The Added Effect of Visual Scene Display AAC Within A Naturalistic Developmental Behavioral Intervention for Young Children on the Autism Spectrum with Minimal Speech
Open Access
- Author:
- Pope, Lauramarie Elizabeth
- Graduate Program:
- Communication Sciences and Disorders
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 13, 2023
- Committee Members:
- Diane Williams, Program Head/Chair
Jessica Caron, Major Field Member
Diane Williams, Major Field Member
David Lee, Outside Unit & Field Member
Janice Light, Chair & Dissertation Advisor - Keywords:
- augmentative and alternative communication
autism
beginning communicators
naturalistic developmental behavioral interventions
augmentative and alternative communication
autism
beginning communicators
naturalistic developmental behavioral interventions - Abstract:
- Many children on the autism spectrum struggle significantly in their early language development, entering kindergarten with little or no functional speech (Kasari et al., 2014; Rose et al., 2016). Naturalistic developmental behavioral interventions (NDBIs) are a promising approach for supporting early language and communication development for young children on the autism spectrum (e.g., Sandbank et al., 2020). NDBIs blend developmental principles with behavioral intervention strategies within naturalistic environments to support child development across domains (Schreibman et al., 2015). However, the children with the greatest need of language supports – those with minimal speech – have limited means to participate within these interventions and are therefore the least likely to benefit from traditional NDBIs that focus primarily on speech production (Kasari et al., 2014). Augmentative and alternative communication (AAC) offers children on the autism spectrum with limited speech the potential means to enhance communication and participate effectively in the interactions needed to support early language and communication development. To date, only one study has directly investigated the impact of adding traditional, grid-based AAC supports into a preexisting NDBI, with promising results (Kasari et al., 2014). However, grid-based AAC systems can still constrain access to contextually-relevant and motivating vocabulary, effectively limiting critical language learning opportunities. No research has explored incorporating AAC systems that have been specifically designed to support early language and communication development into the context of an NDBI. The proposed study aimed to fill this gap by investigating the effect of integrating visual scene display (VSD) AAC supports with “just-in-time” programming and aided AAC input within an NDBI framework for young children on the autism spectrum with minimal speech. VSD systems capture the contexts in which language is learned and used through photographs, embed vocabulary within these familiar scenes, and support quick and easy programming of new vocabulary during interactions in response to children’s interests (Holyfield, Caron, & Light, 2019). These systems give children access to dynamic, contextually relevant, and motivating vocabulary, supporting active engagement within early language learning contexts. In addition, aided AAC input consists of communication partners augmenting their own spoken input by selecting relevant vocabulary on the aided AAC system (O’Neill et al., 2018). Strong evidence indicates that aided AAC input is highly effective in supporting communication and vocabulary development for individuals with limited speech (O’Neill et al., 2018). Using a single case, multiple-probe across participants design, the current study investigated the impact of adding VSD-based AAC supports with just-in-time programming and aided AAC input into NDBI procedures on the total number of symbolic communicative turns taken during 10-minute interactions by young children on the autism spectrum with minimal speech. The following collateral variables were also explored: (a) the cumulative number of unique vocabulary concepts expressed; (b) the communication modality of symbolic turns expressed by participants (e.g., speech, gestures, aided AAC); (c) characteristics of the most frequent expressive vocabulary concepts; (e) characteristics of vocabulary programmed just-in-time in response to participants’ interests; and (f) comprehension of the spoken word for book-related concepts. Results of a caregiver social validity questionnaire are also reported. Participating children were all in the First Words stage of language development (as defined by Tager-Flusberg et al., 2009), indicating that they were in the process of developing an initial corpus of single word expressive communication. During this period of language development, acquiring a robust vocabulary and developing formative social communication skills is critical to establishing the essential building blocks needed to support later language growth, such as word combinations. Participant performance in baseline on (a) the number of symbolic communicative turns per session, (b) the cumulative number of unique vocabulary concepts expressed, and (b) the communication modality of symbolic turns was compared to intervention, with the addition of VSD AAC supports and aided AAC input. All participants tended to take more turns each session and add new expressive vocabulary more rapidly in intervention than in baseline, though with notable variation across participants. Participants generally communicated most frequently using gestures in baseline and aided VSD AAC during intervention, with no notable change in the low rates of speech production across phases. Overall, the ten most frequent expressive vocabulary concepts for each participant consisted mostly of nouns, though with a notable number of verbs. However, interjections (e.g., “Oh, no!” “Wheee!”) were also often at the top of participants’ high frequency vocabulary lists. Vocabulary programmed just-in-time also consisted primarily of nouns. Lastly, participants performed at chance levels identifying the spoken words for book-related vocabulary pre-selected by the researcher across study phases. However, for half of the participants, accuracy was above chance levels on a post-hoc individualized comprehension measure of spoken language that targeted the vocabulary concepts communicated most frequently by each participant (50-70% accuracy). The results of this study indicate that including VSD-based aided AAC systems and strategies designed to support beginning communicators within the framework of an NDBI can increase both the communication frequency and expressive vocabulary of children on the autism spectrum with minimal speech, beyond the effects of NDBI procedures alone. Additionally, these results demonstrate that, when given greater agency over their communication, the expressive vocabularies of children on the autism spectrum with minimal speech in the First Words stage of language development consist predominantly of nouns, with some concrete verbs and interjections, as is common in early language development of neurotypical children who use speech (McDonough et al., 2011). Lastly, study outcomes suggest that the connection between expressive use of aided AAC vocabulary and understanding of the spoken word is complex, requiring further investigation. These results demonstrate the positive impact of intervention strategies that combine the strengths of NDBIs and developmentally appropriate AAC intervention on both social pragmatic (turn taking) and semantic (vocabulary growth) development. In addition, this study lays the foundation for future research expanding NDBI and AAC research into new contexts, with a variety of communication partners, and with more fine-grained comparisons between intervention components.