AAC assessment and intervention for preschoolers with severe speech impairment

This review covers two research papers in one, from the same research group and measuring the same students; the first paper on dynamic assessment of AAC users, and the second paper on intervention for AAC users.

In both studies, the participants were 10 three–four-year-old children with receptive language within normal limits, but severe speech impairment (< 50% intelligible). The children were provided an iPad with Proloquo2Go to use for AAC.

Study #1 (Dynamic Assessment):

Dynamic assessment “uses a teach-test approach”, as opposed to static assessment, which simply tests the child’s current skill set. The researchers state, “… using DA may enable clinicians to improve their ability to predict when children are ready to focus on early syntax when using AAC.”

For the DA procedure, the researchers assessed as much as they could of the following four targets:

  • agent-action-object (e.g. “Pig chase cow.”)
  • possessor-entity (e.g. “Pig plate.”)
  • entity-locative (e.g. “Pig under trash.”)
  •  entity-attribute (e.g. “Pig is happy.”)
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First, using graduated prompting, they provided the student with increasing support as needed (e.g. moving from “Tell me about this one.”...to... “Look… Lion in car… now tell me about this one (target = Pig under trash.) ...to... “See, pig is under the trash. Now you tell me.” ...to... “Tell me pig is under the trash. Pig under trash.”). Also, note that the only grammatical marker required to be used by the children during DA was “is” in the entity-attribute sentences. All the others—“IS, THE, possessive –‘s, and third person singular –s… were included as independent symbols,” but weren’t required to be produced by the children within DA (that came later, in intervention). Vocabulary targeted was all within the children’s receptive vocabulary; a full list of the vocabulary, plus pictures of how they arranged and labeled vocabulary within Proloquo2Go is in the article appendices. Toys, puppets, and figurines were used to demonstrate the target sentences. Ten trials per target (e.g. 10 possessor–entity sentences) were administered.

The researchers found that, not only were the young children able to participate in the DA, but they even learned some expressive syntax types within DA as well. There was some variability in which sentence structure types were difficult for individual children, however, emphasizing that, “… a broad range of targets must be investigated before concluding that a child is not capable of creating rule-based utterances when using graphic symbols to communicate.” Thus, it’s not adequate to test just one or two short sentence types when trying to decide if a child is ready to work on multi-word sentences.

Study #2 (Intervention):

The same 10 children (above) participated in intervention as well. The same four targets (above), with each intervention session focused on one of the four targets. Activities included:

concentrated modeling

  • Ten sentence pairs of one sentence type served as targets, and were “designed to highlight key features of the target”. For example, one pair was “Pig in car” vs. “Pig under car”. The clinician would teach this by first saying Pig is under the car, while acting it out with toys, then providing augmented input on the child’s device. Next, the clinician would repeat the process with the contrasted sentence (Pig under car).

play (20 minutes)

  • After concentrated modeling, they switched to play-based instruction, which was more child-led, but still included adult instruction—“For example, for entity–locative, the examiner could make Cow hide her eyes, place Penguin under the trash can, and then ask the child to tell Cow where Penguin was (Penguin under trash).”
  • Features of the play session included “setting up opportunities for communication… providing spoken and aided models of the target using a range of exemplars… providing indirect and direct spoken prompts… assisting with message productions…”

Results showed that, “the majority of the participants mastered the majority of the targets and did so quickly.” Possessor-entity sentences were the easiest; agent-action-object were the most difficult. The researchers also found that students generalized the new syntactic structures with novel vocabulary, as well.

A really interesting part of the study was that, “nine participants spontaneously used the possessive marker accurately at least once with no aided models provided…”. Only four of the ten students were explicitly taught the grammatical markers (IS, THE, possessive –‘s, and third person singular –s) and these students, “…required only one or two intervention sessions to demonstrate consistent use of the markers.”

Binger, C., Kent-Walsh, J., & King, M. (2017). Dynamic assessment for 3- and 4-year-old children who use augmentative and alternative communication: evaluating expressive syntax. Journal of Speech, Language, and Hearing Research. Advance online publication. doi: 10.1044/2017_JSLHR-L-15-0269

Binger, C., Kent-Walsh, J., King, M., & Mansfield, L. (2017). Early sentence productions of 3- and 4-year-old children who use augmentative and alternative communication. Journal of Speech, Language, and Hearing Research. Advance online publication. doi: 10.1044/2017_JSLHR-L-15-0408