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Section 10
Autism, Augmentative Communication, and Assistive Technology

Question 10 | Test | Table of Contents

Staff/Family Training
The empirical literature specifically focused on staff and family training in augmentative and alternative communication (AAC) and assistive technology with individuals with autism is virtually nonexistent. In fact, only one such study was located in the published literature to date (Stiebel, 1999). In this study, the parents of three children with autism (ages 4-6) were taught a problem-solving intervention to promote the children's spontaneous use of AAC symbols during daily routines at home. The symbols consisted of three-dimensional objects (e.g., candies glued to an index card); associated objects (e.g., an empty, videocassette container, an empty juice bottle); and colored photograph picture cards to represent objects, verbs, people, places, and activities. The symbols were displayed in a variety of formats, including folders or boards with velcro, picture albums, and small baskets. The parents were first taught to use the natural teaching paradigm (NLP; Koegel, O'Dell, & Koegel, 1987; Laski, Charlop, & Schreibman, 1988) to teach use of the symbols in specific natural contexts. Then, they were taught to use an 8-step problem-solving intervention to facilitate generalization of the children's symbol use to novel routines in which this did not occur spontaneously. The eight steps included: ( 1) identifying the problematic routine in which the child did not use the symbols; ( 2) identifying possible reasons for the problem; (3) brainstorming solutions to increase symbol use; (4) discussing the pros and cons of each solution; (5) selecting the solution that best fits with the routine; (6) planning and implementing a strategy; (7) evaluating the strategy in light of its long-term "fit" with the family's lifestyle; and (8) planning a follow-up meeting to review progress. The results indicated that the children learned to use their symbols spontaneously and that the problem-solving intervention was successful at increasing parent-provided opportunities for communication in daily routines. The authors noted the importance of teaching parents to facilitate communication using strategies that can be embedded into relevant daily routines in home and community settings.

Supports for Augmented Input
AAC interventions include a wide range of strategies and procedures whose common goal is to facilitate an individual's ability either to (a) communicate more effectively with others (i.e., expressive communication strategies) or (b) understand communication from others (i.e., augmented input strategies: Wood, Lasker, Siegel-Causey, Beukelman, & Ball, 1998). Although the latter set of strategies has received relatively little attention until recently, there is increasing evidence that many individuals with autism benefit greatly when language input is augmented, particularly through the visual modality (Hodgdon, 1995, 1996; Quill, 1997).

One of the earliest published reports of the use of pictorial symbols (in this case, line drawings) to support comprehension was provided by Lancioni (1983). Three children, two of whom had been diagnosed as having autism (ages 10-4 and 12-8), were involved in a multi-step "training program" that was conducted 6 days a week for 5 hours a day, for a total of over 100 days. They were taught to follow pictorial directions on cards, beginning with simple object discriminations (e.g., touching a pictured object) and terminating with activities that were performed with a peer partner (e.g., carrying an object from the beginning to the end of a row of blocks and dropping the object into a container held by a typical peer). According to the report, both children with autism learned to follow "thousands" of pictorial directions correctly over the course of the study and demonstrated generalized learning with new pictures. This report is among the first to provide support (albeit weak) for the use of visual supports for comprehension.

Schedules
One of the most common augmented input strategies involves the use of pictorial or written schedules to assist individuals to understand and follow predictable activity sequences in school and home settings (Quill, 1997; Wood et al., 1998). In a few published reports investigating this approach, children with autism or their caregivers were taught to use within-task pictorial schedules to assist with completion of specific activities in school and home settings. For example, Pierce and Schreibman (1994) taught Robby, a 6-year-old boy with autism, to use a 10-photograph sequence for "getting dressed." Hall, McClannahan, and Krantz (1995) taught a classroom aide to support Larry, an 8-year-old boy with autism, with a pictorial schedule depicting the steps of an independent writing task in his Grade 2 classroom. Finally, Mirenda, MacGregor, and Kelly-Keough (in press) taught the mother of a 6-year-old girl with PDD-NOS and profound deafness to use a within-task schedule for hair-washing to decrease her tantrum behavior.

In other studies, participants used between-task schedules to access information about what would happen next as they moved from one activity to the next. For example, Flannery and Horner (1994) used a written schedule to support Aviv, an adolescent with autism who engaged in aggression, self-injury, and property destruction. Aviv was known to exhibit problem behaviors when the sequence and duration of activities at school were unpredictable. Because he was able to read, Aviv was provided with a printed, sequential list of upcoming activities and their durations at the beginning of each school period, and was prompted to consult the list regularly to predict "What activity is next?" When the schedule was not available, he engaged in moderately high rates of problem behavior, compared to no such behaviors when the schedule was provided. Similar results were found in a study with young children (ages 6-8; Krantz, MacDuff, & McClannahan, 1993) as well as in one with older children (ages 9-14; MacDuff, Krantz, & McClannahan, 1993). Such results suggest that individuals with autism can learn to use pictorial or written schedules for independent self-management, and that, at least in some cases, their problem behaviors may be reduced or eliminated when these supports are provided.

Visual Symbols for Choicemaking
A few published reports have documented the successful use of visual symbols as augmented input related to choice-making by individuals with autism (e.g., Peterson, Bondy, Vincent, & Finnegan, 1995; Vaughn & Horner, 1995). For example, Vaughn and Horner provided food choices during mealtimes at home to Karl, a young man with autism. Sometimes the choices were presented verbally (e.g., "Do you want X or Y?") and sometimes they were presented verbally and with their corresponding photographs (e.g., "Do you want X [show photo] or T [show photo]?"). With verbal choices only, Karl accepted around two-thirds of the foods he chose, and exhibited frequent disruptive and aggressive behaviors. When verbal + photograph choices were provided, Karl's acceptance rate for the foods he chose rose to around 85%, and there were many days on which he rejected no meals and exhibited no challenging behaviors at mealtime. This study suggests that the use of visual symbols to support choice-making may be of benefit to individuals who require augmented input for language comprehension.
- Mirenda, Pat, Autism, augmentative communication, and assistive technology: what do we really know?, Focus on Autism & Other Developmental Disabilities, Fall 2001, Vol. 16, Issue 3.

Personal Reflection Exercise #4
The preceding section contained information about autism, augmentative communication, and assistive technology.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
Socially-Assistive Robots to Support
Learning in Students on the Autism Spectrum:
Investigating Educator Perspectives
and a Pilot Trial of a Mobile Platform
to Remove Barriers to Implementation

- Silvera-Tawil, D., Bruck, S., Xiao, Y., & Bradford, D. (2022). Socially-Assistive Robots to Support Learning in Students on the Autism Spectrum: Investigating Educator Perspectives and a Pilot Trial of a Mobile Platform to Remove Barriers to Implementation. Sensors (Basel, Switzerland), 22(16), 6125.

Peer-Reviewed Journal Article References:
Hillman, H. (2018). Child-centered play therapy as an intervention for children with autism: A literature review. International Journal of Play Therapy, 27(4), 198–204.

Wang, Q., Hoi, S. P., Wang, Y., Lam, C. M., Fang, F., & Yi, L. (2020). Gaze response to others’ gaze following in children with and without autism. Journal of Abnormal Psychology, 129(3), 320–329. 

Yi, H., Siu, Q. K. Y., Ngan, O. M. Y., & Chan, D. F. Y. (2020). Parents’ experiences of screening, diagnosis, and intervention for children with autism spectrum disorder. American Journal of Orthopsychiatry, 90(3), 297–311. 

QUESTION 10
What is the goal of augmentative and alternative communication (AAC) interventions? To select and enter your answer go to Test.

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