parents of children with complex communication needs in Cyprus have a number of roles when it comes to supporting their children in communicating with others. They attend training sessions to acquire the necessary skills to communicate effectively with their children. They also act as communicating partners with friends, relatives and others. In addition, they act as advocates of their children both in the school, as well as in the wider community. It is vital that a number of online platforms are made openly available in order to increase knowledge and skills on issues related to AAC and inclusion. Of note is the MYHUB Inclusion Hub Platform (www.inclusion-hub.eu) which offers a one-stop-shop for inclusion practices, tools, resources and methods addressed to the pedagogical staff in formal and non-formal educational settings.

Identifying the Core Vocabulary for Adults With Complex Communication Needs From the British National Corpus by Analyzing Grouped Frequency Distributions

Purpose This study is aimed to identify the high-frequency vocabulary (HFV), otherwise termed “core vocabulary” for adults with complex communication needs. Method Three major characteristics of the HFV—a relatively small number of different words (NDW), a relatively high word frequency, and a high word commonality across speakers—were examined so as not to lose any candidate words for the HFV. Specifically, instead of applying the traditionally used cutoff word frequency of 0.5‰, a grouped frequency distribution was used to examine the appropriate frequency ranges to determine the HFV candidates. To improve the representativeness of the HFV across ages, social backgrounds, conversation situations, and topics, 330,000 spoken words of 66 adults (29 men and 37 women; M age = 45.47 years, SD = 16.07) were extracted from the British National Corpus database for analysis. Results A distinct pattern of NDW was observed from the frequency of 0.1‰ in the grouped frequency distribution. In total, 671 words were found to be candidates for the HFV, accounting for 90.94% of the total sample words. After the word commonality analysis indicated at least 80% commonality across speakers, 203 words were selected for the final HFV; accountability was calculated at 80.62%. Conclusions With the innovative word analysis approach, this study provided an HFV list that can be used for a wide range of conversation topics. This method provides a scientific and principled approach to identifying and organizing vocabulary for augmentative and alternative communication (AAC) intervention that does not exist in many AAC resources that promote “core vocabulary” with identifying the source for vocabulary selection.

“Two Friends Spending Time Together”: The Impact of Video Visual Scene Displays on Peer Social Interaction for Adolescents With Autism Spectrum Disorder

Purpose Social interaction poses many challenges for adolescents with autism spectrum disorder (ASD) and complex communication needs. The purpose of this study was to investigate the impact of video visual scene displays (video VSDs) on communication during interactions between adolescents with ASD and peer partners. Method This study used an across-participant multiple-baseline single-case experimental design. Four adolescents with ASD and complex communication needs were taught to use video VSDs, presented on a tablet-based app, during social interactions with peer partners in a high school setting. The video VSDs used during the interactions were selected (and programmed with vocabulary) based on the interests of the adolescent with ASD and their peer partner. Results Following the introduction of the video VSD intervention, all four adolescents with ASD demonstrated an increase in communicative turns compared to baseline (Tau- U = 1.0, 95% CI [0.56, 1]), and all four increased in modes of communication used. Increased use of speech also was observed for the three participants who made use of speech prior to the intervention. All participants with ASD (and their peer partners) expressed an interest in continued use of the video VSD app to support social interaction. Conclusion The use of video VSDs may be a viable option to increase the participation and communication of adolescents with ASD during social interactions with peer partners. Supplemental Material https://doi.org/10.23641/asha.16734532