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Table 2 Interventions, Outcomes, and Recommendations Reported in Each Included Review

From: Augmentative and Alternative Communication for Children with Intellectual and Developmental Disability: A Mega-Review of the Literature

Review Intervention Outcomes Recommendations
Allen et al., (2017). Aided augmented input. Receptive and expressive vocabulary skills increased, pragmatic skills increased. Aided input more effective than non-aided. Studies need to report more detail on dosage of intervention, specific AAC used, provide data on receptive syntax skills before and after intervention.
Alper & Raharinirina, (2006). Effectiveness of assistive technology: 5.88% of included studies on AAC (n = 4). Very young individuals with disabilities are not receiving assistive technology. Participants mostly children: 25% of participants over 22 years. Assistive technology interventions resulted in skill improvement in 67.65% of studies. Explore use of assistive technology with more varied types and degrees of disability, investigate effective teaching strategies for maintenance and generalization.
Alsayedhassan et al. (2016). Picture Exchange Communication System (PECS). Overall positive and successful outcomes: 8 out of 13 studies reported mastery of PECS. Trainers should provide more immediate feedback during intervention. Researchers need to take data on and report procedural integrity.
Alwell & Cobb, (2009). Social and communication interventions for secondary-aged youth with disabilities. AAC subgroup (n = 5): milieu teaching, prompting, shaping, modified interrupted chain procedures. Increase in communication skills in all studies and overall mean slightly positive effect. Use of AAC in secondary settings can support student participation and interaction. Researchers should replicate intervention studies with additional participants, increase methodological quality, and report effect sizes.
Alzrayer et al., (2014). Mobile tablet use in communication interventions with individuals with autism spectrum disorder and other developmental disabilities. Communication skills increased for all participants and some participants continued communication using tablets after intervention ended and across novel contexts. Future research should investigate using communication apps other than Proloquo2Go and investigate wider range of verbal behaviors as well as device navigation.
Andzik et al., (2016). Practitioner implemented functional communication training. From total of 15 studies, 30 out of 31 participants had reported positive results, 1 mixed. Teacher is most common intervention agent and most interventions took place in special education settings. Need more information about specific training for interventionists, need more treatment fidelity data reported, need more programming for generalization and maintenance.
Anttila et al., (2012). Overview of systematic reviews of assistive technology interventions across recreation, vocational support, and communication. Communication addressed in 8 reviews: review authors concluded that quality of evidence is low but AAC may be beneficial for individuals with autism. Urgent need for further and better quality research across different participant demographics and types of AAC.
de Barbosa et al., (2018). AAC for children with Down syndrome. Review of 13 studies: 4 studies used SGD (29 px), 3 used PECS, 2 used manual sign system, 2 used picture symbols, 1 each other types of assistive technology. Speech-generating devices (n = 4) and PECS (n = 3) most frequently used with children with Down syndrome. Both increased communication skills. Need more research on AAC for individuals with Down syndrome and need to measure changes in communication, socialization, language, and motor skills.
Barker et al., (2012). Reading instruction for children who use AAC. Total of 8 studies: n = 5 instruction that directly and explicitly taught phonological awareness, reading, and/or spelling skills. Most participants used SGDs (n = 16 participants). Difficult to compare results due to different measures and strategies used. Need standardized assessments of phonological awareness and reading that don't require speech responses, assess validity of new assessments, assess validity of interventions modified to remove speech elements.
Barton et al., (2017). Technology-aided intervention and instruction (TAII) for students with autism spectrum disorder (ASD) Computer-aided instruction is an evidence-based practice for students with ASD. AAC and virtual reality not identified as evidence-based practices. More research about TAII to determine components, need more research on AAC and virtual reality, specifically group design studies.
Battaglia & McDonald, (2015). PECS for children with ASD and effects on maladaptive behavior. All participants made gains on proficiency with PECS and increased verbal speech but three out of seven total participants did not demonstrate decreases in maladaptive behavior. Further research on functional relation between PECS use and decrease in maladaptive behavior, researchers should determine function of challenging behavior prior to implementation of PECS.
Biggs et al., (2018). Aided AAC modeling. All participants (children and youth with CCN) made gains in expressive communication however due to packaged interventions, benefits cannot solely be attributed to aided AAC modeling. Further research on aided AAC modeling for older children and adults, more research on focused aided AAC modeling. Study authors should report with greater detail for replicability.
Boyle et al., (2017). Interactive reading/shared reading with digital texts. Digital text on tablet/computer with visual scene display programmed with hotspots to label pictures. Initial evidence of benefit: increases in communication turns, word learning. Need more research into how visual scene displays can be used to develop interactive reading interventions. Need research on whether interactive reading between peers and children with disabilities could lead to greater social interactions.
Branson & Demchak, (2009). AAC interventions with infants and toddlers with disabilities. Most studies on unaided AAC and 42% of studies on aided AAC. Improved communication skills for 97% of participants, communication partners successfully taught to create more opportunities and increase child's use of intentional communication acts. Need more research on comparative effectiveness of various types of AAC for kids with specific disabilities, compare aided vs unaided AAC, investigate use of AAC with infants and toddlers.
Brunner & Seung, (2009). Communication treatments for children with ASD. AAC interventions covered were PECS and manual sign. Manual sign used successfully for longer to teach receptive and expressive vocabulary skills; has strong empirical support. PECS is widely utilized in school settings and across verbal operants. Provide more participant information because of heterogeneity of individuals with ASD, have to understand typical interaction/ communication before teaching individuals with ASD.
Brunner et al., (2017). Technology in rehabilitation for people with traumatic brain injury. AAC (n = 27) interventions addressed communication needs, increasing participation, improving quality of life. AAC increased independence and participation. Need further research into apps, social media, virtual reality, blogs, more about user perspectives or experiences accessing internet and using mobile devices and apps.
Bryant et al., (2010). Assistive technology as a support for individuals with intellectual disability. AAC helps users communicate and learn new concepts. Study authors need to report participant standardized test scores, age, and gender data of participants.
Campbell et al., (2006). Practices for teaching young children (infants and toddlers) to use assistive devices. One of the included studies addressed AAC: using a “voice output communication aid” during snack and play routines. All participants increased communication over baseline. Researchers should provide more information about context of communication device use and teach skills within natural contexts and settings.
Chapin et al., (2018). Peer support for preschoolers with ASD. Children who used AAC prior to intervention activities demonstrated moderate level of effect, children who used AAC during intervention reported very strong effect. Mostly PECS used (n=3) with only one study with SGD. Continue research on developmentally appropriate partner training activities, need more research due to small number of studies providing information on peer characteristics.
Chung et al., (2012). Interventions to increase peer interactions for students with complex communication needs. Peer training and multicomponent intervention packages are promising interventions for increasing social communication. Investigate peer training as important component, research multicomponent interventions, more research into adult facilitation, research pragmatics, functions, topics of social communication.
Cumming & Draper Rodriguez (2017). Mobile technology supporting individuals with disabilities. Communication skills (n = 7) overall indicated a weak effect overall for AAC interventions on communication outcomes. Further high quality research in mobile tech and communication. Use greater variety of apps on mobile technology devices (not just Proloquo2Go for communication).
Desideri et al., (2013). Assistive technology recommendations for children with multiple disabilities. Overview of models and instruments to guide AT professionals for assessment of children with multiple disabilities. Need to transition from unsystematic experiences and intuitions of clinicians and establish evidence-based practices and need to use validated intervention models and instruments.
Douglas (2012). Communication partner training for paraeducators to support the communication of individuals who use AAC. Paraeducators’ results: positive behavior changes reported (n= 7), individuals who use AAC: increase in communicative behavior, decrease in challenging behavior, increase in responding and requesting. Need more research to strengthen findings of review, investigate the impact of paraprofessionals to support communication and research on how communication partner training impacts individuals who use AAC.
Dunst et al. (2013). Assistive technology device use by young children with disabilities. All AT device use resulted in improvements in child outcomes except weighted/pressure vests; effect sizes all very large. Research on promoting use of assistive technology needs to pay explicit attention paid to differences between implementation and intervention practices.
Erdem (2017). Assistive technology for students with special needs. Communication: aided and unaided AAC. Assistive technology provides equal educational opportunities for students with disabilities and improve quality of life. Researchers should share results of literature reviews at conferences and with teachers, parents, admin, students, assessment of tech, tools, guide materials, teacher training, sample implementations, cooperation among professionals.
Flippin et al., (2010). PECS effectiveness for children with ASD on communication and speech outcomes. Speech outcomes varied and mixed, questionable effectiveness for increasing speech. Children who complete Phase IV of PECS higher rates of speech gains. Evidence for maintenance and generalization limited and mixed. Need to research moderators on effectiveness, why Phase IV results in more speech gains, and what pretreatment characteristics lead to more gains.
Ganz et al., (2012a). PECS with individuals with ASD PECS interventions for children with ASD. AAC has small to moderate effects on speech outcomes, SGD most effective for ASD without IDD, PECS most effective for ASD and IDD, PECS most effective for preschool. Participants who started with more speech had better speech outcomes, aided AAC doesn’t inhibit speech but may enhance. Further research into measures of speech outcomes pre/post intervention, report standardized definitions of language levels, report standardized diagnostic measures.
Ganz et al., (2012b). Aided AAC for individuals with ASD. Aided AAC for individuals with ASD. All participants had moderate or better effects. AAC has small to moderate effects on speech outcomes. Investigate specific types of AAC with different ages and diagnostic categories. Researchers should provide more information about participants to determine possible mediators (age, severity of disability, level of language skills)
Ganz et al., (2014a). Interaction of participant characteristics and type of AAC. Comparison of three types of aided AAC: PECS, SGDs, other picture-based. Overall small to moderate positive effects on speech outcomes. SGDs most effective for individuals with ASD, PECS most effective for individuals with ASD and comorbid intellectual and developmental disabilities. Further research into impacts of SGDs and picture-based AAC on speech outcomes, need to report participants’ communication skills from standardized assessments, and report diagnostic information.
Ganz et al., (2017). High-tech AAC for individuals with intellectual and developmental disabilities and complex communication needs. Moderate positive effects of high-tech AAC on social communication outcomes. Need more research impact of PECS on academic performance, utility of speech-generating devices and other picture based AAC to improve social skills, component analysis of aided AAC when part of intervention package.
Ganz et al., (2014b). Moderation of effects of AAC based on setting and types of aided AAC. Effects of aided AAC across settings for children with autism spectrum disorder. Aided AAC resulted in the largest effects in general education settings. Both speech-generating devices and PECS had larger effects than other picture-based systems. Speech-generating devices produced larger effects than PECS. Need research on the effects of AAC on skills other than communication, investigate instructional elements of AAC interventions to find most effective, different types of symbols on behavioral objectives.
Gevarter et al., (2013). Comparing AAC intervention components for individuals with developmental disabilities. Comparing symbol sets, instructional strategies, speech output in aided AAC, verbal operants in unaided AAC. Evidence that PECS acquisition doesn't differ based on use of low and high iconicity symbols, pictures and photographs. Effect of type of speech output on increasing vocalizations were inconclusive. More research into differences based on iconicity and receptive learning, compare different symbol sets and SGD-based comparisons. Need more research on whether presence/absence of speech output, type (digitized or synthesized), long or short output influences AAC acquisition.
Gevarter & Zamora, (2018). Naturalistic interventions for increasing expressive skills of children who use SGDs in natural contexts. Mostly positive results (19 of 32 included studies) across variety of types of SGDs, natural change agents as interventionists, peer-mediated interventions successful. Strategies and intervention procedures should be individualized, further research into interventions for individuals with ASD, research with individuals with multiple disabilities, component analysis of strategies.
Gilson et al., (2017). Methods to teach employment skills to secondary students with intellectual and developmental disabilities. AAC: strong positive effect (n = 1), mostly positive effects (n = 5), no studies with mixed effect or no effect included. Need to target social skills in employment interventions. Need more research to support more legislation to create opportunities for adults with disabilities and need more research with participants with severe disabilities.
Hart & Banda, (2010). PECS with individuals with developmental disabilities. PECS interventions resulted in increases in functional communication in all but 1 participant, decreased problem behavior, increased vocal verbal speech in some participants. Researchers should investigate completing formal preference and reinforcer assessments before conducting intervention studies. Need research into how manipulating symbol, referent and instructional variables affects acquisition of pictures during training.
Heath et al. (2015). Impact of FCT on CB and communication outcomes Highest gains for verbal individuals, then aided AAC, then unaided AAC. Highest gains for ASD compared to ID. FCT is evidence based practice for ASD. Research to determine cognitive ability or communicative ability impact on FCT, secondary age participants, component analysis, brief FAs vs FAs and FBA, generalization and maintenance data needed
Holyfield et al., (2017). AAC interventions for adolescents and adults with ASD. Very large effect size for effect of AAC interventions on targeted behaviors for adolescents and adults with ASD. More intervention research for older children and adults with ASD, studies need to have higher methodological rigor, and more research focusing on social interaction.
Hong et al., (2017). Tablet-mediated interventions with individuals with ASD. Tablet-mediated interventions for individuals with ASD have overall large effects across all age groups for social and communication outcomes. Need additional research on tablet-mediated interventions’ effect on academic skills, life skills, community access, household chores, school readiness.
Iacono et al., (2016). Review of reviews of AAC for children with ASD across developmental domains. Included reviews favored aided AAC. Most evidence supports PECS and SGD in interventions, manual sign only used to compare to aided systems. Most research on teaching FCT and focuses on requests. Most research on efficacy of PECS for kids with ASD. Researchers and review authors should provide details of participant characteristics including communication skills of participants at start of intervention, research AAC interventions on more functions than requests, do research in real world environments, and address needs of children with severe and complex disabilities.
Kagohara et al., (2013). Mobile tablets as communication devices for children with developmental disabilities. Participants requested preferred stimuli (food, items) by selecting icons via apps installed on mobile touchscreen tablets. Mobile devices (iPads, iPods, iPhones) can successfully be used by individuals with developmental disabilities; expand communication functions beyond requesting and naming preferred stimuli, assess social validity as SGDs.
Kent-Walsh et al., (2015). Communication partner instruction interventions and effects on communication of individuals who use AAC. Communication partner instruction within AAC interventions has positive effects on communication skills of individuals using AAC. Most frequently targeted strategies are aided AAC modeling, expectant delay, and open-ended question asking. Need to support and teach communication partners within educational, medical, and private sector service delivery settings, and integrate communication partner instruction in preservice personnel preparation programs.
Kim & Kimm, (2017). Mobile device-based technology for individuals with intellectual disabilities. Video prompting, video self-prompting, video modeling, picture prompting, systematic instruction with device, speech-generating app. Mobile device-based intervention very effective for individuals with intellectual disabilities, effect sizes did not significantly differ across target skill domains. Research on effectiveness of mobile devices in various settings and functions beyond instructional in the classroom is in beginning stages: researchers and practitioners should use functional technology in daily activities to improve independence and integration.
Lancioni et al. (2007). PECS and “voice output communication aids” interventions’ effects on requesting by students with developmental disabilities. Most participants who used PECS and speech output devices gained communication skills and successfully learned to make requests. Further research into individual preference for type of AAC and impact on use of AAC and benefits of either type of AAC on speech development.
Lancioni et al., (2001). Microswitches and speech output systems with individuals with intellectual or multiple disabilities. Positive and mixed findings. Speech output resulted in more expressive communication, usually with one communication modality, most often requesting. Need research on strategies to introduce microswitch to individuals with severe disabilities and ways to integrate switch use into daily routines and activities.
Logan et al., (2017). Aided AAC to increase social-communication skills in children with ASD, focusing on communicative functions other than requesting. Emerging evidence that AAC interventions can be used to teach variety of communication functions to children with ASD other than object requests. Included studies did not address generalization, maintenance, or social validity of interventions. Future research on communication functions other than requesting is needed and whether intervention effects are sustained over time.
Lorah et al., (2015). Tablets and portable media players as SGDs for individuals with ASD. Promising evidence for mobile technology as AAC but tablets only compared so far. Most studies used one app on mobile tablets. Most participants prefer tablet over manual sign or PECS. Need research into how AAC can grow with individual, research app interface design, user interaction, user experience, research into creating training protocols on how to learn different functions of communication, and how to program and use devices.
Lynch et al., (2018). Interventions to support graphic symbol learning and aided language development by children who use aided AAC. Aided AAC modeling can be considered an evidence-based practice. Also there is strong research evidence to support use of narrative-based interventions and mand-model procedures to facilitate graphic symbol learning and language acquisition. Researchers should compare effectiveness of instructional strategies at different stages of aided language acquisition and use consistent terminology across research literature.
Machalicek et al., (2010). Literacy interventions for students with physical and developmental disabilities who use aided AAC. Systematic instruction was most effective to increase literacy skills and increase participation in literacy activities. Outcomes mostly positive for all studies and if literacy skills didn’t increase, communication skills did improve. Researchers should conduct more rigorous experimental designs, component analysis of packages to determine individual instructional components effectiveness, and evaluate general education teachers’ delivery of literacy instruction to students included in general education classrooms.
Mancil (2006). Functional communication training interventions for children with ASD. All included studies were successful in reducing challenging behavior and increasing communication but communication mands limited in scope (e.g. taught a single mand). Researchers should use natural opportunities (e.g., lunch time, routines in classroom) during interventions and train natural change agents.
Millar et al., (2006). AAC interventions’ impact on speech production of individuals with developmental disabilities. Included studies: 11% demonstrated no change in speech production as a result of AAC intervention, 89% demonstrated modest gains in speech, 82% reported speech increase, 11% no change, 7% decrease in speech. Researchers should investigate effects of aided AAC on speech production for children and adults with developmental disabilities, what factors may best predict gains in speech production, and determine comparative effectiveness and efficiency of interventions to promote speech production.
Morin et al., (2018). High tech AAC interventions. High tech AAC to teach social-communication skills can be considered an evidence-based practice although comparison studies don’t indicate that high-tech is better than low-tech AAC. Researchers should increase methodological rigor when designing and implementing single case research designs, investigate communication functions than requesting, and conduct interventions in natural settings.
Muharib et al. (2018). High-tech speech-generating devices as an evidence-based practice for children with ASD. High-tech SGD interventions have large effects on manding, intraverbals, multi-step tacting skills with children with ASD. Need more research on interventions in natural environments, using natural communication partners, programming for generalization, communication functions other than manding.
Murray et al., (2014). AAC systems’ impact on communicative effectiveness in children with severe childhood apraxia of speech. Participants used AAC to alleviate frustration and behavior problems due to communication failure. Aided AAC most effective intervention. Future research should compare treatment approaches, should program for generalization and assess maintenance, and compare whether AAC interventions can promote speech gains over speech-based interventions.
Nam et al., (2018). Overview of reviews on interventions using popular AAC systems with individuals with developmental disabilities. Positive effects of using iPads as AAC for individuals with limited speech such as improved communication skills. Future research should evaluate and assess preferred type of AAC for each child and conduct more focused analyses to decrease heterogeneity of participants, designs, and outcomes.
O’Neill et al., (2018). AAC interventions for individuals with CCN. Interventions using aided AAC input were highly effective across participants and language skills. Need further research on long-term outcomes of interventions, older participants, effects on comprehension skills, partner use on communication outcomes.
Odom et al., (2015). Technology-aided interventions for adolescents with ASD. Mobile tech as speech-generating device increased communication skills for participants in school setting (n = 1). Need more research in communication with technology for adolescents with ASD and possible negative effects of technology use.
Ok, (2018). Assistive technology for students with disabilities, specifically iPads. Use of iPads as AAC may be due to lower price compared to other speech-generating devices. Need more research to replicate effects of using iPads as assistive technology and conduct research with populations other than individuals with developmental disabilities.
Ostryn et al., (2008). PECS for individuals with ASD. Positive outcomes for individuals with ASD, particularly with manding and generalizing manding. Researchers should program for generalization from the beginning of intervention, re-evaluate vocabulary and icons because individual needs change over time.
Østvik et al., (2017). Friendship between children who use AAC and peers. Children who use AAC have fewer friends and acquaintance: Their parents’ friends are their friends. Close family members are preferred communication partners. Conversations are limited by vocabulary on SGDs, delayed communication, poor output volume, or poor voice quality. Further research on indicators of social relationships, different types of relationships, characteristics of friendships, models of friendship development, characteristics of friendships at different ages/stages of development, how children who use AAC establish friendships, and reciprocity in friendships between children with AAC and peers.
Pinto et al., (2009). Research on increasing communication for students with severe disabilities. Individuals with severe disabilities can effectively communicate using symbolic or idiosyncratic communication forms. Researchers need to increase programming for generalization and maintenance of outcomes, involve natural change agents such as teachers and parents, increase reporting of treatment integrity, and conduct research in natural contexts.
Preston & Carter, (2009). PECS Preliminary evidence that PECS is readily learned by most participants with positive effects on social-communication and challenging behavior. Effects on speech dev unclear. Most participants mastered at least Phase I of PECS. Further research on component analysis of PECS, compare to other AAC interventions, and studies should have higher methodological rigor to contribute to establishing evidence-based practices.
Ramdoss et al., (2011). Computer-based interventions to deliver instruction on speech and language interventions to children with ASD (n = 4). Limited evidence to support use of computer-based interventions: few studies and small number of participants, but some improvement in communication. Researchers should design interventions to promote generalization across natural settings and natural consequences, investigate prerequisite skills to use technology, and conduct more research with individuals with severe autism.
Rispoli et al., (2010). Speech-generating devices in communication interventions for individuals with developmental disabilities. Mostly positive outcomes (86% of included studies), 54% studies provide conclusive evidence. Evidence base is promising. Researchers should replicate findings with additional participants, investigate communication functions other than requesting, and conduct group design studies.
Roche et al., (2014). Tangible symbols as AAC option (e.g. 3D whole objects or partial objects created uniquely and individualized for the study) for individuals with developmental disabilities. Symbols mostly taught to facilitate requesting, participants learned to use tangible symbols to communicate (54% of participants). Tangible symbol use is promising practice. Researchers should evaluate effects of symbol iconicity, realism, and concreteness on intervention outcomes; compare advantages and disadvantages of using standardized or individualized symbols; and whether tangible symbols are learned faster, maintained better, and preferred over other AAC.
Roche et al., (2015). Microswitches for self-enabling responding in children with profound and multiple disabilities. Positive results for children for accessing preferred stimuli, for making choices, gaining attention/social interaction. Overall positive results and every participant learned to activate microswitches. Researchers should investigate use of microswitches for more functions, compare different types, replicate studies by other teams, research into whether children with profound/multiple disabilities could learn to use emerging new tech (e.g. eye gaze control of computers).
Romski et al., (2015). AAC research in early intervention (1985-2015). Overall increase in number of studies, positive effects of early AAC interventions on communication, language and speech outcomes. Researchers should replicate studies with children with different diagnoses/disabilities, include families in intervention development, impact of multiple languages and cultures, assess long-term outcomes of interventions, study integration of current and future technology.
Schlosser & Wendt, (2008). AAC interventions effects on speech production of children with ASD. AAC does not impede speech production or result in a decline in speech production. Intervention results in modest gains. Research hypotheses for why SGD may facilitate natural speech and research whether there is a causal relation between AAC interventions and speech production.
Schlosser & Blischak, (2001). Role of speech output from AAC systems and benefits for people with ASD. Few studies with speech output as an independent variable. Synthetic speech doesn't have intonation or prosody but might be more helpful for listeners with ASD compared to natural speech. Need more studies to investigate synthetic speech as receptive AAC method, investigate digitized speech, investigate whether speech output could support other treatment methods (e.g. spoken prompt).
Schlosser et al., (2014). Facilitated communication (FC) position statement. Messages generated through FC are authored by the facilitator and not the individual with disabilities. FC has no validity. Outcomes support assumption of facilitator influence. FC is not an EBP or valid method for communication.
Sennott et al., (2016). AAC modeling in naturalistic communication interactions. Large changes in communication performance from baseline. Gains in receptive and expressive language skills. Recommend using AAC modeling as foundation of AAC intervention. Researchers should expand participant population, more contexts of intervention, research across lifespan, include adults who may have acquired disabilities later in life, and research across more communication domains.
Shire & Jones, (2015). Communication partner interventions for partners of children who use AAC. Large effects and positive findings for partner skills and children's communication that maintained over time. Most 11 studies examined aided AAC (n = 11). Researchers should clearly delineate instructional strategies to communication partners and report child communication initiations and responses.
Sievers et al., (2018). Child-related factors impacting intervention effectiveness for AAC outcomes for children with ASD. Child characteristics include pre-intervention cognition, severity of ASD, verbal imitation skills, vocabulary comprehension, object use. Emerging evidence for predictors. Need more research on mediators of AAC intervention effectiveness, need high quality research designs to determine causality, researchers should make datasets more readily available for statistical analyses.
Smith & Iadarola, (2015). Evidence base update for ASD. Communication outcomes: individual focused applied behavior analysis-based interventions with AAC. PECS and SGDs have evidence to support positive effects. Applied behavior analysis-focused AAC is probably efficacious (needs more group design and longer follow up). Use of picture symbols to make requests was most frequently reported outcome. Need more research on mediators and moderators of individualized, comprehensive interventions, having standardized outcome measures would help with treatment comparisons, develop a standard for reporting study procedures, and develop a standardized effect size reporting and quality of evidence measures.
Snell et al., (2006). AAC interventions for students with severe disabilities. Antecedent and consequence intervention components most effective to improve AAC communication for learners ages birth to 21. More research on natural communication partners: peers/siblings and less adults, role of partner, conduct component analysis of interventions, report treatment integrity, examine effects of treatment intensity/dosage, and assess students’ entry skill level.
Stauter et al., (2017). Literacy instruction: Modeling AAC use, adapting materials, subvocal rehearsal of words, contextual learning, and differentiated instruction. AAC in inclusive settings increases children's participation and engagement, children demonstrated preferences for adapted materials/books. Research emergent literacy development for young children under 3, measure secondary measures (children motivation and participation, teacher expectations, teacher perceptions about intervention feasibility), report information about home and social environment, report follow-up, clear definition of emergent literacy outcomes, and conduct studies with larger sample sizes.
Stephenson & Limbrick, (2015). Touchscreen mobile devices with people with developmental disabilities. Very large positive effects for communication with mobile touchscreen devices (e.g. iPod touch). Communication studies used 3 apps: Proloquo2Go, Pick a Word, Pixtalk and focused on requesting. Some participants learned to activate device, navigate across pages, make a choice, and name pictures. Researchers should investigate more apps, effectiveness of dedicated device compared to app, younger participants need to be included, and research how people with disabilities are using devices and apps outside of formal intervention settings.
Still et al., (2014). High-tech AAC to teach functional requesting skills. SGDs most often used, most frequent targets were requesting food or toys, overall largely positive results. Dedicated SGD used more frequently than tablet-based apps. Researchers should conduct more empirical research across range of skills, academic skills, requesting info, conversation skills, and the impact of feedback on correct responding.
Sulzer-Azaroff et al., (2009). PECS: Whether PECS enables nonspeaking participants to initiate functional communication, tested adaptations due to mobility needs, made icon 3D, tactile for vision impaired, compare to other interventions. Improvement in communication for participants who used skills with teachers and caregivers. Participants preferred using PECS. PECS intervention outcomes: resulted in increased speaking and social approaching, decreases in disruptive or dangerous bx. Researchers should record dates, times, settings, personnel, and materials as well as correct/incorrect responses during intervention, increase opportunities to promote generalization.
Therrien et al., (2016). Interventions to promote peer interactions with children who use aided AAC. Most frequently used: teaching children with CCN how to use AAC within social interactions and teaching peers skills and strategies to promote interaction. Positive effects on interactions with peers, although results varied: Older participants had higher effect sizes than younger, more gains in peer communicative interactions, frequency of initiations, and frequency of communicative acts. Researchers should conduct more studies on children with ASD, compare effects of two different interventions, component analyses, training paraprofessionals as facilitators of peer interaction, and identify variables that distinguish friendship from acquaintance.
Tien, (2008). PECS as FCT for individuals with ASD. PECS is effective for improving functional communication skills, increasing spontaneous communication, and increase in mean length of utterances. Further research with individuals with other diagnoses/disabilities.
Tincani & Devis, (2011) PECS PECS is moderately effective in establishing mands up to Phase IV. Higher levels of manding found when PECS taught to individuals without ASD. For small subset of participants, PECS appears to facilitate speech. Need more research to establish efficacy of later phases of PECS (most stopped at Phase III), replicate operational definitions and settings of current studies due to variability in speech definitions and outcome measured, and increase use of natural change agents.
Van Der Meer & Rispoli. (2010). SGD interventions for children with ASD. Overall positive outcomes: 87% positive outcomes, 13% mixed outcomes, no negative outcomes reported. Most studies investigated requesting, used behavioral strategies, and were conducted in school settings. Future research should investigate teaching skills other than requesting, child preference for different AAC systems, and determining differential effects of discrete trial training compared to naturalistic interventions.
Van der Meer et al., (2011). Preferences for AAC options in communication interventions by individuals with developmental disabilities. 67% of participants had some degree of preference for using SGD compared to 33% participants’ preference for picture exchange. Research participant preference for different AAC options and whether preferences generalize across situations and communicative partners.
Walker & Snell, (2013). Effectiveness of AAC interventions on challenging behavior of individuals with disabilities. AAC intervention has positive moderate effects on decreasing CB for individuals with varying disabilities. Need additional research on teaching typical interventionists to conduct functional behavior assessments and increase social validity data and reporting.
Walker et al., (2018). Functional communication training (FCT) implemented in schools with children who use AAC. AAC interventions using FCT were effective in reducing challenging behavior and promoting aided or unaided AAC use. Researchers should make sure behavior change maintains over time and specific instructional procedures to provide guidelines for practitioners.