For individuals with Autism spectrum disorder (ASD), communication can be difficult. ASD can impact the development of social interaction and both verbal and non-verbal communication (Lal, 2010).
The majority of children with ASD will learn to communicate via spoken language, however it's estimated approximately 25-30% of children with ASD will remain minimally verbal (Anderson et al., 2009; Tager-Flusberg & Kasari, 2013). For those who remain minimally verbal, even after intervention, AAC can be an effective mode of communication for language development.
Syriopoulou-Delli and Eleni (2021) completed a systematic review examining the research literature on the use of both aided and unaided AAC systems for intervention for children with ASD to determine the effectiveness of these AAC systems for communication and language development.
In this review, the authors aimed to explore the intervention methods used for communication development for children with ASD. Based on their set inclusionary criteria, 20 studies met the requirements of the review. Within those 20 studies, 242 children with ASD were included. The authors addressed several research questions including the following.
Question: Were the forms of AAC used successful in teaching requesting skills to children with ASD?
With this question, the authors aimed to determine the success of the different forms of AAC in teaching requesting skills. Many studies they investigated found requesting skills as a common targeted communication skill.
The use of picture exchange system (PECS) for requesting was acquired quickly according to Ganz and colleagues (2009) while Choi and colleagues (2010) found that children with ASD who utilizes various types of AAC (PECs, SGDs) were able to obtain skills for requesting, rejecting, and re-requesting items.
It's important to remember that requesting is just one type of communication function. It's easy to get "stuck" on requesting, thus AAC intervention should focus on a wide variety of communication functions such as identifying, commenting, describing, or protesting.
Question: Were AAC interventions effective in increasing the maintenance and generalization of communication in children with ASD?
Out of the 20 studies, 9 looked at generalization and 12 of them examined skill maintenance. Generalization is the ability to learn a skill and then demonstrate the skill in a variety of different settings, outside the controlled therapy room. Skill maintenance is whether or not the child retained the newly acquired communication skill.
The authors found positive generalization outcomes in 8 out of the 9 studies with mixed generalization outcomes in 1 of the 9 while there were positive results for maintenance in 8 of the 12 and mixed results in 4 of the 12.
What does this tell us? AAC interventions for children with ASD can support both generalization of skills and maintenance of skills! Generalization and maintenance is crucial for the use of AAC as a means of communication. A skill that is demonstrated in a controlled environment, such as a therapy room, needs to be able to generalize out to the child's natural environment to make it efficient communication for the AAC user.
Question: Did children with ASD demonstrate a preference for a particular AAC method?
Out of the 20 studies in the review, only two completed a preference assessment to determine a user’s preference for a specific AAC device or system and of the two studies, there were only two participants.
It’s important to remember that AAC users are going to choose the mode that will allow them to communication effectively and efficiently in that moment, in that environment, with that communication partner. Speech-language pathologists must provide a variety of multimodal supports to allow AAC users to communicate various communication functions across all environments.
Addressing communication early for children with ASD is crucial for their language development! AAC as a mode of communication for individuals with ASD can provide positive language outcomes. Because up to 30% of individuals with ASD will be minimally verbal even into adulthood, AAC introduced as early as possible is crucial for social language and functional communication development.
Anderson, D. K., Oti, R. S., Lord, C., & Welch, K.(2009). Patterns of growth in adaptive social abilities among children with autism spectrum disorders. Journal of Abnormal Child Psychology, 37(7), 1019–1034. https://doi.org/10.1007/s10802-009-9326-0B
Choi, H., O’Reilly, M., Sigafoos, J., &Lancioni, G. (2010). Teaching requesting and rejecting sequences to four children with developmental disabilities using augmentative and alternative communication. Research in Developmental Disabilities, 31(2), 560–567. https://doi.org/10.1016/j.ridd.2009.12.006
Ganz, J. B., Parker, R., & Benson, J. (2009). Impact of the Picture Exchange Communication System: Effects on communication and collateral effects on maladaptive behaviors picture exchange communication and maladaptive behaviors. Augmentative and Alternative Communication, 25(4), 250–261. https://doi.org/10.3109/07434610903381111
Lal, R. (2010). Effect of alternative and augmentative communication on language and social behavior of children with autism. Educational Research and Reviews, 5(3), 119-125.
Tager-Flusberg, H., & Kasari, C. (2013). Minimally verbal school-aged children with autism spectrum disorder: The neglected end of the spectrum. Autism Research, 6(6), 468–478. https://doi.org/10.1002/aur.1329
Syriopoulou-Delli, C. K., & Eleni, G. (2021). Effectiveness of different types of Augmentative and Alternative Communication (AAC) in improving communication skills and in enhancing the vocabulary of children with ASD: A review. Review Journal of Autism and Developmental Disorders, 1-14. https://doi.org/10.1007/s10803-021-04868-2
Katie Threlkeld, M.S., CCC-SLP is a Doctoral Candidate at the University of Missouri and the Educational Program Developer at Forbes AAC. She has over 8 years of experience in AT and AAC assessment and treatment across the lifespan. Her goal is to provide all AAC users and those around them with evidence-based information for best practice in AAC.