Research Articles

Literature Review:  Evaluation of the Efficacy of Communication-Based Treatments for Autism Spectrum Disorders. Brunner, D., & Seung, H.

 

This review covers 36 studies from 2003-2007 in support of communication based treatments for children with autistic spectrum disorders. It explores evidence presented in seven treatment categories: applied behaviour analysis, naturalistic behavioural, developmental, classroom-based, video modeling, social skills and augmentative and alternate communication.

 

Back in 2002 there was considerable evidence collected to support the effectiveness of communication based interventions or ABA (Applied Behavioural Analysis) such as discrete trial training, natural milieu and sign language. During this time there was evidence that PECS, self-monitoring and family/parent based interventions were effective for non-verbal children with ASD.

 

In 2006, there was a greater focus on functional communication training when addressing challenging behaviours in non-verbal children. This included discovering the root of the behaviour and replacing it with more appropriate behaviour, using highly motivating objects or activities. It was found that the training had more effect if it was consistent in the natural environment as well as in school/daycare.

 

Sample PECS training session- Phase 1

 

Developmental interventions assume that language is based on strong, positive adult-child interactions. This relies heavily on parental and adult training and involvement. Adults must assume that all verbal productions are deliberate and purposeful. Because of this the adults must be extremely aware and in tune with the child and this increases the social interactions, thereby increasing the developmental opportunities for the child.

Classroom based interventions are considered natural environments for providing communication training. It can use several approaches as listed above and tailor training for each individual child. Assistive and augmentative tools may also be utilized and data collected to monitor ongoing success with the communication goals.

By 2007, video modeling showed evidence that motivation increased with attaining communication goals by targeting a behaviour or skill using peers (point-of-view modeling) or themselves (self-modeling). To date,  Bellini, Akullian, et al. (2007), state that there is stronger evidence appearing to support video modeling as a strategy to increase social engagement and behaviours.

Sample Video-Modeling     A Haircut

 

Social stories, a written narrative designed to improve social understanding and behaviours/responses, are often less intimidating than role playing which were the more traditional social skills training used prior to 2006. However, despite their wide-spread use, there doesn’t seem to be clear evidence that support the efficiency of using social stories.

Using Social Stories to Improve Behaviour:

 

According to Simpson et al. (2005), 50% of all children with ASD will remain non-verbal which highlights the importance of using non-speech communication strategies. Augmentative and alternative communication methods (AAC) are effective for ASD students of all ages and developmental stages. This study focused on four areas of AAC: augmented input (visual schedules, choice boards), augmented input and output (system for augmenting communication), augmented output only (PECS), and assistive technology (speech generated devices, mobile devices).

In conclusion, this literature review suggests that with any treatment or method, it should not be used in isolation; that a combination of approaches can be very helpful for non-verbal children. For example, PECS training can be combined with video modeling to improve communication skills. Video modeling can be combined with social stories is another example. With the ever increasing availability of new applications in AAC, the possibilities are endless for reaching all of our non-verbal students.

References:

Bellini, S., & Akullian, J. (n.d.). A Meta-Analysis of Video Modeling and Video Self-Modeling Interventions for Children and Adolescents With Autism Spectrum Disorders. ASHA's Evidence Maps. Retrieved March 23, 2013, from http://www.ncepmaps.org/Review-534.php

Brunner, D., & Seung, H. (2009). Evaluation of the Efficacy of Communication-Based Treatments for Autism Spectrum Disorders . Communication Disorders Quarterly . Retrieved March 23, 2013, from http://cdq.sagepub.com/content/31/1/15

Simpson, R., deBoer-Ott, S., Griswold, D., Myles, B., Byrd, S., & Gantz, J. (n.d.). Evidence-Based Practices and Students With Autism Spectrum Disorders . Focus on Autism and Other Developmental Disabilities . Retrieved March 23, 2013, from http://foa.sagepub.com/content/20/3/140.short

 

 

Article 2:

Teaching Functional Communication Skills Using Augmentative and Alternative Communication in Inclusive Settings.  S. Johnston, A. McDonnell, C. Nelson, A. Magnavito

This was a case study of three pre-school children with significant disabilities who were taught functional communication behaviours using augmentative and alternative communication (AAC) devices. After reading many similar articles, this one stood out because of its sensitivity in keeping the child at the heart of the study. There seemed to be a great deal of thought invested in gathering as much information on the child as a whole person, their environment, their background, their abilities and needs, and the suitability or fit for the AAC device to be most appropriate, rather than the child for research purposes.

A great deal of time was spent on creating an accurate baseline, documenting the intervention along with the maintenance conditions. At the onset, the authors were quick to point out that AAC systems alone do not ensure functional use of AAC but that it requires effective interventions in order to acquisition of AAC skills. They strove to embed intervention opportunities where children were given opportunities to practice specific goals that are included within an activity or event that expands, modifies or adapts the activity while still be meaningful and interesting to the child. In other words, the teaching strategies must remain authentic and interesting to the child. This requires a thorough knowledge of the child and careful planned use of intervention strategies that appear as normal as possible. The use of communication boards using visuals the child easily recognizes, and electronic communication aides in the learning environment would be an example of this.

They stress that ensuring any AAC device is socially valid is another interesting point in this study. Social validation or the assessing the impact of social significance on the goals, methods and outcomes from the point of view of the child, teachers and parents is considered very important.

The data also looked into rating how the teachers viewed these interventions. This seems very important because teachers need to understand, and buy into the effectiveness of using AAC devices in order for strategies to be sustainable.  A detailed survey was used by teachers to assess the acceptability and perceived effectiveness of the intervention strategy. It included opinions from teachers in each step of the intervention as well as whether or not they saw the impact on the classroom environment disruptive to classroom routines and whether or not it would be difficult to maintain the strategy while still meeting the needs of the rest of the class. This factor made this study very interesting as most research articles focused on the effects of the student themselves and/or families.

In summary, this case study recommends that future studies need to be carried out to look into the validity of using AAC in supporting students with communication challenges. In particular, they suggest that social validation as viewed by teachers implementing AAC devices, an important piece in determining whether or not strategies will be effective and sustainable.

References

Johnston, S., MacDonnell, A., Nelson, C., & Magnavito, A. (n.d.). Teaching Functional Communication Skills Using Augmentative and Alternative Communication in Inclusive Settings . Journal of Early Intervention . Retrieved March 23, 2013, from http://jei.sagepub.com/content/25/4/263

Additional links:
 

Autism Canada- about autism, characteristics, early signs, screening tools and diagnosis.http://autismcanada.org/aboutautism/diagnoses.html?gclid=CJXUrq3rk7YCFaZFMgodq3YA9w

What is non-verbal autism?http://autism.about.com/od/autismterms/f/nonverbal.htm

Toronto Star: The Autism Project: iPads ‘speak’ for non-verbal, autistic kidshttp://www.thestar.com/news/investigations/2012/11/12/the_autism_project_ipads_speak_for_nonverbal_autistic_kids.html

Autism: How Do You Communicate With a Non-Verbal Child?: http://www.comeunity.com/disability/autism/autismnonverbal.html