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AbstractAppropriate vocabulary selection for augmentative and alternative communication (AAC) intervention is crucial to support communication and language development in children with intellectual and developmental disabilities (IDD). Core vocabulary lists are commonly used to guide this process, and there is a need for language-specific consideration. This paper aimed to develop a wordlist for selecting the core vocabulary for AAC intervention for young Hebrew-speaking children with IDD. Five children (age 3;5–8;4) were audio-recorded in naturalistic interactions with an interviewer and family members. Using Levy’s clinical corpus in the Child Language Data Exchange System (CHILDES) and Child Phonology Analyzer (CPA) tools and preestablished codes, wordlists with usage frequencies were extracted and coded for lexeme, lexical categories and functions or content. The percentages of the 20, 50, 100, and 200 most frequent lexemes were calculated for each child and for the five children combined. The top 200 most frequently used lexemes constituted 85% of the composite lexicon. A comparison was made between this study list and a previous list derived from language samples of typically developing (TD). Lexemes representing function words dominated, albeit with a slight preference for content words in children with IDD. Among the content words, children with IDD used more adverbs, while children with TD used more verbs. Implications for AAC core vocabulary are discussed. [ABSTRACT FROM AUTHOR]

AbstractSmart Predict is a novel two-tablet application developed to improve conversational efficiency for people who use augmentative and alternative communication (AAC) devices. The Smart Predict system consists of two distinct applications that were built for use with two Android tablets and/or phones with Bluetooth® capability. One application is referred to as the AAC User app and the second application is called the Partner app. Smart Predict integrates vocabulary supplementation from communication partners in real-time while persons who rely on AAC generate text and maintain full control to choose words within a word prediction line. Using single-case research designs with adapted alternating treatments under two counterbalanced treatment conditions (AAC User app alone versus AAC User app + Partner app), we examined message efficiency with persons who rely on switch scanning for on-screen keyboards. User experience questionnaires were administered to determine satisfaction and workload, and to provide feedback for future development efforts. Three adults with complex communication needs and motor impairments conversed with research staff about fourteen movie trailers. Characters per minute and switch selections per character produced by the person with complex communication needs and motor impairments were measured during 15-minute interviews to represent communication speed and effort. Results indicate that message efficiency increased with the dual-tablet Smart Predict, indicating faster message generation with the vocabulary supplementation system. User satisfaction increased and perceived effort decreased under the Smart Predict conditions. Given these results within a research and development framework, the Smart Predict concept is a viable feature that could be considered within smart AAC technologies. [ABSTRACT FROM AUTHOR]

Augmentative and alternative communication (AAC) strategies benefit learners with complex communication needs (CCN) by allowing them to participate, interact and learn. AAC is realised in the South African Education policy; however, research indicates that many teachers still have limited AAC knowledge. With this study we aimed to describe the effect of a newly developed evidence-based AAC training programme on special school teachers' perceptions of their own abilities related to teaching learners with CCN as well as their perceptions of the general academic, communication, and classroom interaction skills of learners with CCN and finally the teachers' perceptions of the inclusion of learners with CCN. A quasi-experimental pre-test-post-test group design with a non-randomised control group was used, employing a standardised measuring instrument, with 5 subscales, namely the modified teachers attitude scale (MTAS). The sample size included 58 teachers who participated: 6 in the pilot, 34 in the experimental and 18 in the control group. The brief AAC training session of 4 hours had a positive, statistically significant effect on several items on the subscales measuring teachers' perceptions of their abilities related to teaching learners with CCN, as well as their perceptions of the communication of learners with CCN, classroom interaction skills, and teachers' perceptions on the inclusion of learners with CCN. AAC training is recommended for special school teachers to enhance their own knowledge and to enhance the academic and social skills of learners with CCN. Furthermore, future studies are recommended to determine the prevalence of learners with CCN to influence the planning of services for this population in this context. [ABSTRACT FROM AUTHOR]

AbstractIt is well-known that children with expressive communication difficulties have the right to communicate, but they should also have the right to do so in whichever language they choose, with a voice that closely matches their age, gender, and dialect. This study aimed to develop naturalistic synthetic child speech, matching the vocal identity of three children with expressive communication difficulties, using Tacotron 2, for three under-resourced South African languages, namely South African English (SAE), Afrikaans, and isiXhosa. Due to the scarcity of child speech corpora, 2 hours of child speech data per child was collected from three 11- to 12-year-old children. Two adult models were used to “warm start” the child speech synthesis. To determine the naturalness of the synthetic voices, 124 listeners participated in a mean opinion score survey (Likert Score) and optionally gave qualitative feedback. Despite limited training data used in this study, we successfully developed a synthesized child voice of adequate quality in each language. This study highlights that with recent technological advancements, it is possible to develop synthetic child speech that matches the vocal identity of a child with expressive communication difficulties in different under-resourced languages. [ABSTRACT FROM AUTHOR]

The aim of this pilot study was to explore the feasibility and language outcomes of coaching parents to implement an aided language stimulation intervention using Pragmatic Organisation Dynamic Display (PODD) communication books. Two parent–child dyads, with children aged 4 years 6 months and 4 years 8 months participated in a home-based intervention. An AB design was used. Data were collected in mealtime and play activities. Dependent variables were frequency of parent use of AAC symbols and speech and frequency of child symbol use (speech, signs or graphic symbols). The intervention was feasible as parents reported they were confident in implementing it and the timeframes were appropriate for single-case research designs. An increase in parent AAC symbol use was associated with PODD book use in mealtime and for one parent in play. Both children increased their symbol use, with the clearest association in the mealtime activity. Overall, the encouraging results suggest that this approach warrants further research using stronger designs. [ABSTRACT FROM AUTHOR]

Background: Pictures drawn by people with aphasia (PWA) are often more challenging to understand than those drawn by healthy people. There are two types of objects: those that tend to be drawn symbolically (symbolically drawn objects—SOs) and those that are likely to be drawn realistically (realistically drawn objects—ROs). Aims: To compare the identification rate and number of misunderstanding types between SOs and ROs drawn by PWA and healthy controls (HCs). To reveal trends in the misunderstandings of drawings by PWA, and to identify the language or cognitive abilities related to the identification rate of pictures drawn by PWA. Methods & Procedures: We designed a drawing task involving SOs and ROs. A total of 18 PWA and 30 HCs completed the task, and respondents identified the drawings. The identification rate and number of misunderstandings were analysed with two‐way analysis of variance (ANOVA) including group (PWA and HCs) and object type (SOs and ROs). The misunderstandings were divided into four categories varying in semantic and morphological similarity; these ratios were examined with a chi‐square test. The relationships of language and cognitive abilities with the identification rate were investigated with multiple regression analyses. Outcomes & Results: There was a significant effect of the interaction between group and object type on the identification rate (F(1.1387) = 3.90, Mean Squared Error (MSE) = 4139.67, p = 0.04): the identification rates for ROs were lower in the PWA than in the HCs. For the number of misunderstanding types, an interaction was observed between group and object type (F(1.56) = 8.26, MSE = 26.93, p < 0.01): the number of misunderstanding types for ROs in the PWA was greater than that in the HCs. The misunderstanding patterns differed between ROs and SOs (χ2(3) = 694.30, p < 0.001, V = 0.37). ROs were semantically related, whereas SOs were morphologically related. The identification rates of ROs and SOs were correlated only with Kanji writing scores (ROs: β = 3.66, p = 0.01; SOs: β = 6.57, p < 0.01). Conclusions & Implications: In drawings by the PWA, SOs had a higher identification rate, while ROs had a lower identification rate and a greater variety of misunderstandings. SOs may increase drawing motivation. Interventions to improve the identifiability of SOs and ROs should reflect each character. Identification rates were correlated only with Kanji writing scores. The PWA, whose native language was Japanese and had preserved Kanji writing abilities, and their communication abilities may be increased through drawing. WHAT THIS PAPER ADDS: What is already known on the subject: PWA often have impaired drawing abilities and draw pictures that third parties misinterpret. Some objects tend to be drawn symbolically, and some are drawn realistically. However, it is not clear whether there is a difference between these types of drawings depicted by PWA in identifiability and the tendency to be misunderstood by ordinary people. In addition, the relationships between language or cognitive abilities and the identification rate of drawn pictures are not clear. What this paper adds to the existing knowledge: The identification rate differed between SOs and ROs. In drawings by PWA, SOs had a higher identification rate, while ROs had a lower identification rate and the greatest variety of misunderstandings. Approximately half of the misunderstandings were related to the target object. SOs tended to be confused with morphologically related objects, while ROs tended to be confused with semantically related objects. Identification rates were correlated only with Kanji writing scores. What are the potential or actual clinical implications of this work?: To motivate PWA's drawing, it is suitable to begin with SOs. Examining drawing ability from the perspective of SOs and ROs increases the chance of identifying drawing ability. PWA whose native language is Japanese and have preserved Kanji writing abilities may be able to increase their communication abilities through drawing. [ABSTRACT FROM AUTHOR]

Background Aim Method & Procedures Outcomes & Results Conclusions & Implications What this paper adds What is already known on the subject What this paper adds to existing knowledge What are the practical and clinical implications of this work? Over 8 million children with disabilities live in Africa and are candidates for augmentative and alternative communication (AAC), yet formal training for team members, such as speech–language therapists and special education teachers, is extremely limited. Only one university on the continent provides postgraduate degrees in AAC, and other institutions provide only short modules at an undergraduate level. The need for an introductory training course on AAC that is accessible by university students continent‐wide was identified. An online programme, namely an intelligent tutoring system (ITS), was identified as a possible option to facilitate interactive learning without the need for synchronous teaching. The use of an ITS is shown to be effective in developing knowledge and clinical reasoning in the health and rehabilitation fields. However, it has not yet been applied to student teaching in the field of AAC.To determine both the feasibility of an ITS to implement an AAC curriculum for students in four African countries, and the usability and effectiveness of such a system as a mechanism for learning about AAC.The study included two components: the development of a valid AAC curriculum; and using the ITS to test the effectiveness of implementation in a pre‐ and post‐test design with 98 speech–language therapy and special education students from five universities.Statistically significant differences were obtained between pre‐ and post‐test assessments. Students perceived the learning experience as practical, with rich content.The findings suggest that the ITS‐based AAC curriculum was positively perceived by the students and potentially offers an effective means of providing supplementary AAC training to students, although modifications to the system are still required. Professionals typically lack formal training in AAC. In Africa, this presents a serious challenge as there are over 8 million children who are candidates for AAC. A need for an introductory training course on AAC, which can be accessed by university students continent‐wide, was identified. An AAC curriculum was developed and integrated into an ITS, an online programme allowing interactive learning through asynchronous teaching. Students from four African countries completed the AAC ITS curriculum. The curriculum was positively received by the students and statistically significant changes in knowledge were identified. This feasibility study shows that the use of an ITS is an effective means of providing AAC training to university students in these African countries. The results provide a valuable contribution toward ensuring the equitable distribution of AAC training opportunities in the African context. This will have a significant positive impact on those who are candidates for AAC. [ABSTRACT FROM AUTHOR]

Non-speaking autistic individuals grapple with the profound impact of the 'double empathy problem' in their daily interactions with speaking others. This study rethinks the communication challenges faced by non-speaking autistic individuals, challenging traditional approaches that predominantly focus on speech and complex communication devices (AAC). By spotlighting the natural phenomenon of "interactive stimming," a powerful mode of communication among autistic individuals, this study advocates for a shift from a conventional emphasis on speech towards the foundational role of the body in autistic communication. Central to this exploration is the introduction of the Magical Musical Mat (MMM), an innovative interactive environment mapping interpersonal touch to musical sounds. Through a robust mixed-methods approach integrating video-based fieldwork and designbased research, this paper engages three non-speaking autistic children and their mothers in a 5-day empirical intervention. Results reveal significant transformations in parent-child interactions as both parents and children are acquainted with touch in a new environment. Children assert their autonomy, exploring at their own pace, and discovering sensory features of the environment. Notably, the introduction of sound prompts heightened awareness of the stims, leading to diversified and expressive stim movements. Foregrounding interpersonal touch eventually guides parents into their children's sensory activities where parents attune to the stims of their children by joining in and facilitating their expressiveness, co-creating extended, evolving patterns of repetitive cycles. The collaborative stim cycles can be likened to free improvisation, where dynamical coherence between individuals occurs through a blend of stability and active flexibility. By shifting the focus from speech to co-created sensory experiences, this paper sheds light on the value of transformative multisensory environments, envisioning a world where varied modes of communication are valued and embraced. [ABSTRACT FROM AUTHOR]

Professionals and communication partners report experiencing challenges with regard to developing the knowledge and skills needed to support individuals with complex communication needs who use augmentative and alternative communication (AAC). These challenges can be exacerbated in rural and remote areas where access to resources and training may be limited. This practitioner-focused article provides evidence-based strategies for addressing the knowledge and skill needs experienced by professionals and communication partners in rural communities, including strategies for (a) identifying AAC knowledge and skill needs, (b) accessing AAC resources, (c) using principles of instructional design and instructional coaching to address identified areas of need, (d) considering contexts for instruction, and (e) examining contextual fit. [ABSTRACT FROM AUTHOR]

This simulation study assessed the ability of Speech-Output Technologies (SOTs) to keep in-time during conversational repair. Fifty-eight Other Initiated Repair (OIR) initiators were collected from transcripts of repair interaction sequences collected from past research. A range of selection latencies were then used to calculate simulated utterance composition delays for the OIR initiators using two popular SOT software apps, with and without the use of word prediction. To determine whether OIR utterances could be produced within a socially sensitive temporal gap, composition delay was compared to a conservative temporal limit obtained for oral communicators (Kendrick, 2015). Even at the fastest 0.5 s selection latency level, utterance-level composition delays for both SOTs were substantially greater than the OIR limit set for this study. Next, AAC production rate data spanning a variety of technologies, access methods, tasks and user profiles was obtained from the literature. Communication performance for these groups was then evaluated against the identified temporal OIR limit. None of the user groups were found to be capable of producing full OIR utterances within the temporal limits of oral-speech conversation, with most unable to type even a single selection within these bounds. Because of the frequency and importance of repair in conversation, these results have important implications for designing devices to enable their users to successfully engage in such important conversational activities. [ABSTRACT FROM AUTHOR]

This case study examines the effective use of Augmentative and Alternative Communication (AAC) tools in enhancing communication skills in a 15-year-old male with Autism Spectrum Disorder (ASD). Initially exhibiting non-verbal tendencies, the subject experienced significant improvements in communication and social interaction following the introduction of a letter board and subsequent transition to an iPad. These AAC tools facilitated a marked development in his ability to articulate thoughts, engage in academic activities, and express complex ideas, particularly in science. The study highlights the role of AAC in expanding the communicative capabilities of individuals with limited or no verbal language, demonstrating notable advancements in both verbal expression and cognitive engagement. The findings underscore the transformative impact of personalized AAC interventions and suggest the potential for broader application in ASD support strategies. This case highlights the need for further research, including randomized controlled trials, to explore the efficacy of AAC tools in diverse ASD contexts. [ABSTRACT FROM AUTHOR]

Sign language is a form of communication that helps deaf and mute people interact with those who can hear. In the country, around 2.78% of people are unable to speak, i.e., are mute or deaf. Their primary means of communication is through hand motions and gestures. The paper proposes a new technique called the "artificial speaking mouth" for individuals with speech impairments. Humans connect with each other through thoughts and ideas, but some people lack the ability to speak. For them, sign language is the only means of communication. Nowadays, technology has reduced this communication gap with systems that translate sign language into speech. Sign Language Recognition (SLR) and gesture-based control are two major applications used for hand gesture recognition technologies. On the other hand, the controller converts sign language into text and speech, using text-to-speech conversion and analog-to-digital conversion. [ABSTRACT FROM AUTHOR]

AbstractThe relationships between the use of nouns and verbs, and other word classes have been well established in the typical language development literature. However, questions remain as to whether the same relationships are seen in the language use of individuals who use graphic symbol-based augmentative and alternative communication (AAC). The aim of the study was to examine relationships between the use of verbs and nouns, and the use of prepositions, adverbs, and adjectives through a secondary analysis of language transcripts taken from 12 children and adolescents who used aided AAC in conversation with an adult. A series of multiple linear mixed-effect regression analyses showed a positive predictive association between the use of verbs and the use of prepositions and adverbs, as well as a positive predictive relationship between the use of nouns and the use of adjectives. The theoretical and practical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

E-textiles have been the focus of interest in health technology, but little research has been done so far on how they could support persons with complex communication needs. A global estimate is that 97 million people may benefit from Augmentative and Alternative Communication (AAC). Unfortunately, despite the growing body of research, many persons with complex communication needs are left without functional means to communicate. This study aimed to address the lack of research in textile-based AAC and to build a picture of the issues that affect novel textile-based technology development. We arranged a focus group study for altogether 12 speech and language therapists to elicit user scenarios to understand needs, activities, and contexts when implementing a novel, textile-based technology in a user-centred approach. As a result, we present six user scenarios that were created for children to enhance their social interaction in everyday life when using textile-based technology that recognizes touch or detects motion. The persistent availability and the individual design to meet a person's capability along with ease of use and personalization were perceived important requirements. Through these scenarios, we identified technological constraints regarding the development of e-textile technology and its use in the AAC field, such as issues regarding sensors and providing power supply. Resolving the design constraints will lead to a feasible and portable e-textile AAC system. E-textiles are a novel approach to Augmentative and Alternative Communication (AAC) for children with motor dysfunctions and intellectual disabilities. -A portable AAC system implementing e-textiles for children with complex communication needs will enable several activities in daily-life situations. Therefore, further research is needed to resolve the design constraints to reduce the bulkiness of technology embedded in textiles, e.g., looking into the possibilities of passive and battery-free solutions. The developed user scenarios offer a starting point for developing initial prototypes for touch-based and motion-detection systems to enhance social interaction and motivation for persons with complex communication needs. [ABSTRACT FROM AUTHOR]

Camera Mouse is a freely available software program that visually tracks the movement of facial features to allow individuals with motor impairments to control a computer mouse. The goal of this case study was to provide an evaluation of Camera Mouse as a computer access method as part of a multiple modality communication system for an individual with cerebral palsy. The participant was asked to reproduce sentences and respond to ethical dilemmas for language sampling. Tasks were completed using natural speech and an AAC solution consisting of Camera Mouse paired with an orthographic selection interface and speech synthesis. The participant completed a questionnaire for satisfaction with the introduced assistive technology. Camera Mouse resulted in higher intelligibility than natural speech, while natural speech had a higher rate. She used more complex language with her natural speech. The participant rated Camera Mouse as at least 3/5 on all measures, including 5/5 on weight and safety. The results of this case study suggest Camera Mouse is a promising computer access system for communication supported by the participant's satisfaction rating, expressive language, and synthesized speech production capabilities. [ABSTRACT FROM AUTHOR]

Background: The ability to engage successfully in repair is central to accomplishing shared conversational activities. Based on two case studies, this paper describes one strategy individuals with dysarthria who use speech generating devices (SGD) may engage in to manage extended repair in multiparty conversation. Method: Conversation Analysis was applied to video data of two extended repair interactions involving an aided speaker and two interlocutors, one familiar, the other less familiar. Results: Aided speakers took an agentive role in the organization of repair when dyadic repair with the less familiar conversant was unsuccessful by selecting the more familiar partners to participate in repair. Aided speakers capitalized on the partner shift by immediately switching to use of idiosyncratic communication modalities and by making reference to past shared experiences relevant to the repair. Conclusion/Discussion: The use of this strategy warrants further exploration as a means for managing extended repair in SGD-mediated conversation. [ABSTRACT FROM AUTHOR]

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The growth of new high-technology devices in the field of augmentative and alternative communication (AAC) has been rapid. However, a vast number of individuals with complex communication needs are left without functional means to communicate in their lives. Intelligent textiles are one of the growing industries in health technologies yet to be explored for the possibility of implementation as an AAC solution. This study aimed to investigate the potential of intelligent textiles and their functions in daily life perceived by experienced speech and language therapists and to obtain data, which will offer direction on how to proceed with prototype development. Focus group discussions were conducted remotely within two groups of experienced speech and language therapists (n = 12). The data obtained from the discussions were analysed thematically. According to the stakeholders in question, intelligent textiles were perceived most useful for individuals with motor disabilities and those with severe intellectual disabilities. The most prominent themes for the purpose of using the intelligent textiles were social interaction and accessing meaningful activities independently. The participants also described how this technology could be used in terms of the textile, the input needed and the output the technology provides. The versatile results are discussed along with directions for future research. Wireless textile-based augmentative and alternative communication (AAC) technologies are a new alternative to AAC designs using rigid electronics. Intelligent textile-based AAC may help specifically those with motor impairments and intellectual disabilities. The technological solution should adapt to the capability rather than the disability. [ABSTRACT FROM AUTHOR]

Augmentative and alternative communication (AAC) is a core component of speech-language pathology practice however international literature has highlighted that speech-language pathologists (SLPs) do not feel confident in this area. An online survey was used to investigate the self-perceived knowledge, confidence, and attitudes of Australian SLPs in relation to AAC for children and young people using a 7-point Likert scale; 205 participants responded. Participants reported moderate levels of knowledge (M = 4.95; SD = 1.07) and confidence (M = 5.09; SD = 1.25); attitude had the highest overall ratings (M = 5.64; SD = 1.20). Generally, knowledge, confidence and attitude scores were greater for SLPs who worked in a metropolitan area, had more experience and a higher percentage of AAC users on their caseload. SLPs rated the adequacy of their pre-professional training in AAC for children and young people as low (M = 3.69; SD = 2.05). These findings suggest further investigation into the training of SLPs in AAC is required to ensure that this training is preparing SLPs for the contemporary workforce. [ABSTRACT FROM AUTHOR]

Children with Autism Spectrum Disorder (ASD) who have Complex Communication Needs (CCN) benefit from Augmentative and Alternative Communication (AAC) to support communication. Research on the use of AAC and how different stakeholders perceive the use of AAC has been heavily focused on Western culture. The purpose of this study was to understand Indonesian caregivers' perspectives of their child's use of AAC by conducting semi-structured interviews. Caregivers yearned for support and collaboration from professionals, showed perseverance and resilience by seeking other learning opportunities, supporting their children, and acting as advocates, and noted benefits from AAC when implemented in culturally responsive ways. Future directions and implications for practice and policy related to supports for Indonesian children with ASD and CCN are discussed. [ABSTRACT FROM AUTHOR]

This case study examines the effective use of Augmentative and Alternative Communication (AAC) tools in enhancing communication skills in a 15-year-old male with Autism Spectrum Disorder (ASD). Initially exhibiting non-verbal tendencies, the subject experienced significant improvements in communication and social interaction following the introduction of a letter board and subsequent transition to an iPad. These AAC tools facilitated a marked development in his ability to articulate thoughts, engage in academic activities, and express complex ideas, particularly in science. The study highlights the role of AAC in expanding the communicative capabilities of individuals with limited or no verbal language, demonstrating notable advancements in both verbal expression and cognitive engagement. The findings underscore the transformative impact of personalized AAC interventions and suggest the potential for broader application in ASD support strategies. This case highlights the need for further research, including randomized controlled trials, to explore the efficacy of AAC tools in diverse ASD contexts.

Motor speech and augmentative and alternative communication (AAC) interventions are commonly used with children with cerebral palsy (CP) but there is limited literature comparing the effectiveness of these interventions. The purpose of this study was to investigate the effectiveness of intensive AAC, Rapid Syllable Transition Treatment (ReST), and blended intervention, a combination of motor-speech and AAC, on speech accuracy and sentence length and complexity. A single case experimental design across participants with repeated measurements across phases (ABACADA design) was used. Four participants aged 8–14 years with CP who used a speech-generating device (SGD) received three 6-week intervention blocks that included ReST, AAC, and blended intervention. Measures were taken during intervention and baseline phases and at maintenance two and four weeks after the last intervention phase. Participants were randomized to starting with either ReST or AAC with the blended intervention delivered last. All participants improved their speech accuracy and sentence length and complexity in speech and with their SGD in all three interventions. The data demonstrated overall immediacy of the effect with all interventions and retention of gains across the whole sequence of phases. The order of AAC or ReST interventions or the severity of CP did not impact the intervention gains. This study suggests that intensive AAC, a multi-modal approach, and ReST improve speech accuracy and sentence length and complexity in children with moderate CP, but all require further investigation. In this paper intensive AAC intervention with a speech generating device (SGD), ReST treatment and multimodal blended intervention were effective in improving speech accuracy and sentence length and complexity in both verbal speech and on communication with the SGD. ReST treatment has not been used with children with CP before. This study established a proof of concept for its effectiveness in children with CP. Further research is warranted. [ABSTRACT FROM AUTHOR]

Parental interventions can help parents use strategies to support their child's language and communication development. The ComAlong courses are parental interventions that focus on responsive communication, enhanced milieu teaching, and augmentative and alternative communication. This interview study aimed to investigate the course leaders' perceptions of the three ComAlong courses, ComAlong Habilitation, ComAlong Developmental Language Disorder, and ComAlong Toddler, and to evaluate their experiences of the implementation of the courses. Qualitative content analysis was used to analyze the interview data. Thereafter, three categories resulted from the findings: Impact on the Family, A Great Course Concept, and Accessibility of the Courses. The results indicate that participants perceived that the courses had positive effects on both parents and themself. Furthermore, it was described that parents gained knowledge about communication and strategies in how to develop their child's communication; however, the courses were not accessible to all parents. The collaboration between the parents and course leaders improved, and course leaders viewed the courses as an important part of their work. The following factors had an impact on the implementation: several course leaders in the same workplace, support from colleagues and management, and recruitment of parents to the courses. [ABSTRACT FROM AUTHOR]

The present study investigated the relationship between lexicon and grammar in individuals who use graphic symbol-based aided augmentative and alternative communication (AAC). Data came from 60 transcripts of generalization sessions that were part of two previous intervention studies, aimed at improving the expressive vocabulary and grammar of 12 children and youth who used graphic symbol-based AAC. The specific aims of the current study were to (a) describe vocabulary composition across different levels of expressive vocabulary and (b) analyze the relationship between global measures of expressive vocabulary and the use of grammar in individuals who use aided AAC. A series of multiple linear mixed effect regression analyses showed a positive predictive association between overall vocabulary size and the use of closed-class words, and a positive relationship between the use of verbs and the use of closed-class words. Additionally, the use of verbs had a significant positive association with the use of inflectional morphology, while the use of nouns did not. Theoretical and practical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Although augmentative and alternative communication (AAC) has been in use for several decades, many multidisciplinary teams do not implement the available knowledge in their practice. Limited availability of AAC programs has been purported as a reason for its limited use. The purpose of this study was to investigate the effects of a dynamic intensive continuing education program aimed to provide multidisciplinary teams with theoretical and practical knowledge in AAC, teamwork, literacy, and family issues regarding the application of AAC for individuals with complex communication needs, on the participants' knowledge, skills, attitudes, and myths. A mixed method was used to investigate two out‐service and three in‐service continuing education programs consisting of 136 multidisciplinary staff members. Results demonstrate that participants gained knowledge and skills, changed attitudes, and refuted previously held myths. Participants reported changes in practice and in collaboration within their teams, with individuals at their settings, and with their families. [ABSTRACT FROM AUTHOR]

Abstract Many children who require hospitalization in the pediatric intensive care unit (ICU) are unable to or have difficulty communicating through speech, whether because of preexisting or acute conditions. Children who are unable to be heard and understood using only speech benefit from aided augmentative and alternative communication (AAC), including in hospital settings. This qualitative interview study sought to understand the perspectives of nurses on care and support for children who use or would benefit from aided AAC in the pediatric ICU. Participants were six nurses who worked in pediatric intensive care at a tertiary care unit of a children’s hospital in the United States. Three main themes were identified related to nurses’ views about supporting children’s communication: (a) Caring for the Whole Child, (b) Needing Support from Others and Moving between Roles, and (c) Working with Available Resources and Demands. Nurses emphasized the importance of a holistic approach to care, the impact of others’ support and knowledge, and a desire for building greater capacity for promoting children’s access to effective communication. Findings offer insight that could improve patient-centered care for children with complex communication needs and support for nurses themselves, particularly within the broader context of ICU liberation. [ABSTRACT FROM AUTHOR]

Für Interaktionsarbeit „an und mit Menschen" werden die betrieblichen und technologischen Rahmenbedingungen und ihre Anforderungen an die Beschäftigten zunehmend thematisiert. Der Beitrag fokussiert einen bisher wenig beachteten Aspekt: Er beleuchtet am Beispiel der Versorgung von neurologisch schwer erkrankten Patient*innen die Anforderungen, die sich daraus ergeben, dass die Adressaten von personenbezogenen Dienstleistungen aufgrund gesundheitlicher Beeinträchtigungen nur eingeschränkt in der Lage sind, an der Interaktionsgestaltung mitzuwirken. In asymmetrischen Kommunikationssituationen kommt professionell Helfenden die Rolle zu, eine Interaktionsfähigkeit der Klient*innen erst einmal herzustellen. Dies ist neben den technischen und organisatorischen Bedingungen der Interaktionsarbeit als eine eigenständige Anforderung zu begreifen, die entsprechende Kompetenzen und Ressourcen erfordert. For interaction work "on and with people", the operational and technological framework along with its demands on the employees is an increasingly addressed issue. This article focuses on an aspect that has received little attention so far: using the example of caring for seriously neurologically ill patients, it highlights the requirements that arise from the fact that the recipients of personal services are only able to participate in shaping the interaction to a limited extent due to health impairments. In asymmetric communication situations, professional helpers have the role of establishing the client's ability to interact in the first place. In addition to the technical and organisational conditions of the interaction work, this is to be understood as an independent demand that requires corresponding competences and resources. [ABSTRACT FROM AUTHOR]

Abstract Background Literacy is one of the most important skills a students can achieve, as it provides access to information and communication. Unfortunately, literacy skills are not easily acquired, especially for students with intellectual disabilities who require augmentative and alternative communication (AAC). There are many barriers to literacy acquisition, some due to low expectations from parents and teachers and lack of evidence-based reading programs and reading materials adapted for AAC. Barriers as a result of extensive support needs is also a real factor. This trial aims to deliver reading instructions to 40 students with intellectual disabilities who require AAC and contribute in the debate on how to best support this population through reading instructions to maximizes their reading skills. Methodology Forty non-verbal or minimally verbal students (age 6–14) with intellectual disabilities who require AAC will be part of a reading intervention with a multiple single-case design with four randomized baselines. The intervention period will last for 18 months and will commence in March 2023. The students will receive the intervention in a one-to-one format, working systematically with a reading material that contains phonological awareness and decoding tasks based on the Accessible Literacy Learning (ALL) developed by Janice Light and David McNaughton. All the teachers will be trained to deliver the reading intervention. Discussion The reading material “Lesing for alle” (Reading for all) is based on and follow the strategies behind the research of ALL. The current trial will through a reading intervention contribute to move beyond only teaching sight words and combine several reading components such as sound blending, letter-sound correspondence, phoneme segmentation, shared reading, recognition of sight words, and decoding. The strategies and methods in use is built on the existing science of reading, especially what has been effective in teaching reading for students with intellectual disabilities who require AAC. There is limited generalizability of prior findings in reading-related phonological processing interventions to different populations of them who use AAC specially outside of the USA. More research is needed to understand how programs designed to improve reading skills across other settings understand the program’s long-term effects and to study the effectiveness when delivered by educators who are not speech language therapists or researchers. Trial registration NCT05709405 . Registered 23 January 2023.

To examine the effect of a communication intervention package on expressive communication and visual attention in individuals with Rett syndrome. A modified withdrawal (A-B1-A1-B2-A2) single case experimental design with a direct inter-subject replication across three participants was applied. Three women with Rett syndrome participated. The study took place over a six-week period and comprised 32 sessions with each participant. All sessions were video recorded. During the intervention the communication partner used aided language modelling on a gaze-controlled device in combination with using responsive partner strategies. Expressive communication was assessed as synthesised words per minute and unique synthesised words per minute. Visual attention was assessed as rate of focused gazes (1 s or longer) in interaction. An intervention effect was found on the rate of unique words for all participants. The rate of words increased for two participants when the intervention was introduced but no withdrawal effect could be seen. An intervention effect on visual attention could be seen for one participant. The intervention appeared to have social validity as reported by caregivers. Aided language modelling (ALM), while using responsive partner strategies and a gaze-controlled device may be used with adult individuals with Rett syndrome to increase their rate of expressive communication. Detailed observational measures revealed individual learning patterns, which may provide clinically valuable insights. Adults with Rett syndrome may benefit from access to gaze-controlled devices in combination with responsive partner strategies. Responsive partner communication may be effective for some individuals with Rett syndrome to increase their rate of synthesised utterances. Rate of focused gazes may be considered as an outcome measure for individuals with oculomotor difficulties when introducing aided language modelling. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic required many speech-language pathologists (SLPs) to transition to teletherapy service delivery. This study was designed to explore the experiences and perceptions of SLPs who made this transition with children with disabilities who used aided augmentative and alternative communication (AAC). Semi-structured interviews were conducted virtually with 10 SLPs who provided regular teletherapy services to children who used AAC during but not before the pandemic. Interview transcripts were analyzed thematically using immersion, reduction, and constant comparison to understand SLP experiences and perceptions individually and across the group. Results reveal that despite the challenges faced transitioning to teletherapy, there were benefits. Furthermore, many of the participating SLPs developed successful strategies and solutions for the challenges they faced. Participants in this study highlighted the unique and important role that caregivers and parents played in the success of the teletherapy they provided. This study suggests that SLPs, caregivers, and children demonstrated resilience in the face of a large-scale, unforeseen change. SLPs consistently reported the ability to maintain continuity of care during a stressful transition period, while meeting the unique needs of the children who used AAC they served. [ABSTRACT FROM AUTHOR]

Purpose: In our prior study (Malhi et al., 2021), we demonstrated that cognitive ability may be masked by communication impairments. We used binary choice (i.e., yes/no) neuropsychological tests to assess cognitive functioning in four patients with severe brain injury and communication impairments. In this study, we aimed to better understand the decision-making process of their substitute decision makers (SDMs). Methods: We interviewed SDMs – two SDMs were supporting patients in the minimally conscious state, one SDM was supporting a patient who had locked-in syndrome and was an augmentative communication user, and the last SDM was supporting a patient who was an alternative communication user. Results: SDMs were performing various roles ranging from making all decisions to simply being the vocal advocate (for the augmentative and alternative communication users). SDMs described heuristics they used to make decisions, and all identified auditory comprehension capabilities as being an important element for decision making. Conclusion: We argue that if mode of communication is established and utilized, and binary choice neuropsychological tests are used to ascertain cognitive functioning, SDMs may more confidently make low/medium stakes decisions based on the present condition and context, rather than solely on past wishes and values before capacity was in question. [ABSTRACT FROM AUTHOR]

This research examined an evidence based dialogic shared reading strategy which incorporated aided language modelling and increased communication partner responsiveness with two children with complex physical, cognitive, and sensory needs (CPCSN) who use auditory plus visual partner assisted scanning (PAS) to access a Pragmatic Organised Dynamic Display (PODD) communication book. The dialogic reading strategy prompted the communication partner to comment on the story, invite a communication turn, and respond contingently to the child. A case study design was employed, and data were collected via child and adult communication frequency measures, field notes, observations, and a semi-structured interview with the children's teacher. Overall, the results indicated a positive effect on the children's communication skills, both within the intervention sessions and the classroom. This included increases in turn taking, initiations, efficiency, and conveying meaning. Shared storybook interventions that include strategies such as aided language stimulation, responsiveness and wait time can support the communication outcomes of children with CPCSN who use PAS. [ABSTRACT FROM AUTHOR]

Background: Literacy is one of the most important skills a students can achieve, as it provides access to information and communication. Unfortunately, literacy skills are not easily acquired, especially for students with intellectual disabilities who require augmentative and alternative communication (AAC). There are many barriers to literacy acquisition, some due to low expectations from parents and teachers and lack of evidence-based reading programs and reading materials adapted for AAC. Barriers as a result of extensive support needs is also a real factor. This trial aims to deliver reading instructions to 40 students with intellectual disabilities who require AAC and contribute in the debate on how to best support this population through reading instructions to maximizes their reading skills. Methodology: Forty non-verbal or minimally verbal students (age 6–14) with intellectual disabilities who require AAC will be part of a reading intervention with a multiple single-case design with four randomized baselines. The intervention period will last for 18 months and will commence in March 2023. The students will receive the intervention in a one-to-one format, working systematically with a reading material that contains phonological awareness and decoding tasks based on the Accessible Literacy Learning (ALL) developed by Janice Light and David McNaughton. All the teachers will be trained to deliver the reading intervention. Discussion: The reading material "Lesing for alle" (Reading for all) is based on and follow the strategies behind the research of ALL. The current trial will through a reading intervention contribute to move beyond only teaching sight words and combine several reading components such as sound blending, letter-sound correspondence, phoneme segmentation, shared reading, recognition of sight words, and decoding. The strategies and methods in use is built on the existing science of reading, especially what has been effective in teaching reading for students with intellectual disabilities who require AAC. There is limited generalizability of prior findings in reading-related phonological processing interventions to different populations of them who use AAC specially outside of the USA. More research is needed to understand how programs designed to improve reading skills across other settings understand the program's long-term effects and to study the effectiveness when delivered by educators who are not speech language therapists or researchers. Trial registration: NCT05709405. Registered 23 January 2023. [ABSTRACT FROM AUTHOR]

Introduction: Young children with Down syndrome (DS) present with speech and language impairments very early in childhood. Historically, early language intervention for children with DS included manual signs, though recently there has been an interest in the use of speech-generating devices (SGDs). This paper examines the language and communication performance of young children with DS who participated in parent-implemented communication interventions that included SGDs. Specifically, we compared the functional vocabulary usage and communication interaction skills of children with DS who received augmented communication interventions (AC) that included an SGD with those children with DS who received spoken communication intervention (SC). Methods: Twenty-nine children with DS participated in this secondary data analysis. These children were part of one of two longitudinal RCT studies investigating the effectiveness of parent-implemented augmented communication interventions in a larger sample of 109 children with severe communication and language impairments. Results: There were significant differences between children with DS in the AC and SC groups in terms of the number and proportion of functional vocabulary targets used and the total vocabulary targets provided during the intervention at sessions 18 (lab)and 24 (home). Discussion: Overall, the AC interventions provided the children with a way to communicate via an SGD with visual-graphic symbols and speech output, while the children in the SC intervention were focused on producing spoken words. The AC interventions did not hinder the children’s spoken vocabulary development. Augmented communication intervention can facilitate the communication abilities of young children with DS as they are emerging spoken communicators. [ABSTRACT FROM AUTHOR]

This study's goal was to inform the selection of the most frequently used words to serve as a reference for core vocabulary selection for Hebrew-speaking children who require AAC. The paper describes the vocabulary used by 12 Hebrew-speaking preschool children with typical development in two different conditions: peer talk, and peer talk with adult mediation. Language samples were audio-recorded, transcribed, and analyzed using the CHILDES (Child Language Data Exchange System) tools to identify the most frequently used words. The top 200 lexemes (all variations of a single word) in the peer talk and adult-mediated peer talk conditions accounted for 87.15% (n = 5008 tokens) and 86.4% (n = 5331 tokens) of the total tokens produced in each language sample (n = 5746, n = 6168), respectively. A substantially overlapping vocabulary of 337 lexemes accounted for up to 87% (n = 10411) of the tokens produced in the composite list (n = 11914). The results indicate that a relatively small set of words represent a large proportion of the words used by the preschoolers across two different conditions. General versus language-specific implications for core vocabulary selection for children in need of AAC devices are discussed. [ABSTRACT FROM AUTHOR]

A descriptive case-study design was used to document the implementation of a four-phase intervention for a child with autism spectrum disorder (ASD) who uses augmentative and alternative communication (AAC) in an inclusive classroom. The focus of the intervention was on enhancing social communication through peer modelling of the child's speech-generating app during news-sharing, and the intervention was developed and enacted in a collaborative partnership with the classroom teacher. Various sources of data, including interviews, observations, and data from the child's AAC system, were collated and analysed. From this analysis, three key themes emerged: (a) Enhanced Participation, (b) Optimising AAC Acceptance and Use, and (c) Increased Teacher Agency. These themes suggest positive outcomes for a naturalistic, social-communication intervention, adding to the calls for further research in this area. [ABSTRACT FROM AUTHOR]

Participation in society is the cornerstone to living a meaningful, connected, and healthy life. Persons with complex communication needs, however, often have restricted opportunities to participate in everyday contexts and situations. Reasons for this include societal attitudinal barriers, as well as limited knowledge and skills about augmentative and alternative communication (AAC) to enhance participation. Enhancing participation of persons with complex communication needs requires a holistic and multi-faceted approach. The 17 Sustainable Development Goals (SDGs) with their disability-inclusive agenda provide an impetus for shaping the approach of the Centre for Augmentative and Alternative Communication (CAAC) in enhancing participation of persons with complex communication needs in South Africa. This paper aims to provide a reflective description and application of the work conducted by the CAAC in addressing the SDGs in South Africa. Research and training conducted by the CAAC is shown to be aligned to five SDGs, namely zero hunger (SDG 2), good health and well-being (SDG 3), quality education (SDG 4), decent work and economic growth (SDG 8) and peace, justice, and strong institutions (SDG 16), with a focus on reaching these goals in order to benefit persons with complex communication needs. The paper demonstrates that, despite some gains in addressing the SDGs, research and clinical practice still needs to be on these and the remaining SDGs. Furthermore, there is a need to also find ways to integrate the SDGs to ensure participation of persons with complex communication needs in major life activities and society. [ABSTRACT FROM AUTHOR]

“Digitalisation” is the buzzword of many societal as well as social changes. Participation in society is increasingly realized digitally, which is why it is important to be involved in these processes and to participate in the digital world. The UN CRPD also assigns an important role to (digital) technology as a prerequisite for inclusion and participation. Universal design, accessibility, assistive technology, and reasonable accommodation should help to avoid exclusion for people with disabilities. People with profound intellectual and multiple disabilities (PIMD), who often have complex communication needs (CCN) in addition to severe cognitive impairments, have fundamentally limited opportunities for participation. These are also visible in the context of digitalisation. At the same time, digital media also offer specific opportunities, particularly for people with PIMD and CCN. Among other things through the combined use of assistive technologies, digital media can significantly facilitate their daily lives. The present paper examines the significance, requirements and challenges as well as the potentials of digital participation and digital education in the lives of adults with PIMD and CCN and presents considerations for the design of digital education for adults. Finally, a conceptual framework for digital education for people with PIMD is presented.

IntroductionYoung children with Down syndrome (DS) present with speech and language impairments very early in childhood. Historically, early language intervention for children with DS included manual signs, though recently there has been an interest in the use of speech-generating devices (SGDs). This paper examines the language and communication performance of young children with DS who participated in parent-implemented communication interventions that included SGDs. Specifically, we compared the functional vocabulary usage and communication interaction skills of children with DS who received augmented communication interventions (AC) that included an SGD with those children with DS who received spoken communication intervention (SC).MethodsTwenty-nine children with DS participated in this secondary data analysis. These children were part of one of two longitudinal RCT studies investigating the effectiveness of parent-implemented augmented communication interventions in a larger sample of 109 children with severe communication and language impairments.ResultsThere were significant differences between children with DS in the AC and SC groups in terms of the number and proportion of functional vocabulary targets used and the total vocabulary targets provided during the intervention at sessions 18 (lab)and 24 (home).DiscussionOverall, the AC interventions provided the children with a way to communicate via an SGD with visual-graphic symbols and speech output, while the children in the SC intervention were focused on producing spoken words. The AC interventions did not hinder the children’s spoken vocabulary development. Augmented communication intervention can facilitate the communication abilities of young children with DS as they are emerging spoken communicators.

Historically, individuals with Rett syndrome, a rare neurodevelopmental disorder, have been cast as “silent angels,” “nonverbal,” and “speechless.” As a consequence, they have not been consulted in their medical care. Recently, however, augmentative and alternative communication (AAC) devices that use eye-tracking technology have facilitated communication for individuals with Rett syndrome. Yet, no prior research has investigated how such communication occurs within medical settings. Through an applied linguistics lens that centers the analysis of language use, we construct a case report capturing how Kalika, a child with Rett syndrome, offers medical information. Kalika’s device-mediated language use suggests multiple implications for applied linguistics scholars and language educators, including: broadening notions of speaking, increasing consideration of AAC, exploring more device-mediated language use, extending multimodal considerations, nuancing notions of communicative competence, presuming competence, and, last but not least, more deliberately espousing principles of linguistic justice in our field.

Purpose: To explore and describe a trained communication partner’s use of responsive strategies in dyadic interaction with adults with Rett syndrome. Introduction: Responsive partner strategies facilitate social, communicative, and linguistic development. The common feature is that the communication partner responds contingently to the other’s focus of attention and interprets their acts as communicative. Research on responsive partner strategies that involves individuals with significant communication and motor disabilities remains sparse. The same applies to if, and how, the use of communication aids impacts on the partner’s use of responsive strategies. Materials and methods: A therapist, trained in responsive partner strategies and aided communication interacted during 14 sessions with each of three participants. The participants were adults with Rett syndrome. A gazecontrolled device and responsive strategies were used during all sessions. The Responsive Augmentative and Alternative Communication Style scale (RAACS) was used to assess the partner’s responsiveness. RAACS consists of 11 items including ratings of to what extent the partner is being attentive to, confirms, and expands the individual’s communication. During eight of the 14 sessions, aided AAC Modelling was also used, i.e., the communication partner pointed at symbols on the gaze-controlled device while interacting. In addition to RAACS, each time the communication partner confirmed or expanded on communication when (a) the participants used the gaze-controlled device and (b) the participants did not use the gaze-controlled device was counted. Descriptive statistics were used to present the results. Non-parametric tests were used to compare means between the two conditions and between participants. Results: Inter-rater agreement for the different RAACS items ranged from 0.73 to 0.96 and was thus found to be fair to excellent. The communication partner’s use of responsive strategies varied when communicating with different participants and the scores were higher when aided AAC modeling was used. The communication partner’s number of responses and use of responsive strategies were higher when the participants communicated through a gaze-controlled device. Conclusion: The communication partner’s use of responsive and scaffolding strategies is not a fixed construct but varies in interactions with different nonspeaking persons. The same is true whether the non-speaking person uses a gaze-controlled device with digitized speech or not. [ABSTRACT FROM AUTHOR]

Telepractice offers speech-language pathologists (SLPs) increased flexibility to support language development, including emergent literacy in clients with complex communication needs. However, clinicians may feel uncertain how to pair books with augmentative and alternative communication (AAC) over telepractice. Following an overview of telepractice, book sharing, and e-helpers, we describe four practical ways to combine storybooks with AAC online. These include: (a) using accessible books, (b) screen sharing e-books and communication aid, (c) adapting slide shows, and (d) creating asynchronous videos. Finally, we offer suggestions for modeling AAC, prioritizing emotions in storybooks, and tips for clinical supervisors. This topic can direct future researchers and is relevant to practicing clinicians who want to support language development for clients using aided communication systems. [ABSTRACT FROM AUTHOR]