Augmentative and Alternative Communication Telepractice During the COVID-19 Pandemic: A National Survey of Speech-Language Pathologists

Purpose: The novel coronavirus (COVID-19) pandemic has led to sudden, widespread use of telepractice, including providing services to children who use aided augmentative and alternative communication (AAC). This exploratory study examined speech-language pathologists' (SLPs) experiences using telepractice to provide services to children and youth aged 3–21 years who used aided AAC during the earlier months of the pandemic (May–June 2020). Method: Three hundred thirty-one SLPs responded to an online survey. Closed- and open-ended survey items were analyzed quantitatively and qualitatively and mixed at the point of interpretation to understand the experiences of SLPs related to the use of telepractice with children who use aided AAC, including how they perceived effectiveness. Results: Most SLPs were using telepractice to provide both direct and consultation/coaching services to children who used aided AAC. There was fairly wide variation in perceptions of effectiveness of both types of services, but SLPs were more likely to rate consultation/coaching services as being more effective than direct services. SLPs identified factors impacting effectiveness across five dimensions: broader factors, practice-based factors (i.e., technology, the type of services), the child, parents and family members, and professionals. School-based SLPs perceived telepractice as being less effective than non–school-based SLPs. Conclusions: The use of telepractice during the COVID-19 pandemic has unfolded quite differently for different SLPs and the children who use aided AAC that they serve. Although AAC telepractice offers promise for the future, particularly for partnering with families, further research is needed to know how to overcome challenges experienced by SLPs. Supplemental Material https://doi.org/10.23641/asha.17139434

The Effectiveness of Aided AAC Modeling for Belizean Children: A Case Study

Purpose Augmentative and alternative communication (AAC) interventions have been deemed efficacious. However, even with the medium to large effect sizes, there is a paucity of research investigating the effects of aided modeling on expressive outcomes for children from multicultural and multilingual backgrounds. Method This case series study examined the effectiveness of aided AAC modeling on aided and unaided expressive output (i.e., one- and two-symbol messages) in three children from different cultures in Belize (one Creole and two Mestizo) in a preschool-like group setting. Additionally, treatment intensity metrics (i.e., number of sessions, number of minutes, and number of aided/unaided models) were analyzed to determine whether this was an appropriate intensity for children in Belize. Results Results indicated that all children increased their aided and unaided symbol message production within five intervention sessions lasting 180 min per day (15 hr total). Additionally, the average number of aided/unaided models, sampled several times over the course of 5 days, was 43.75 per 15-min period. Conclusions Aided AAC modeling intervention was beneficial for these children. However, the length of each session (3 hr) may have negatively impacted expressive outcomes. The number of models per 15-min period was beneficial and in line with previous research outcomes. The multicultural clinical implications are also discussed.

Child–Parent–Provider Interactions of a Child With Complex Communication Needs in an Inpatient Rehabilitation Facility: A Pilot Study

Purpose Children with complex medical needs often require extensive hospitalizations in the first years of life. Many of these children also experience complex communication needs and use augmentative and alternative communication (AAC) strategies to interact with health care staff. Unfortunately, suboptimal communication experiences have been reported among these children, their families, and hospital staff; however, no studies have described the patterns of interactions beyond measures of self-report. The purpose of this study was to describe child–parent–provider interaction patterns that occurred in an inpatient unit. Method Observational techniques were used to systematically describe the interactions of a 28-month-old child with complex communication needs, her parents, and 26 health care providers on an inpatient rehabilitation unit over 10 days. Results Results indicated that substantial variability in the child's routine occurred across days and providers. Interactions were generally short and occurred for only a small proportion of the child's waking hours. The child and her mother actively communicated to varying degrees across sessions, yet health care providers often dominated interactions. The child used multiple modes of communication in each interaction; however, no aided AAC systems were used despite availability. Conclusions Training is urgently required to equip health care providers to (a) incorporate the use of aided AAC strategies during inpatient interactions and (b) increase the active participation of both children with complex communication needs and their parents during these interactions. Supplemental Material https://doi.org/10.23641/asha.13345187

A Scoping Review of the Involvement of Children's Communication Partners in Aided Augmentative and Alternative Communication Modeling Interventions

PurposeThe purpose of this study was to inform practice and research by identifying and synthesizing research on interventions in which natural communication partners implemented aided augmentative and alternative communication (AAC) modeling strategies.MethodA scoping review yielded 29 studies. Data were charted related to participant characteristics, intervention characteristics, partner instruction and assessment, and partner perspectives of social validity.ResultsMore than 157 peer and 100 adult communication partners (e.g., parents, special educators, paraprofessionals) implemented aided AAC modeling strategies within included studies. To teach communication partners intervention strategies, researchers frequently reported using (a) oral instruction, (b) modeling, and (c) practice or application opportunities with performance feedback. Partner instruction frequently involved both training and concurrent support (e.g., coaching, facilitation, consultation, follow-up support).ConclusionFindings from this review inform the design and delivery of aided AAC modeling interventions by children's natural communication partners. Findings also highlight important avenues for enhancing the rigor of future research on interventions involving aided AAC modeling, including the quality of reporting and application of principles from implementation science.Supplemental Materialhttps://doi.org/10.23641/asha.8038505

Systematic Review of Interventions Involving Aided AAC Modeling for Children With Complex Communication Needs

Building the communicative competence of individuals who use augmentative and alternative communication (AAC) requires intervention and support. This systematic review examined experimental studies involving aided AAC modeling to promote the expressive communication of children and youth (i.e., birth to age 21) with complex communication needs. A search yielded 48 studies involving 267 participants. Interventions were categorized according to three different approaches to aided AAC modeling—augmented input, models as prompts, and models within instructional demonstrations. Although the procedures varied, interventions were generally effective at improving diverse measures of expressive communication. This review provides insight for both researchers and practitioners by describing interventions involving three distinct approaches to aided AAC modeling, highlighting areas needing future research, and offering implications for practice.