Revisiting AAC abandonment: the SLP perspective

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Last month, we reviewed an article about parents’ perspectives on why their children’s AAC devices ended up rejected or abandoned. (Are you picturing a sad, dusty cabinet full of non-functional GoTalks and retro Dynavoxes? I am.) Now, we’ve got a natural companion piece from the same authors, flipping the script and talking to a group of Australian SLPs about similar situations.

Sometimes these interview-based studies tell us a lot of what we already know, and can lead to the pessimists among us getting bogged down in Barriers-ville. This one, though, has some thought-provoking and useful ideas for working with families to implement AAC systems more successfully.

First, commit yourself to family-centered practice. Specifically, the authors discuss:

  • Stepping up our counseling to help families move through any grief and increase their readiness for AAC.

  • Helping connect families of AAC users so they can support each other.

  • Moving away from a deficit mindset with families (they’re overwhelmed, they’ve got other priorities, they don’t have the resources…) and capitalizing on their strengths.

  • Focus on relationships, and bring families into the process as much as possible, through device trials, hands-on support, and follow-ups.

Next, orchestrate some early wins. Families may need to see their child being successful with AAC to overcome doubts, resistance, or previous negative experiences around devices. This might mean making an effort to share progress from speech sessions (via videos, maybe?) or even starting off with simpler systems like activity displays, to build momentum and motivation, before jumping into a complex device*.

Finally, this last point is the part where we clinicians need to humble ourselves a bit. Sometimes devices don’t work because the SLP didn’t recommend the right system for that child. We all have our favorites, the ones we know best, the ones we like most for many, totally valid reasons. But we can’t unilaterally impose that preference on our clients. That’s clinician-centered, arrogant, and just less likely to work. Clinician experience is also important here. The study authors suggest that having newer grads supported by seasoned AAC pros could improve device acceptance.

Selecting and implementing AAC is a complex balancing act between the user, the device/system, the family, the environment, and the clinician. Like the EBP triangle, but more of a pentagon? When we don’t consider all those factors, we’re risking another addition to that sad cabinet of lonely devices.  

*This is NOT to suggest that kids need to start with low tech AAC, or implying any prerequisites to using a robust language system.

 

Moorcroft, A., Scarinci, N., & Meyer, C. (2019). Speech pathologist perspectives on the acceptance versus rejection or abandonment of AAC systems for children with complex communication needs. Augmentative and Alternative Communication. doi:10.1080/07434618.2019.1609577

Characteristics of culturally- and linguistically-responsive interventions

Although we do our best to review EBP for culturally and linguistically diverse students, the reality is that most interventions are researched using monolingual English speakers. There’s even fewer studies out there about interventions for really young kids, even though we know that early intervention is vital for later academic and language outcomes. The authors of this new study reviewed high-quality, culturally/linguistically-responsive language interventions for kids under five to see what we DO know. But first, what counts as a responsive intervention, anyway? 

Linguistically-responsive interventions encourage the use of the home language or language variety. This doesn’t mean SLPs have to be bilingual. Coaching parents on language stimulation strategies to use in their native language counts.

Culturally-responsive interventions incorporate the values, beliefs, practices, experiences and materials relevant to the cultural backgrounds of children and their families. Culturally-responsive interventions can take many forms, but might include strategies centered around the way people from the family's culture typically interact with young children, or using materials that represent the family’s background. 

So what seems to work? Explicit instruction of target skills was particularly effective, with 100% of studies reporting an increase in English skills and 78% reporting an increase in home language skills. These interventions, delivered individually or in small groups, tended to be especially useful for vocabulary growth. Classroom curriculum and book reading interventions, delivered in the home or school, were also promising (especially when delivered in the students’ home languages), but with a wider range of effect sizes. 

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Importantly, interventions that met the criteria for being both linguistically and culturally responsive were the most effective for improving children’s language abilities in English and the home language. Including the child’s home language did not detract from the effectiveness of the interventions. Unfortunately, less than a third of the studies reviewed used culturally-responsive interventions! SLPs can (and need to) do better to use interventions that match families' backgrounds.

 

Larson, A.L., Cycyk, L.M., Carta, J.J., Hammer, C.S., Baralt, M., Uchikoshi, Y., … Wood. C. (2019). A systematic review of language-focused interventions for young children from culturally and linguistically diverse backgrounds. Early Childhood Research Quarterly. doi: 10.1016/j.ecresq.2019.06.001

Who benefits most from pragmatic language intervention?

Not all children respond the same to various interventions. Parsons et al. helps us with this problem by identifying which school-aged children with autism respond best to a peer-mediated play-based pragmatic language intervention.

The intervention consisted of ten weekly 50-minute sessions for students with ASD (ages 6–11, without intellectual disability) paired with typically developing peers. During each session, SLPs and OTs targeted individualized pragmatic language skills through:

  • Self video-modeling

  • “Feedforward” discussions of target skills (where you focus on what to do next time, vs. feedback.)

  • Child-led play

  • Peer and therapist modeling

Parents were encouraged to carry over targeted skills at home by reviewing videos, holding playdates, and reading a provided parent manual. See the original article and this article for even more details about this intervention.

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So which children benefited most? The results might surprise you.

  1. Children with higher separation anxiety, possibly because this intervention created a safe space with positive social interactions.

  2. Children with greater ability to use and interpret communicative intent, suggesting that this skill may be an important prerequisite for this type of pragmatic intervention.

  3. Children with lower nonverbal communication skills had better pragmatic outcomes, likely because the intervention targeted these exact skills.

As a school-based SLP, you might consider these results when determining which students would be appropriate for various intervention types. For instance, if a child has significant difficulty using and interpreting communicative intent, the type of intervention used here might not be your first line of treatment. When working with a high-anxiety student, you might consider a more structured session with one peer rather than pushing in to a classroom with 10 other students.

 

Parsons, L., Cordier, R., Munro, N., & Joosten, A. (2019). A play-based, peer-mediated pragmatic language intervention for school-aged children on the autism spectrum: Predicting who benefits most. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-04137-3

Using animal filters to help kids with ASD identify emotions

This study looked at whether the use of animal filters—or “anthropomorphic” stimuli—could help adolescents (12–17) with autism recognize and interpret emotions. The participants matched emotion words (angry, sad, afraid, happy, or surprised) to either photos of faces or the same photos with animal filters over them, like, this:

 
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Fun! And, the best part is, the animal filters made a big difference: the kids were significantly more accurate in matching when the animal filter was present (specifically, for “happy” and “angry”). Based on findings from previous research, the authors speculated that the animal filters may have increased the kids’ social interest and motivation, making it easier for them to focus on and correctly identify emotions. And, note, most of the participants also had an intellectual disability. The variability in cognitive and social functioning among kids with ASD makes finding appropriate evidence-based interventions challenging, so it’s great that this activity could theoretically work for a whole range of clients.

The researchers make it really easy to replicate this activity for your clients, too. The images they used are freely available for research purposes, but it would be just as easy to use your own photos or stock photos that you find online. And this free website was used to make the animal filters. Happy animal filter-making!

 

Cross, L., Farha, M., & Atherton, G. (2019). The animal in me: Enhancing emotion recognition in adolescents with autism using animal filters. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-019-04179-7

It’s not too late to work on word finding with older students

Most of our research on language treatment is done with younger children, despite the fact that challenges for people with language disorders persist into adulthood. One of these challenges might be word finding difficulties, or being unable to say a known word when needed. Previous research has given us proven treatments for word finding difficulties in children and young adolescents, but the authors of this study wanted to see if they could also improve word finding in older students.

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The researchers gave students aged 16–19* a standardized word finding test before the study started, after a period of no treatment, and after a short period of treatment. In eight 30-minute treatment sessions, students boosted their semantic knowledge of nouns by sorting them into categories and answering questions about them (see Appendix 5 for examples).  Students’ improvement on the word finding test was higher across the treatment period than the no-treatment period, suggesting that the treatment improved their general word finding ability. The study wasn’t experimental, so we can’t make strong conclusions, but it does suggest that teenage students can still make progress on word finding skills.

*College students in the UK, where the study was conducted; high school students in the US

 

Campbell, L., Nicoll, H., & Ebbels, S. H. (2019). The effectiveness of semantic intervention for word-finding difficulties in college-aged students (16–19 years) with persistent Language Disorder. Autism & Developmental Language Impairments. doi:10.1177/2396941519870784