Skip to main content
SpringerLink
Log in

Aided AAC for people with severe to profound and multiple disabilities: A systematic review of interventions and treatment intensity

  • REVIEW
  • Published:
Advances in Neurodevelopmental Disorders Aims and scope Submit manuscript

Abstract

Given the limited evidence, along with a rapidly evolving state of technology, research is needed to drive effective and efficient communication intervention for people with severe to profound and multiple disabilities. The purpose of the current review was to synthesize and evaluate the state of the aided, augmentative and alternative communication (AAC) intervention literature for this population from 1997 to 2016. Results synthesized findings from 25 studies (n = 59) on the extracted participant characteristics, intervention, and dosage parameters from the studies. Results included an under-reporting of sufficient dosage parameters in addition to implications for future directions in the areas of maintenance, generalization, and discriminated use of skills, and bridging aided low and high-tech AAC interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Studies marked by an asterisk (*) are reviewed in this paper.

  • Abbeduto, L., Evans, J., & Dolan, T. (2001). Theoretical perspectives on language and communication problems in mental retardation and developmental disabilities. Mental Retardation and Developmental Disabilities Research Reviews, 7, 45–55.

    Article  PubMed  Google Scholar 

  • Ali, E., MacFarland, S. Z., & Umbreit, J. (2011). Effectiveness of combining tangible symbols with the picture exchange communication system to teach requesting skills to children with multiple disabilities including visual impairment. Education and Training in Autism and Developmental Disabilities, 46, 425–435.

    Google Scholar 

  • American Speech-Language-Hearing Association. (2005). Evidence-based practice in communication disorders [Position Statement]. Available from www.asha.org/policy.

  • Beukelman, D. R., Light, J. C., & Reichle, J. (Eds.). (2002). Exemplary practices for beginning communicators: Implications for AAC. Baltimore: Paul H. Brookes Publishing Company.

    Google Scholar 

  • Bracken, M., & Rohrer, N. (2014). Using an adapted form of the picture exchange communication system to increase independent requesting in deafblind adults with learning disabilities. Research in developmental disabilities, 35, 269–277.

    Article  PubMed  Google Scholar 

  • Brady, N. C., Bruce, S., Goldman, A., Erickson, K., Mineo, B., Ogletree, B. T., et al. (2016). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. American Journal on Intellectual and Developmental Disabilities, 121, 121–138.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown, F., Gothelf, C. R., Guess, D., & Lehr, D. H. (1998). Self-determination for individuals with the most severe disabilities: moving beyond chimera 1. Research and Practice for Persons with Severe Disabilities, 23, 17–26.

    Article  Google Scholar 

  • Byiers, B. J., Dimian, A., & Symons, F. J. (2014). Functional communication intervention in Rett syndrome: a preliminary study. American Journal of Intellectual and Developmental Disabilities, 119, 340–350.

    Article  Google Scholar 

  • Cosbey, J. E., & Johnston, S. (2006). Using a single-switch voice output communication aid to increase social access for children with severe disabilities in inclusive classrooms. Research and Practice for Persons with Severe Disabilities, 31, 144–156.

    Article  Google Scholar 

  • Cress, C. J., & Marvin, C. A. (2003). Common questions about AAC services in early intervention. Augmentative and Alternative Communication, 19, 254–272.

    Article  Google Scholar 

  • Dalmau, Y. C. P., Wacker, D. P., Harding, J. W., Berg, W. K., Schieltz, K. M., Lee, J. F., et al. (2011). A preliminary evaluation of functional communication training effectiveness and language preference when Spanish and English are manipulated. Journal of Behavioral Education, 20, 233–251.

    Article  Google Scholar 

  • Durand, V. M. (1999). Functional communication training using assistive devices: recruiting natural communities of reinforcement. Journal of Applied Behavior Analysis, 32, 247–267.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fey, M. E., Yoder, P. J., Warren, S. F., & Bredin-Oja, S. L. (2013). Is more better? Milieu communication teaching in toddlers with intellectual disabilities. Journal of Speech, Language, and Hearing Research, 56, 679–693.

    Article  PubMed  Google Scholar 

  • Gilroy, S. P., McCleery, J. P., & Leader, G. (2017). Systematic review of methods for teaching social and communicative behavior with high-tech augmentative and alternative communication modalities. Review Journal of Autism and Developmental Disorders, 4, 307–320.

    Article  Google Scholar 

  • Hart, B., & Risley, T. R. (1975). Incidental teaching of language in the preschool. Journal of Applied Behavior Analysis, 8, 411.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hyppa-Martin, J. H., Reichle, J., Dimian, A., & Chen, M. (2013). Communication modality sampling for a toddler with Angelman syndrome. Language, Speech, and Hearing Services in Schools, 44, 327–336.

    Article  PubMed  Google Scholar 

  • Iacono, T., Carter, M., & Hook, J. (1998). Identification of intentional communication in students with severe and multiple disabilities. Augmentative and Alternative Communication, 14, 102–114.

    Article  Google Scholar 

  • Individuals With Disabilities Education Improvement Act, 20 U.S.C. § 1400 (2004).

  • Ivy, S. E., Hatton, D. D., & Hooper, J. D. (2014). Using the picture exchange communication system with students with visual impairment. Exceptional Children, 80, 474–488.

    Article  Google Scholar 

  • Johnson, J. M., Inglebret, E., Jones, C., & Ray, J. (2006). Perspectives of speech language pathologists regarding success versus abandonment of AAC. Augmentative and Alternative Communication, 22, 85–99.

    Article  PubMed  Google Scholar 

  • Johnston, S. S., McDonnell, A. P., Nelson, C., & Magnavito, A. (2003). Teaching functional communication skills using augmentative and alternative communication in inclusive settings. Journal of Early Intervention, 25, 263–280.

    Article  Google Scholar 

  • Johnston, S. S., Reichle, J., & Evans, J. (2004). Supporting augmentative and alternative communication use by beginning communicators with severe disabilities. American Journal of Speech Language Pathology, 13, 20–30.

    Article  PubMed  Google Scholar 

  • Johnston, S., Reichle, J., Feeley, K., & Jones, E. (2012). Augmentative and alternative communication strategies for individuals with moderate to severe disabilities. Baltimore: Paul H. Brookes.

    Google Scholar 

  • Lancioni, G. E., O’Reilly, M. F., & Basili, G. (2001). Use of microswitches and speech output systems with people with severe/profound intellectual or multiple disabilities: a literature review. Research in Developmental Disabilities, 22, 21–40.

    Article  PubMed  Google Scholar 

  • Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Oliva, D., & Baccani, S. (2006). Teaching ‘yes’ and ‘no’ responses to children with multiple disabilities through a program including microswitches linked to vocal output device. Perceptual and motor skills, 102, 51–61.

    Article  PubMed  Google Scholar 

  • Lancioni, G. E., O’Reilly, M. F., Cuvo, A. J., Singh, N. N., Sigafoos, J., & Didden, R. (2007a). PECS and VOCAs to enable students with developmental disabilities to make requests: an overview of the literature. Research in Developmental Disabilities, 28, 468–488.

    Article  PubMed  Google Scholar 

  • Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Oliva, D., & Baccani, S. (2007b). Enabling students with multiple disabilities to request and choose among environmental stimuli through microswitch and computer technology. Research in developmental disabilities, 28, 50–58.

    Article  PubMed  Google Scholar 

  • Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Sigafoos, J., Oliva, D., & Severini, L. (2008). Enabling two persons with multiple disabilities to access environmental stimuli and ask for social contact through microswitches and a VOCA. Research in Developmental Disabilities, 29, 21–28.

    Article  PubMed  Google Scholar 

  • Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Sigafoos, J., Didden, R., Oliva, D., et al. (2009). Persons with multiple disabilities accessing stimulation and requesting social contact via microswitch and VOCA devices: new research evaluation and social validation. Research in Developmental Disabilities, 30, 1084–1094.

    Article  PubMed  Google Scholar 

  • Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Ricci, I., Addante, L. M., & Trubia, G. (2011). A woman with multiple disabilities uses a VOCA system to request for and access caregiver-mediated stimulation events. Life Span and Disability, 14, 91–99.

    Google Scholar 

  • Lechago, S. A., & Carr, J. E. (2008). Recommendations for reporting independent variables in outcome studies of early and intensive behavioral intervention for autism. Behavior Modification, 32, 489–503.

    Article  PubMed  Google Scholar 

  • Lund, S. K., & Troha, J. M. (2008). Teaching young people who are blind and have autism to make requests using a variation on the picture exchange communication system with tactile symbols: a preliminary investigation. Journal of Autism and Developmental Disorders, 38, 719–730.

    Article  PubMed  Google Scholar 

  • Mirenda, P. (2003). Toward functional augmentative and alternative communication for students with autism manual signs, graphic symbols, and voice output communication aids. Language, Speech, and Hearing Services in Schools, 34, 203–216.

    Article  PubMed  Google Scholar 

  • National Joint Committee for the Communication Needs of Persons with Severe Disabilities. (1992). Guidelines for meeting the communication needs of persons with severe disabilities.

  • Parker-McGowan, Q., Chen, M., Reichle, J., Pandit, S., Johnson, L., & Kreibich, S. (2014). Describing treatment intensity in milieu teaching interventions for children with developmental disabilities: a review. Language, Speech, and Hearing Services in Schools, 45, 351–364.

    Article  PubMed  Google Scholar 

  • Phillips, B., & Zhao, H. (1993). Predictors of assistive technology abandonment. Assistive Technology, 5, 36–45.

    Article  PubMed  Google Scholar 

  • Radstaake, M., Didden, R., Lang, R., O’Reilly, M., Sigafoos, J., Lancioni, G. E., & Curfs, L. M. (2013). Functional analysis and functional communication training in the classroom for three children with Angelman Syndrome. Journal of Developmental and Physical Disabilities, 25, 49–63.

    Article  Google Scholar 

  • Reichle, J. (1997). Communication intervention with persons who have severe disabilities. The Journal of Special Education, 31, 110–134.

    Article  Google Scholar 

  • Reichle, J., Sigafoos, J., & Sigafoos, J. (1991). Implementing augmentative and alternative communication: strategies for learners with severe disabilities. Paul H. Brookes 12.

  • Reichle, J., Byiers, B. J., & Reeve, A. (2016a). Conditional use of a request for assistance: considering generalization. Focus on Autism and Other Developmental Disabilities, 1088357616647349.

  • Reichle, J., Drager, K., Caron, J., & Parker-McGowan, Q. (2016b). Playing the Long Game: Considering the Future of Augmentative and Alternative Communication Research and Service. In Seminars in Speech and Language 37(4), 259–273. Thieme Medical Publishers.

  • Reichle, J., & Wacker, D. P. (2017). Functional communication training for problem behavior. New York: Guilford Publications.

    Google Scholar 

  • Reichow, B., Volkmar, F. R., & Cicchetti, D. V. (2008). Development of the evaluative method for evaluating and determining evidence-based practices in autism. Journal of Autism and Developmental Disorders, 38, 1311–1319.

    Article  PubMed  Google Scholar 

  • Renwick, R., Nourhaghighi, N., Manns, P. J., & Rudman, D. L. (2003). Quality of life for people with physical disabilities: a new instrument. International Journal of Rehabilitation Research, 26, 279–287.

    Article  PubMed  Google Scholar 

  • Richman, D. M., Wacker, D. P., & Winborn, L. (2001). Response efficiency during functional communication training: Effects of effort on response allocation. Journal of Applied Behavior Analysis, 34, 73–76.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rispoli, M. J., Franco, J. H., van der Meer, L., Lang, R., & Camargo, S. P. H. (2010). The use of speech generating devices in communication interventions for individuals with developmental disabilities: a review of the literature. Developmental Neurorehabilitation, 13, 276–293.

    Article  PubMed  Google Scholar 

  • Roche, L., Sigafoos, J., Lancioni, G. E., O’Reilly, M. F., & Green, V. A. (2015). Microswitch technology for enabling self-determined responding in children with profound and multiple disabilities: A systematic review. Augmentative and Alternative Communication, 31, 246–258.

    Article  PubMed  Google Scholar 

  • Rodi, M. S., & Hughes, C. (2000). Teaching communication book use to a high school student using a milieu approach. Journal of the Association for Persons with Severe Handicaps, 25, 175–179.

  • Schlosser, R. W., & Sigafoos, J. (2006). Augmentative and alternative communication interventions for persons with developmental disabilities: narrative review of comparative single-subject experimental studies. Research in Developmental Disabilities, 27, 1–29.

    Article  PubMed  Google Scholar 

  • Sigafoos, J., Didden, R., & O'Reilly, M. (2003). Effects of speech output on maintenance of requesting and frequency of vocalizations in three children with developmental disabilities. Augmentative and Alternative Communication, 19, 37–47.

    Article  PubMed  Google Scholar 

  • Sigafoos, J., Drasgow, E., Reichle, J., O’Reilly, M., Green, V. A., & Tait, K. (2004a). Teaching communicative rejecting to children with severe disabilities. American Journal of Speech-Language Pathology, 13, 31–42.

    Article  PubMed  Google Scholar 

  • Sigafoos, J., O’Reilly, M., Seely-York, S., & Edrisinha, C. (2004b). Teaching students with developmental disabilities to locate their AAC device. Research in Developmental Disabilities, 25, 371–383.

    Article  PubMed  Google Scholar 

  • Sigafoos, J., Green, V. A., Schlosser, R., O’Reilly, M. F., Lancioni, G. E., Rispoli, M., & Lang, R. (2009). Communication intervention in Rett syndrome: a systematic review. Research in Autism Spectrum Disorders, 3, 304–318.

    Article  Google Scholar 

  • Simacek, J., Reichle, J., & McComas, J. J. (2016). Communication intervention to teach requesting through aided AAC for two learners with Rett syndrome. Journal of Developmental and Physical Disabilities, 28, 59–81.

    Article  Google Scholar 

  • Smith, N. (1981). The certainty of evidence in health evaluations. Evaluation and Program Planning, 4, 273–278.

    Article  PubMed  Google Scholar 

  • Snell, M. E., Chen, L. Y., & Hoover, K. (2006). Teaching augmentative and alternative communication to students with severe disabilities: a review of intervention research 1997-2003. Research and Practice for Persons with Severe Disabilities, 31, 203–214.

    Article  Google Scholar 

  • Snell, M. E., Brady, N., McLean, L., Ogletree, B. T., Siegel, E., Sylvester, L., et al. (2010). Twenty years of communication intervention research with individuals who have severe intellectual and developmental disabilities. American Journal on Intellectual and Developmental Disabilities, 115, 364–380.

    Article  PubMed  PubMed Central  Google Scholar 

  • Snodgrass, M. R., Stoner, J. B., & Angell, M. E. (2013). Teaching conceptually referenced core vocabulary for initial augmentative and alternative communication. Augmentative and Alternative Communication, 29, 322–333.

    Article  PubMed  Google Scholar 

  • Stasolla, F., Caffò, A. O., Picucci, L., & Bosco, A. (2013). Assistive technology for promoting choice behaviors in three children with cerebral palsy and severe communication impairments. Research in developmental disabilities, 34, 2694–2700.

    Article  PubMed  Google Scholar 

  • Stasolla, F., De Pace, C., Damiani, R., Di Leone, A., Albano, V., & Perilli, V. (2014). Comparing PECS and VOCA to promote communication opportunities and to reduce stereotyped behaviors by three girls with Rett syndrome. Research in Autism Spectrum Disorders, 8, 1269–1278.

    Article  Google Scholar 

  • Stephenson, J., & Linfoot, K. (1996). Intentional communication and graphic symbol use by students with severe intellectual disability. International Journal of Disability, Development and Education, 43, 147–165.

    Article  Google Scholar 

  • Stokes, T. F., & Baer, D. M. (1977). An implicit technology of generalization. Journal of Applied Behavior Analysis, 10, 349–367.

    Article  PubMed  PubMed Central  Google Scholar 

  • Strasberger, S. K., & Ferreri, S. J. (2014). The effects of peer assisted communication application training on the communicative and social behaviors of children with autism. Journal of Developmental and Physical Disabilities, 26, 513–526.

    Article  Google Scholar 

  • Sturm, J. M., & Clendon, S. A. (2004). Augmentative and alternative communication, language, and literacy: fostering the relationship. Topics in Language Disorders, 24, 76–91.

    Article  Google Scholar 

  • Urbanowicz, A., Downs, J., Girdler, S., Ciccone, N., & Leonard, H. (2015). Aspects of speech language abilities are influenced by MECP2 mutation type in girls with Rett syndrome. American Journal of Medical Genetics Part A, 167, 354–362.

    Article  Google Scholar 

  • Urbanowicz, A., Leonard, H., Girdler, S., Ciccone, N., & Downs, J. (2016). Parental perspectives on the communication abilities of their daughters with Rett syndrome. Developmental Neurorehabilitation, 19, 17–25.

    Article  PubMed  Google Scholar 

  • Volkert, V. M., Lerman, D. C., Call, N. A., & Trosclair-Lasserre, N. (2009). An evaluation of resurgence during treatment with functional communication training. Journal of Applied Behavior Analysis, 42, 145–160.

    Article  PubMed  PubMed Central  Google Scholar 

  • Warren, S., Fey, M., & Yoder, P. (2007). Differential treatment intensity research: a missing link to creating optimally effective communication interventions. Mental Retardation and Developmental Disabilities Research Review, 13, 70–77.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge Quannah Parker-McGowan, for her insight and efforts in coding.

Funding

Preparation of this article was supported in part by grant #2-T73MC12835-03-00 from the Maternal and Child Health Bureau (MCHB) of the US Department of Health and Human Services awarded to the University of Minnesota.

Author information

Authors and Affiliations

  1. University of Minnesota, 56 East River Rd., Minneapolis, MN, 55455, USA

    Jessica Simacek, Brittany Pennington, Joe Reichle & Quannah Parker-McGowan

Authors
  1. Jessica Simacek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brittany Pennington
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joe Reichle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Quannah Parker-McGowan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessica Simacek.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Simacek, J., Pennington, B., Reichle, J. et al. Aided AAC for people with severe to profound and multiple disabilities: A systematic review of interventions and treatment intensity. Adv Neurodev Disord 2, 100–115 (2018). https://doi.org/10.1007/s41252-017-0050-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41252-017-0050-4

Keywords

Search

Navigation