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A Review of Speech Generating Device Use in Autism Spectrum Disorder

Amanda Weil, Sandra Heidt, Deborah Sons and

Dr. Valerie Boyer, Project Supervisor Southern Illinois University

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Background

  • Extension of previous work on SIU’s Center for Autism Spectrum Disorder on augmentative and alternative communication (AAC)
    • AAC=multiple ways to communicate (including high-tech devices) that can supplement or compensate for individuals with difficulty expressing wants, needs, and comments.
    • Abandonment=AAC system recommended but not used
    • Rejection=an individual refuses the device

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  • Sandra’s story
  • Purpose: gather literature and resources on speech generating device use in ASD and why a family may abandon/reject a device

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  • Why does this matter?
    • Research shows AAC enables more than 2 million children and adults to communicate
    • As many as three out of five AAC devices are abandoned or rejected

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Methods

  • Literature review
    • Peer-reviewed research
    • SLP resources/blogs
    • Lived experience
    • Conversations with professionals

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  • Develop resource guide and PowerPoint presentation
  • Target audience: Speech-language pathologists (SLPs) working with adults and families with children 2-6 years of age, living with ASD and a speech delay

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SLP Perspectives in AAC Abandonment

  • SLPs play an important role in reducing AAC abandonment
    • SLPs work in specific/specialized contexts such as at clinics and classrooms in 15-45 minute sessions
  • As SLPs, how do we promote the generalization of AAC use and decrease AAC abandonment?

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AAC Abandonment/Rejection

  • Staff shortages
  • Whole-staff trainings at schools (e.g., paraprofessionals, special education teachers)
  • Accessibility of devices and tools
  • Lack of family centered approaches and family training
  • Insufficient/outdated training in graduate school
  • Overwhelming workload
  • Effective AAC requires time SLPs do not have & generalization in environments
  • Lack of bilingual/multilingual SLPs

SLP perspectives include:

  • Family buy-in/weren’t included in decision making
  • Capacity amongst settings
  • Intelligence levels
  • Clinician perspectives
  • Availability/cost
  • Multicultural differences/language
  • Parent training/resources
  • Waiting lists for services
  • Parent grief/loss as a contributor

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Parent perspectives include:

Why does AAC abandonment occur?

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SLPs can Reduce Abandonment during High-Tech Device Selection

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  • Choose programs based on priorities for individual user
    • Symbols, words available, access mode, display, vocabulary arrangement

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  • What other factors do we consider?
    • Attention, memory, executive functioning, motor abilities
      • Types of navigation systems (semantic categories vs. word association)

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  • The importance of a robust language system
    • 300+ core words, word classes, morphological changes, supports motor automaticity, allows for planned growth, text-to-speech, word prediction

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Accessing the Device and Initial Parent Training

Physical Accessibility

Display Features

Parent Training

    • Symbols in consistent location and organized by color

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    • Cartoon or real images produce similar results in communication efficiency

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    • Customizable enhanced cursors and animation
    • Keyguards, stylii, and device stands for fine motor skills

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    • Eye gaze and head tracking features for difficulties with gross motor skills
    • Online training effective

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    • Train in natural environment, formal training, opportunities for practice and feedback

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    • Support and communication with trained SLP

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High-Tech Device Selection Continued

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  • Consult SLP who is trained in AAC assessment or AT (assistive technologist)
    • WATI Assistive Technology Consideration to Assessment, Functional Communication Profile - Revised, Dynamic Assessment Goals Grid, Communication Matrix, SETT framework

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  • Trial different devices
  • There is no “one-size fit all” approach

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SLPs can Reduce Abandonment through Implementation

  • Survey results substantiate SLP’s feel they had inadequate AAC coursework and clinical training
  • The current model lacks interprofessional participation and collaboration
    • Support assistive technologist, paraprofessionals, families, occupational therapists, and special education teachers on teams

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  • “Having an AAC device doesn’t make you a communicator any more than having a piano makes you a musician” (Beukelman, 1991)

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  • Consider - how long and how much teaching does it take to learn a new language?

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Effective Implementation: Including Parents

Simple solutions to support families include:

  • Seek family vocabulary/language history through surveys/questionnaires
  • Learn about inclusive practices
  • Use alternative tools to show AAC (viewing/creating personal or YouTube videos)
  • Allow use of dual methods of teaching with AAC device (e.g., visual cards, symbol boards, gestures, sign language)
  • Be accessible/work around family schedules
  • Have family start a journal for discussing failures and questions
  • Join an online/in-person AAC community

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Effective Implementation: S’MORRES

  • Partner Augmented Input is a powerful, evidence-based approach in which communication partners point to the symbols on the child’s communication board or device while simultaneously talking.”

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  • Dr. Jill Senner, owner of Technology and Language Center
  • Matthew Baud, Assistive Technology Coordinator at Niles Township District for Special Education

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Key AAC Takeaways

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  • AAC systems have multiple components (gestures, communication boards, high-tech devices)
  • There is a wide variety of high-tech devices
  • Learning to use an AAC device is like learning a new language
  • Once a device is selected, consider quality implementation

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  • Role of technology
    • “For people without disabilities, technology makes things easier. For people with disabilities, technology makes things possible” (IBM Training Manual, 1991)
  • HB #5354 (Amends the Customized Employment for Individuals with Disabilities Act) , Assistive Technology Act, IDEA, DD Act, Rehabilitation Act includes AAC

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Fact Sheet

Treatment planning fact sheet created for AAC team and families

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Community Resources

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    • Treatment planning fact sheet created for AAC team and families
    • Comparing AAC language programs for AAC team and families
    • 6 Steps of Thematic Analysis Survey/a Component of AAC Assessment
    • The Communication Capability Approach/Dynamic AAC Assessment
    • Accessibility and Parent Training Fact sheet
    • The Illinois Assistive Technology Program (IATP)
      • https://iltech.org/
    • Great Lakes ADA Center Accessible Information Technology (AIT) Initiative
      • www.adagreatlakes.org/AIT/
    • The Arc of Illinois AT Resource Flyer
      • https://www.thearcofil.org/

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Acknowledgements

Special thanks to our supervisor Dr. Valerie Boyer.

Valerie E. Boyer is a tenured Associate Professor in the Communication Disorders and Sciences program.Dr. Boyer holds a Ph.D. in Special Education (2006) and M.S. in Communication Disorders and Sciences (2000), both from Southern Illinois University Carbondale. She is a licensed speech-language pathologist holding a Certificate of Clinical Competence (CCC).

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Center for Autism Spectrum Disorders

https://casd.siu.edu/

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Also, thank you to LEND faculty, Dr. Katie Arnold, and our fellow LEND trainees for their support.

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Wilkinson KM, Madel M. Eye Tracking Measures Reveal How Changes in the Design of Displays for Augmentative and Alternative Communication Influence Visual Search in Individuals With Down Syndrome or Autism Spectrum Disorder. Am J Speech Lang Pathol. 2019;28(4):1649-1658. doi:10.1044/2019_AJSLP-19-0006

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