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Purpose: The purpose of this clinical focus article is to consider a framework of identity in provision of services to individuals with severe disabilities who use augmentative and alternative communication (AAC). Method: Components of the framework for identity include personal, social, and cultural areas. These aspects are identified in extant literature on AAC services and discussed through the lens of the Communication Bill of Rights (National Joint Committee for the Communication Needs of Persons with Severe Disabilities in 1992). Identity-focused practice is discussed as being relevant to self-determination and quality of life among individuals with severe disabilities. Results: A case study illustrates identity-focused practice in delivery of services to an adolescent who uses AAC, considering personal, social, and cultural identities. Conclusions: This clinical focus article proposes a theoretical framework and provides a practice example for addressing the intersecting identities of individuals with severe disabilities. Furthermore, this clinical focus article argues that identity is a basic human right and area in which additional efforts are needed in the application of AAC solutions.

The National Research Council recommends 25 hr per week of active engagement for children with Autism Spectrum Disorder (ASD). This clinical brief describes a parent training program (PACE-CPI) designed to increase active engagement episodes between parents and children with autism. Observations from this program’s introductory use with one family and suggestions for further development are provided.

Q (1) Are there communication and socialization differences in subjects at baseline?;(2) Do subjects improve at similar or different rates based upon baseline performance?;(3) Do demographic variab...

Purpose The intended purpose of this research note is to share the findings of a needs assessment online survey of speech and hearing professionals practicing in North Carolina to explore their interest in pursuing a research-focused PhD in Communication Sciences and Disorders (CSD) and to document their perceptions of barriers to pursing a PhD in CSD. In view of the well-documented shortage of doctor of philosophy (PhD) faculty to attract, retain, and mentor doctoral students to advance research and to prepare future speech and hearing professionals, CSD faculty must assess the needs, perceptions, and barriers prospective students encounter when considering pursuing a doctoral research degree in CSD. Method The article describes the results of a survey of 242 speech and hearing professionals to investigate their interest in obtaining an academic research-focused PhD in CSD and to solicit their perceived barriers to pursuing a research doctoral degree in CSD. Results Two thirds of the respondents (63.6%) reported that they had considered pursuing a PhD in CSD. Desire for knowledge, desire to teach, and work advancement were the top reasons given for pursuing a PhD in CSD. Eighty-two percent of respondents had no interest in traditional full-time study. Forty-two percent of respondents indicated that they would be interested in part-time and distance doctoral study. The barriers of time, distance, and money emerged as those most frequently identified barriers by respondents. Conclusion The implications inform higher education faculty on how they can best address the needs of an untapped pool of prospective doctoral students in CSD.

This paper considers milieu training (MT) as a communication treatment for adults with severe intellectual disabilities. The paper seeks the following answers: (1) What is MT? (2) How does current research inform the MT knowledge base? and (3) Is MT a viable treatment option for adults with severe intellectual disabilities challenged by communication impairments? Research describes MT as a viable treatment option for young children with communication and language impairments. Specifically, MT has been applied with fidelity to several populations demonstrating emergent communication and language disabilities. The literature, however, suggests that recommendations regarding optimal treatment dosage remain unclear. Limited findings identify MT as a potential treatment for adults with a severe disability who present limited communicative abilities. MT is an established treatment for communication impairment in young children with language disabilities and has potential applications for adults with severe intellectual disabilities. Future research should focus on efficacy studies designed to examine MT with this population.

This brief report describes a large-group application of the Communication Partner Instruction (CPI) training model as a means of improving the interactive skills of stakeholders who communicate with individuals with severe intellectual disabilities presenting complex communication and physical profiles. Findings support CPI for large stakeholder groups as study participants reported general satisfaction with both the training sequence and their use of skills learned 1 year post training.

Purpose This article considers the following 3 realities facing augmentative and alternative communication (AAC) providers today: (a) Users are not homogeneous with respect to culture and language,...

Procedures to evaluate the communication of individuals with severe intellectual disabilities have grown to include myriad nonstandardized tests and procedures. This article examines the utility of existing nonstandardized assessment methods for generating representative and reliable findings for individuals with severe disabilities limited to nonsymbolic or emergent symbolic communicative abilities. Specifically, the use of informants, observations, and structured sampling are explored as to their strengths and limitations as assessment tools. Strategies for improving these methods are provided including preassessment planning, efforts to minimize observer subjectivity, and informant/observer training. Potential new directions for nonstandardized communication evaluation with this special population including applications of eye gaze and digital recording technology are also proposed.

Purpose Interprofessional collaborative practice (IPCP) is introduced as a viable and preferred clinical methodology for speech-language pathologists and others serving persons with severe disabilities. Contributions to this clinical forum dedicated to IPCP and severe disabilities are described. Method This clinical focus article introduces IPCP and reviews literature specific to its origins and effectiveness, defines severe disabilities, and proposes IPCP as a vital tenet in effective communication-related and other service delivery for this population. Conclusion IPCP is supported as a recommended practice methodology for speech-language pathologists and other team members providing services to persons with severe disabilities.

Authors introduce key features of interdisciplinary evaluation of autism spectrum disorder. The Comprehensive-Developmental Approach (CDA) is identified as a useful framework for conducting interdisciplinary evaluation. The CDA emphasizes the role of cohesive team functioning as critical for assessment work with families. Principles of evidence-based assessment and diagnostic instruments that meet evidence-based guidelines are identified. Links between interdisciplinary evaluation and intervention planning are described, including possibilities for “co-treatment” by interdisciplinary teams after the evaluation is complete. Strengths and limitations of interdisciplinary evaluation and intervention are introduced and authors conclude that interdisciplinary collaboration is worthwhile. The chapter concludes with a case study that illustrates interdisciplinary evaluation within a school setting.

Students with high-functioning autism spectrum disorder (HFASD) may have difficulties with writing despite average or above-average intellectual ability. We designed an intervention strategy (Draw, Sentence, Detail, Check) to improve the ability of an 8-year-old with HFASD to write elaborated sentences in response to written prompts. We investigated the effectiveness of the strategy using a single-subject A-B-A design. Results indicated that the student’s written responses were longer and contained more details after the treatment and that gains were maintained 10 weeks later. Here we consider the intervention strategy and findings from a social cognitive perspective. We discuss theoretical and instructional implications as well as suggestions for future research.

This brief clinical exchange article supports the use of milieu training (MT) as a communication treatment option for adults with severe intellectual disabilities (SID). It examines aspects of MT that appear well matched to the communication and other abilities of adults with SID. It also provides an argument that MT is not unlike functional communication training (FCT), an intervention frequently and successfully used with adults with SID. In addition, Developing Communicative Interactions (DCI), one little-known framework that advocates for MT use with this population, is briefly introduced. Finally, a clinical example is provided that illustrates the application of MT with one adult with SID. The article concludes with comments for clinicians charged with communication treatment for this special population.

This investigation employed the Communication Partner Instruction (CPI) training model in a large North Carolina residential facility for persons with significant intellectual disabilities. A single-subject multiple baseline study design was employed by researchers. Four adult women (staff participants) were trained to support the expressive communicative abilities of one individual with severe intellectual disabilities (resident) who used AAC (a static book of approximately 100 symbols). Staff participants varied with respect to their daily contact and interaction with the resident. Two participants were staff trainers, one was a chaplain, and one was a teacher. Staff participants experienced demonstrable gains with two of three trained dependent variables: providing communication opportunities and modeling AAC system use. Results of training for a third variable, assuring AAC system access, were inconclusive. Training effects were not maintained post intervention. The resident, though not a focus of training efforts, initiated communication with her system more frequently with all staff participants after training. Findings provide preliminary support for CPI training as a means of teaching communication partners strategies to support AAC use; although, additional research is needed. Future directions for CPI training and study are proposed.

Venter, C. E., McDuffie, A., Weismer, S. E., & Abbeduto, L. (2011). Increasing verbal responsiveness in parents of children with autism: A pilot study. Autism, 16, 568–585. Source of funding and disclosure of interest: No source of funding reported, and no conflicts of interest reported by the original authors of this research report.

Challenges associated with the provision of AAC treatment can be daunting, especially in light of the intense training requirements of many populations. Stakeholder training can optimize treatment efforts led by speech-language pathologists (SLP) and result in co-training relationships where the SLP and stakeholder appreciate and adapt to family and other variables that often impact treatment success. In this article, I will provide a brief review of concepts and literature central to the use of stakeholders as trainers, discuss benefits of stakeholder involvement in training including a heightened awareness of family systems and events, and present a short illustrative case describing a successful AAC treatment where stakeholder training was implemented. I will introduce the concept of AAC stakeholders as trainers and the reader will learn about the Communication Partner Instruction model (Kent-Walsh & McNaughton, 2005) as a possible vehicle for training.

A milieu teaching sequence was used to train photograph exchange as a method of requesting to a 7-year-old boy with autism. A multiple baseline design across four items (ball, puzzle, books, bubbles) was used to identify a functional relation between requesting and the milieu teaching sequence. Although performance during intervention was variable, possibly as a result of external factors such as fatigue and irritability, treatment effects were observed in three of four items trained. Results of maintenance probes collected 5 weeks after the study concluded may indicate variations in item salience. Findings were interpreted to support milieu training for this participant. Clinical implications and study limitations are discussed.

Speech-language pathologists (SLPs) participating in supervisory processes in a clinical setting often face challenges, including an expanding scope of professional practice and constraints associated with time and resources. Evidence-Based Communication Assessment and Intervention (EBCAI) can guide a supervisor and supervisee in determining effective treatment options for a variety of populations and can save the supervisor time in researching disorders and appraising treatment methods, as the appraisals have already been completed. This article provides brief illustrations that describe how a supervisor might use EBCAI commentaries in clinical instruction. Although other resources on evidence-based practices should not be ignored, EBCAI appraisals provide an excellent starting point in generating and evaluating evidence-based practices in speech-language pathology. Source of funding: No source of funding reported.

This literature review was conducted to evaluate the current state of evidence supporting communication interventions for individuals with severe intellectual and developmental disabilities. We reviewed 116 articles published between 1987 and 2007 in refereed journals meeting three criteria: (a) described a communication intervention, (b) involved one or more participants with severe intellectual and developmental disabilities, and (c) addressed one or more areas of communication performance. Many researchers failed to report treatment fidelity or to assess basic aspects of intervention effects, including generalization, maintenance, and social validity. The evidence reviewed indicates that 96% of the studies reported positive changes in some aspects of communication. These findings support the provision of communication intervention to persons with severe intellectual and developmental disabilities. Gaps in the research were reported as were recommendations for future research.

ed from: Gregory, M. K., DeLeon, I. G., & Richman, D. M. (2009). The influence of matching and motor-imitation abilities on rapid acquisition of manual signs and exchange-based communication responses, Journal of Applied Behavior Analysis, 42, 399–404. Source of funding: National Institute of Child Health and Human Development.

This paper describes effective augmentative and alternative communication (AAC) practices for nonsymbolic communicators with severe intellectual disabilities (SID). Eligibility issues related to AAC for individuals with SID are examined, with the conclusion that AAC is appropriate for any individual displaying unmet communication needs. Strengths and challenges for perlocutionary and illocutionary individuals are reviewed and a representative sample of AAC practices for these populations is discussed. In addition, ideas for implementation of these practices are reviewed within a tri-focused treatment context. The paper concludes with a discussion of how stakeholders might work to re-define the concept of AAC success for individuals with SID.

The National Joint Committee for the Communication Needs of People With Severe Disabilities (NJC) reviewed literature regarding practices for people with severe disabilities in order to update guidance provided in documents originally published in 1992. Changes in laws, definitions, and policies that affect communication attainments by persons with severe disabilities are presented, along with guidance regarding assessment and intervention practices. A revised version of the Communication Bill of Rights, a powerful document that describes the communication rights of all individuals, including those with severe disabilities is included in this article. The information contained within this article is intended to be used by professionals, family members, and individuals with severe disabilities to inform and advocate for effective communication services and opportunities.

The prelinguistic stage is viewed as the time period between birth and when a child or adult begins to use words/signs meaningfully. It is a time when children typically increase their ability to communicate with others, first using eye gaze, attending, and social-emotional affect and later adding gestures and other nonverbal means to communicate. This stage builds the foundation for later developing skills such as using words (or signs) and combining them into sentences to communicate, as well as understanding and gaining appreciation of the nuances of successful communication. For children, youth, and adults with autism spectrum disorder (ASD), the skills typically learned during this stage can be critical to helping these individuals be effective and successful communicators throughout their lives. Individuals with significant developmental disabilities including ASD can have substantially protracted prelinguistic periods of communication and language development. For some, a singular reliance on prelinguisitic communication may continue into adolescence or adulthood. Others may fail to develop productive communication altogether. Knowledge of prelinguistic skills, their developmental hierarchy, and their impact on children’s and adults’ current and future ability to communicate are key factors to be considered in assessing and intervening with children, youth, and adults with ASD. In this chapter, current research related to prelinguistic communication skills will be highlighted, along with challenges faced when examining prelinguistic skills, and the research and practice implications of looking at and intervening in the area of prelinguistic communication.

This article describes effective communication-related practices by reviewing specific evidence-based techniques, sharing how these techniques have been used in various treatment approaches, and discussing a constellation of general principles vital to treatment success. A comprehensive model of service delivery is provided to illustrate these key features of effective practice within the ecological and cultural contexts of families and their everyday lives.

Purpose This article defines interprofessional collaborative practice and links its key features with accepted practice conceptualizations of physical therapy. Cotreatment with speech-language pathology is described as a vehicle for interprofessional collaborative practice for children with severe disabilities. Method The article reviews the International Classification of Functioning, Disability, and Health (WHO, 2015) and the Hypothesis-Oriented Algorithm for Clinicians II (Rothstein, Echternach, & Riddle, 2003) as existing service-delivery frameworks in physical therapy and discusses how interprofessional collaborative practice between speech-language pathologists and physical therapists can be useful within these practice guidelines. Results A case illustration featuring interprofessional collaborative practice during cotreatment for a child with severe disabilities through physical therapy and speech-language pathology showed more seamless care and better progress in the pursuit of three main goals: physical movement, communication of needs, and participation in classroom activities. Conclusions Interprofessional collaborative practice is supported as a recommended practice methodology for physical therapists and speech-language pathologists serving persons with severe disabilities.

Purpose The principles of interprofessional collaborative practice (IPCP) are illustrated through the case of Mary, a child with severe disabilities. Method Mary's experiences from early childhood to young adulthood are highlighted by both optimal and less-than-ideal examples of clinical services and collaborative practice. The range of collaboration illustrates potential variations in service delivery. Thematic comments and resources are provided by professionals experienced with and committed to IPCP who represent the following four disciplines: occupational therapy, physical therapy, special education, and speech-language pathology. Conclusions Although potentially challenging, IPCP is a dynamic practice methodology appropriate for speech-language pathologists and others serving persons with severe disabilities.

Goal setting poses a significant challenge for service providers in both clinical and educational settings. With today's call for services that contribute to meaningful changes in children, there is an increased need for goal-setting procedures that are socially valid. This article presents such a procedure and illustrates its use through a case study. Suggestions for socially valid goal setting are provided.

Partner-perceived communication behaviors are catalogued from four institutionalized adults with severe intellectual disabilities who are not intentional communicators. These behaviors have been observed in typically developing infants and are speculated to comprise the earliest end of a developmental continuum culminating in conventional communication. Clinical applications of findings are discussed.

This article describes practices effective in assessing communication and language in persons with autism. We begin with a review of the basic principles that govern assessment in the discipline of speech-language pathology. This is followed by a discussion of features associated with the syndrome of autism that impact communication and language assessment. A few general strategies to address these features are provided. We conclude with a presentation of assessment protocols useful for persons with autism at all functioning levels.

This paper addresses the special challenges encountered when working with graduate students whose academic and/or clinical performance is marginal or less than satisfactory. From a variety of perspectives including instructional, professional, financial, ethical, and legal, among others, working effectively with marginal students deserves serious and systematic consideration. The purpose of this paper is to present the results of a national survey that explore the prevalence, profiles, and documented impact of marginal students on professional training programs in speech–language pathology and audiology. Current strategies for prevention and intervention, factors inhibiting implementation of such strategies, and implications for the student and the program are discussed. Learning outcomes (1) To learn the prevalence, profiles, and documented impact of marginal students on professional preparation programs in communication sciences and disorders. (2) To become familiar with current strategies for prevention and intervention with marginal students, factors inhibiting implementation of such strategies, and implications for the student and the program. (3) To understand professional preparation as a system of academic, clinical, and supervisory instruction, including evaluation and due process; namely, a student’s right, a program’s responsibility. (4) To identify critical questions generated by this study that must be addressed by the professions and individual programs.

Effective communication instruction has drawn heavily from applied behavior analysis (ABA). Although intervention practices have evolved over time, technologies developed through the adherence to ABA principles and techniques continue to flourish. This article examines ABA-based communication instruction for persons with autism by providing a historical context for ABA as an instructional methodology and by reviewing ABA-related treatment options.

Team-based service delivery is a common method for families and related professionals to make decisions about children with special needs. Unfortunately, preprofessional training in the area of team functioning has been inadequate. Furthermore, resources to understand and apply the principles of teaming are limited. This article describes current team models and provides guidelines specific to optimal team participation.

Repeated storybook reading interventions use storybooks as a context for presenting instructional strategies to promote language and literacy. This article discusses repeated storybook reading using adult scaffolding and phonological awareness strategies to facilitate oral and written language in children with language delays. The discussion is framed around common questions posed by educators considering repeated storybook reading as an instructional method.

This article reviews goal attainment scaling as an alternative method for evaluating treatments and programs for children with autism. Traditional evaluation methods such as compliance monitoring and efficacy studies may be unable to account for the elaborate set of components mandated by the Individuals with Disabilities Education Act and the number and variety of treatment/program options available to students with autism. Assessing the quality of program services delivered to children (i.e., process goals) and the progress of children in meeting those goals (i.e., outcome goals) should be the fundamental concern of programs for students with autism. The use of goal attainment scaling as an alternative evaluation method may provide a convergent link between student outcome goals and program goals within a framework of family-centered practices. A case study is provided to illustrate the use of goal attainment scaling.

This case study investigated the efficacy of repeated storybook reading (RSR) with adult scaffolding as an intervention for a child with autism. An ABA single-subject design was employed. The results suggested that RSR encouraged spontaneous language use. Guidelines for using RSR with children with autism are provided.

The role of the speech-language pathologist in the schools is changing in response to myriad developments within and outside the discipline of speech-language pathology. Collaborative service delivery models are replacing traditional "pull-out" approaches in many schools. In this article, the authors identify challenges that have reshaped the role of the school speech-language pathologist and use a case example to illustrate how speech-language services can be implemented within a collaborative framework.

This article examines the structure-functionality relationship in traditional communication-based treatment approaches for children with autism. Contrary to popular opinion supporting either highly structured or highly functional treatment, viable middle ground is proposed. The article concludes with instructional tips specific to the implementation of structured yet functional treatment.

Introduction: This article presents emerging neurological findings in Autism Spectrum Disorders (ASD) with particular attention to how this information might inform treatment practices addressing communication impairments.Methods: The article begins with a general discussion of the brain–behaviour relationship and moves to the presentation of recent research findings related to ASD. There is particular attention to individuals with autism who are either non-verbal or present emergent verbal abilities.Results/Discussion: A specific communication treatment, the Picture Exchange Communication System (PECS), is presented as an example of an intervention that addresses the learner needs of many individuals with ASD. The success of PECS is discussed within the context of its fit with brain-based learner characteristics.

This article proposes assessment targets and protocols for children with profound developmental disabilities who are nonsymbolic communicators. Targets include children's actual or perceived communicative behaviors, their communicative partners, and their communicative environments. Protocols consist of interviews, observations, structured sampling, and, if needed, formal assessment measures.

This study evaluated a training sequence designed to increase an interdisciplinary school team's response sensitivity and consistency toward the perceived communication of children with profound mental handicaps. Analysis of data revealed response sensitivity training to be effective. That is, after participating in the training sequence, all subjects recognized more child behaviors as communicative. In contrast to response sensitivity findings, no significant training effects were noted for response consistency. More specifically, subjects' consistent recognition of child behaviors (i.e., attribution of identical behavioral states or communicative functions) did not improve across treatment sessions.

This study describes, and determines the effectiveness of, an innovative treatment sequence designed to facilitate semantic/pragmatic language development in a child with high-functioning autism. The independent variable was a treatment sequence emphasizing video vignettes and role-plays. Dependent variables included efficient gaze, responding without delays, and topic maintenance. Findings and practitioner applications are provided.