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Purpose: Miniature linguistic systems (also known as matrix training) is a method of organizing learning targets to achieve generative learning or recombinative generalization. This systematic review is aimed at determining whether matrix training is effective for individuals with autism spectrum disorder (ASD) in terms of improving recombinative generalization for instruction-following, expressive language, play skills, and literacy skills. Method: A systematic review methodology was employed to limit bias in the various review stages. A multifaceted search was conducted. Potential primary studies were imported into Covidence, a systematic review software, and inclusion criteria were applied. Data were extracted regarding (a) participant characteristics, (b) matrix designs, (c) intervention methods, and (d) dependent variable. A quality appraisal using the What Works Clearinghouse (WWC) Single-Case Design Standards (Version 1.0, Pilot) was carried out. In addition to the visual analysis of the data, an effect size estimate, non-overlap of all pairs (NAP), was generated for each participant. Independent t tests and between-subjects analyses of variance were conducted to identify moderators of effectiveness. Results: Twenty-six studies including 65 participants met criteria for inclusion. All included studies were single-case experimental designs. Eighteen studies received a rating of "Meets Standards Without Reservations" or "Meets Standards With Reservations." The aggregated combined NAP scores for acquisition, recombinative generalization, and maintenance of a range of outcomes were in the high range. Conclusions: Findings suggested that matrix training is an effective teaching method for individuals with ASD for acquisition, recombinative generalization, and maintenance of a range of outcomes. Statistical analyses to identify moderators of effectiveness were insignificant. Based on the WWC Single-Case Design Standards matrix training meets criteria to be considered an evidence-based practice for individuals with ASD.

Many children with autism spectrum disorder (ASD) demonstrate poor comprehension of language at the sentence level in both the spoken modality and the graphic symbol modality. This study explored whether children with ASD are able to follow directives when presented with a graphic symbol sentence that includes an animated symbol for a verb. A total of five participants with moderate-to-severe ASD were presented with 10 graphic symbol sentences and asked to perform the directive using the provided figurines/objects. Results demonstrated that children with ASD can correctly carry out full-sentence directives to varying degrees when the directives represented graphically include an animated verb. Several observations were noted pertaining to participants' performance and autism severity. The results of this study may have important implications for using animation as a tool to facilitate symbol syntax comprehension.

The purpose of this study was to investigate the effects of interface display and respondent group on listener attitudes toward and perceived communicative competence of persons with aphasia. The Attitudes Toward Nonspeaking Persons scale and the Communicative Competence Scale was used to measure listener attitudes and communicative competence, respectively. A 2 × 3 mixed factorial design was used. Interface display videos served as the within-subjects variable (i.e., grid and scene displays), and the respondent group served as the between-subjects variable. A total of 113 respondents (i.e., undergraduate lower-division students, undergraduate upper-division students, and family caregivers of individuals with aphasia) watched an individual with aphasia using a grid display in one video and a scene display in another video. The respondents completed the two scales. Significant main effects (p < 0.05) were found for interface display and respondent group. The use of scene displays had a more favorable impact on competence ratings than the use of grid displays. Family caregiver ratings were significantly (p < 0.05) more favorable than ratings from other groups. The Communicative Competence Scale was found to be a reliable measure of perceived communicative competence. Scene displays have the potential to enhance the perceived communicative competence of this population.

Smartwatches may provide a natural, portable, and unobtrusive strategy by which to support directive-following for individuals with autism spectrum disorders (ASD). A mentor can send visual supports (e.g., photographs, videos, text) "just-in-time" (JIT) to a learner's smartwatch. This may reduce the need for extraneous face-to-face intervention within social and educational settings and thereby preserve the naturalness of interactions for individuals with ASD. In this article, the following questions are explored: (1) Will some children with ASD with limited functional speech tolerate wearing a smartwatch after receiving only spoken instructions? (2) Can children with ASD who did not initially tolerate wearing a smartwatch increase their tolerance for wearing a smartwatch after they view video models within a visual schedule? and (3) Will children with ASD who tolerate wearing a smartwatch attend to, and follow, scene cue text messages received on the watch? Results provide preliminary evidence for the feasibility of using a smartwatch with children with ASD. Limitations of this study are addressed and implications for future research are posited.

For this study, 11 children with moderate to severe autism spectrum disorder (ASD) were given directives containing prepositions in three cue conditions: (a) spoken alone, (b) a short video clip along with spoken cues, and (c) a sequence of three graphic symbols accompanied by spoken cues. Participants followed directives significantly more accurately with the video clip than with spoken cues only, and significantly more accurately with spoken cues only relative to the sequence of graphic symbols. Results suggest that the short video clip along with spoken cues may be an optimal mode for enhancing learners' ability to follow directives containing prepositions. In addition, results reveal three statistically significant correlations between participants' preexisting skills and directive-following accuracy: a positive correlation between spoken preposition preassessment total score and accuracy in the spoken-alone condition; a positive correlation between spoken noun preassessment total score and accuracy in the video-clip condition; and a positive correlation between ASD severity and the need for repetition in the video-clip condition. Results also suggested that, for children with more severe ASD symptoms, the video clips require repetitions so that the relationships illustrated within it can gain more semantic salience. Implications for clinical practice and future research are discussed.

Purpose: The effects of animation on identification of graphic symbols for verbs were studied using the Autism Language Program Graphic Symbols Set in children diagnosed with mild-to-severe autism spectrum disorder between the ages of 3 and 7 years. Method: The participants were randomly assigned to an animated symbol condition or a static symbol condition. Static symbols were spliced from the animated symbols to ensure that the symbols differed only in terms of the absence or presence of movement. The participants were asked to identify a target symbol among foils given the spoken label. Results: There were no significant differences between the groups with respect to chronological age, autism severity, and receptive target verb knowledge. An independent "t" test revealed that animated symbols were more readily identified than static symbols. Conclusions: Animation enhances the identification of verbs in children with autism spectrum disorder. Clinicians are encouraged to take advantage of animation when introducing graphic symbols representing verbs. Limitations and implications for future research are discussed.

Facilitated communication (FC) has been a heavily debated and documented topic across multiple disciplines, including sociology, education, psychology, pediatrics, speech-language pathology, and disability studies. Although many professionals from various disciplines and advocates have offered opinions, suggestions, and research on the topic, there has been minimal input from the occupational therapy (OT) profession. The lack of OT input is noteworthy as OTs are experts in enabling upper extremity performance and independence through a variety of training, adaptation and modification strategies, and use of external supports. Because of their professional code of ethics and a specific knowledge base, OTs are uniquely positioned to provide a host of ethical and evidence-based strategies that enable independent access to communication technology. The consideration of multiple access options is contrary to the typical facilitated encounter where facilitators exclusively choose to manipulate an upper extremity in order for letters to be selected on a display or keyboard. The purpose of this paper is threefold: (a) To offer insight into the standard of care by OTs including their ethical standards; (b) to identify varied accommodations that enable access using a feature-matching standard of care that eliminates the need for a facilitator; and (c) to highlight how to increase independent assistive technology/augmentative and alternative communication access, thus dissuading the need or use of facilitated access to letters. [ABSTRACT FROM AUTHOR]

Objectives: Everyday technologies (e.g. iPads, smart phones, Apple Watch®) might be successfully repurposed to meet the needs of children with disabilities. Although visual supports are an empirically supported treatment, they are typically not provided just-in-time (JIT). In this study, we aimed to provide JIT visual supports in the form of scene cues (representative photos or video clips) to augment spoken input to children with a dual diagnosis of intellectual disability and autism. The objectives of this study were to (a) explore whether JIT-delivered scene cues permit these children to implement directives they were unable to complete with speech alone, and (b) test the feasibility of providing scene cues on the Apple Watch® with a focus on display size. Methods: Using a case series design, five children with an intellectual disability and autism were presented with directives and required to carry out the directives with figurines and objects as a table top activity. Initially, each directive was presented in spoken form only, and static scene cues (photos) and subsequently dynamic scene cues (video clips) were provided as augmented input as needed (JIT). Results: The hierarchical JIT visual supports enabled the five children with intellectual disability and autism to carry out the majority of directives. Conclusions: The relatively small display size of the Apple Watch does not seem to hinder children with a dual diagnosis of intellectual disability and autism to glean critical information from visual supports. The JIT provision of scene cues resulted in successful directive-following in these children.

Using augmented input might be an effective means for supplementing spoken language for children with autism who have difficulties following spoken directives. This study aimed to (a) explore whether JIT-delivered scene cues (photos, video clips) via the Apple Watch® enable children with autism to carry out directives they were unable to implement with speech alone, and (b) test the feasibility of the Apple Watch® (with a focus on display size). Results indicated that the hierarchical JIT supports enabled five children with autism to carry out the majority of directives. Hence, the relatively small display size of the Apple Watch does not seem to hinder children with autism to glean critical information from visual supports.

Purpose: The effects of animation on naming and identification of graphic symbols for verbs and prepositions were studied in 2 graphic symbol sets in preschoolers. Method: Using a 2 × 2 × 2 × 3 completely randomized block design, preschoolers across three age groups were randomly assigned to combinations of symbol set (Autism Language Program [ALP] Animated Graphics or Picture Communication Symbols [PCS]), symbol format (animated or static), and word class (verbs or prepositions). Children were asked to name symbols and to identify a target symbol from an array given the spoken label. Results: Animated symbols were more readily named than static symbols, although this was more pronounced for verbs than for prepositions. ALP symbols were named more accurately than PCS in particular with prepositions. Animation did not facilitate identification. ALP symbols for prepositions were identified better than PCS, but there was no difference for verbs. Finally, older children guessed and identified symbols more effectively than younger children. Conclusions: Animation improves the naming of graphic symbols for verbs. For prepositions, ALP symbols are named more accurately and are more readily identifiable than PCS. Naming and identifying symbols are learned skills that develop over time. Limitations and future research directions are discussed.

The burgeoning role of technology in society has provided opportunities for the development of new means of communication for individuals with Autism Spectrum Disorders (ASD). This paper offers an organizational framework for describing traditional and emerging augmentative and alternative communication (AAC) technology, and highlights how tools within this framework can support a visual approach to everyday communication and improve language instruction. The growing adoption of handheld media devices along with applications acquired via a consumer-oriented delivery model suggests a potential paradigm shift in AAC for people with ASD.

Purpose: The effects of animation on transparency, name agreement, and identification of graphic symbols for verbs and prepositions were evaluated in preschoolers of 3 age groups. Methods: A mixed-group design was used; in each age group, half of the children were randomly allocated to 1 of 2 orders of symbol formats. The 52 children were asked to guess the meaning of symbols and to identify a target symbol among foils given the spoken label. Results: Animated symbols were more transparent than static symbols, although this was more pronounced for verbs. Animated verbs were named more accurately than static verbs, but there was no difference between animated and static prepositions. Verbs were identified more accurately compared with prepositions, but there was no difference between symbol formats. Older children guessed, named, and identified symbols more effectively than younger children. Conclusion: Animation enhances transparency and name agreement, especially for verbs, which reduces the instructional burden that comes with nontransparent symbols. Animation does not enhance identification accuracy. Verbs are easier to identify than prepositions. A developmental effect was observed for each measure. Limitations and implications for future research are discussed.

Purpose: This systematic review aimed to determine the effects of augmentative and alternative communication (AAC) intervention on speech production in children with autism or pervasive developmental disorder-not otherwise specified. Method: A systematic review methodology was utilized to limit bias in searching, selecting, coding, and synthesizing relevant treatment studies. This involved a multifaceted search for studies written between 1975 and May 2007 using various bibliographic databases, dissertation databases, hand searches of selected journals and published compilations of AAC theses and dissertations, and ancestry searches. To be included, studies had to meet stringent criteria. A coding manual and form facilitated data extraction in terms of participant characteristics, treatment characteristics, design and measurement, and outcomes. Results: Nine single-subject experimental design (27 participants) and 2 group studies (98 participants) were included. Results indicated that AAC interventions do not impede speech production. In fact, most studies reported an increase in speech production. However, in-depth analyses revealed that the gains were rather modest. Conclusions: Although AAC interventions do not appear to impede speech production and may result in increased speech production, the modest gains observed require realistic expectations among clinicians and other stakeholders. Future research should be more hypothesis driven and aim to identify predictive child characteristics, such as prior speech imitation and object exploration skills. (Contains 5 tables and 1 footnote.)

Research on graphic symbol learning suggests that symbols with a greater visual resemblance to their referents (greater iconicity) are more easily learned. The iconicity hypothesis has not yet been explored within the intervention protocol of the Picture Exchange Communication System (PECS). Within the PECS protocol, participants do not point to a symbol but exchange the symbol for an object. The purpose of this study was to examine whether children learn to request more readily with PECS when the symbols involved are highly iconic versus symbols that are low in iconicity. An adapted alternating treatments design combined with a multiple baseline design across subjects was used to evaluate the effectiveness and efficiency of symbol learning under two conditions: high iconicity and low iconicity. Four students with autism or pervasive developmental disorders between the ages of six and nine years participated. Results indicated that students learned to request desired objects under both conditions, lending further support for the effectiveness of PECS. There was little to no difference, however, in the effectiveness and efficiency of requesting between the two conditions during Phases I and II of PECS training. Thus learners do not benefit from symbols that bear more resemblance with their referents during the first two phases of PECS instruction. (Contains 1 table and 2 figures.)

Requesting is often taught as an initial target during augmentative and alternative communication intervention in children with autism. Speech-generating devices are purported to have advantages over non-electronic systems due to their synthetic speech output. On the other hand, it has been argued that speech output, being in the auditory modality, may not be compatible with the processing preferences of learners with autism. The purpose of this study was to evaluate whether five children with autism and little or no functional speech learn to request more efficiently when provided with speech output during instruction (SPEECH condition) rather than without speech output (NO-SPEECH condition). A secondary purpose was to monitor changes in natural speech production. An adapted alternating treatments design was used to evaluate the relative effectiveness and efficiency of both conditions. The results showed frequent requesting under both conditions. Two students requested more effectively with speech output and one student requested more effectively without speech output while there was no difference for the remaining two students. In terms of elicited vocalizations, only one student showed some improvement. The other children did not show any improvement in natural speech production. These data extend previous research on the effects of speech output on requesting in children with autism.

Evidence-based practice (EBP) is increasingly being advocated as the preferred approach to practice in augmentative and alternative communication (AAC). The EBP process involves multiple steps. The asking of a well-built question is the first step in the quest for answers. At the same time it is also often the first stumbling block for practitioners. To facilitate the asking of well-built questions it may be helpful to follow a template. The most frequently used template is PICO, which stands for patient, intervention, comparison, and outcome [Richardson, W., Wilson, M., Nishikawa, J., & Hayward, R. (1995). The well-built clinical question: A key to evidence-based decisions. "ACP Journal Club," 123, A12-A13]. In this article, we examine the suitability of the PICO template for AAC in terms of the representativeness of the components, and the appropriateness of its subcomponents, and their terminology. Based on this analysis, we propose the PESICO template, which stands for person, environments, stakeholders, intervention, comparison, and outcome. This template is then illustrated with examples representing a range of decision-making areas in AAC. Finally, directions for future research are provided. Learning outcomes: The reader will be able to: (1) appreciate the importance of asking well-built questions, (2) name the shortcomings of the PICO template, and (3) describe the components of the proposed PESICO template for asking well-built questions.

This study evaluated the effectiveness of pyramidal training with direct care staff in group homes. Training focused on teaching staff how to provide opportunities for communication to non-speaking children with developmental disabilities to communicate. Staff were taught through a combination of a workshop, and nondirective consultation following an adult education model. A multiple-probe design across three cohorts of direct care staff was used to evaluate the effectiveness of the training in terms of the number of opportunities provided by staff and the percentage of requests emitted by participating children. Results showed that pyramidal training resulted in more opportunities provided to the children and concurrent increases in children's requesting. Results are discussed in terms of the suitability of pyramidal training for group home settings, and implications for future research. (Contains 1 figure.)

Background: Efficient library searches for research evidence are critical to practitioners who wish to engage in evidence-based practice (EBP) as well as researchers who seek to develop systematic reviews. Aims: This review will propose the benefits of the search technique "Pearl Growing" ("Traditional Pearl Growing") as well as an adaptation of this technique ("Comprehensive Pearl Growing"), until now ignored by the literature on EBP and systematic reviews, to aid in the retrieval of research evidence. These search techniques are illustrated with examples from the field of augmentative and alternative communication. Main Contributions: Traditional Pearl Growing is proposed as an important addition to the arsenal of EBP search strategies for practitioners. The literature on Traditional Pearl Growing is extended in that EBP presents a newly identified purpose for this technique and the benefits in identifying appropriate quality filter goes beyond its previously exclusive focus on keywords. Comprehensive Pearl Growing is projected as a new strategy for researchers searching for studies to be included in systematic reviews. Not only does it provide data-based guidance in selecting effective keywords and quality filters, but also it provides appropriate databases. Conclusions: Although the techniques Traditional Pearl Growing and Comprehensive Pearl Growing are believed to be useful for locating research evidence in any field, it may be particularly important for interdisciplinary topics where the use of effective controlled vocabulary plays a greater role in bringing together evidence that may be scattered across databases. (Contains 1 note and 4 tables.)

In this systematic replication of a previous study (R. W. Schlosser, D. M. Blischak, P. J. Belfiore, C. Bartley, & N. Barnett, 1998), the effects of speech and print feedback on spelling performance were evaluated. Four children with autism and no functional speech were taught to spell words with a speech-generating device under 3 feedback conditions. In the auditory-visual condition, children received both speech and print feedback, whereas in the auditory and visual conditions, only 1 type of feedback was provided. An adapted alternating treatments design was used. All 4 children reached criterion across conditions. Although 3 children reached criterion first with print or speech-print feedback, 1 child was most efficient with speech-print followed by speech feedback. Based on the findings of both studies, 2 distinct profiles of feedback efficiency are proposed. Children that exemplify the primarily visual profile spell words most efficiently when feedback involves print. Children that fit the auditory profile spell words most efficiently when feedback involves speech. The implications for understanding the learning characteristics of children with autism, as well as those for practice and further research are derived.KEY WORDS: assistive technology, augmentative and alternative communication, autism, feedback, intervention, literacy, speech-generating device, spelling, synthetic speech

Evaluation of client progress is an important topic in communicative disorders research and clinical literature. Goal attainment scaling (GAS) is a technique for evaluating individual progress toward goals. Despite recognition of GAS as a clinical-outcome assessment technique in other clinical professions, the current debate on measuring client progress and outcome measurement in communication disorders has largely ignored GAS. The purpose of this paper is threefold: (a) to introduce GAS to the field of communication disorders, (b) to offer a critical review, and (c) to explore directions for harnessing the value of GAS for the field. In addition to the ability of GAS to evaluate individualized longitudinal change, it offers the following positive attributes: (a) grading of goal attainment, (b) comparability across goals and clients through aggregation, (c) adaptability to any International Classification of Functioning, Disability, and Health levels and domains, (d) versatility across populations and interventions, (e) linkage tied to expected outcomes, (f) facilitator of goal attainment, and (g) a focal point for team energies. The unique value of GAS could render this technique as a welcomed addition to the present set of options available to clinicians interested in assessing progress and evaluating change. Reliability and validity of GAS will be discussed. Finally, directions for harnessing the potential of GAS for communication disorders are offered for clinical practice and clinical-outcome research. Learning outcomes: (1) As a result of this activity, the participant will be able to delineate the steps involved in GAS. (2) As a result of this activity, the participant will be able to describe the positive attributes of GAS as a method for assessing client progress. (3) As a result of this activity, the participant will be able to identify issues that enhance the reliability and validity of GAS.

This study evaluated effects of training a school team in use of the Participation Assessment Framework and barrier-specific interventions (including technology applications) on the participation in literacy and math activities of a 10-year-old student with cerebral palsy and no functional speech. It found that the systematic training was effective in increasing student participation and was perceived as useful and effective by training recipients. (Contains references.) (Author/DB)

A nonspeaking student (age 10) with autism was taught to spell words under three feedback conditions using a voice output communication aid. Results found that the provision of speech output alone and in combination with orthographic feedback resulted in more efficient spelling than the provision of orthographic feedback alone. (Author/CR)