laurie mclay, university of canterbury larah van der meer, victoria university of wellington

Comparing Picture Exchange, Manual Signs, and iPad™-based SGDs as AAC Options for

Children with AutismLaurie McLay, University of Canterbury

Larah van der Meer, Victoria University of Wellington

New Zealand

Communication Impairment

(Osterling, Dawson, & McPartland, 2001)

Speech Non-Verbal0

10

20

30

40

50

60

70

80

90

100

AAC Systems

Speech-Generating Devices (SGD)

Manual Signs (MS)

Picture Exchange (PE)

A Frequent Question

Which AAC system is best suited to individuals with autism?

Comparative Studies

All three systems have been taught

No major or consistent differences

(Lancioni et al., 2007; Mirenda, 2003)

Self-Determination

Can we let the child decide?

General Approach

Teach two or more systems

Ensure comparable experience

Provide opportunities to choose

Questions

1. Do individual children with autism show idiosyncratic preferences for MS v. PE v. SGD?

2. Can preferences be identified at the beginning stages of intervention?

3. Are preferences stable over time and across contexts?

4. Does preference influence how quickly and efficiently children learn to use AAC?

5. Does preference influence the maintenance of communication skills; that is, the extent to which children continue to use their newly acquired AAC skills after the intervention has ended?

Hypotheses

Children will show idiosyncratic preferences for different forms of alternative communication

Use of the child's most preferred option will improve the acquisition and maintenance of alternative communication skills

Experimental Design and Procedures

Multiple baseline across participants Alternating treatments

Baseline› Opportunities to request, no prompting

Acquisition training› Prompted to use each system until

acquisition criterion Preference Assessment

› All systems available to choose from

Example (McLay et al., in progress)

1. Assessments2. Freeplay3. Baseline4. Intervention 5. Preference Assessment 6. Post-Intervention7. Follow-Up

McLay and Colleagues

Participants› Six participants with autism

(Sparrow, Cicchetti, & Balla, 2005)

Age Gender

CommunicationReceptive

Communication Expressive

Pene 7:0 Male 1:5 1:6

Mika 8:0 Female O:10 0:9

Hemi 10:1

Male 0:6 0:9

Manu 10:3

Male 1:0 0:3

Lomu 5:4 Male 1:2 0:9

Afasa 5:2 Male 3:7 1:8

Method Context

› General request for “more” toys Materials

›SGD using iPad Mini™ with Proloquo2Go™ ›PE using PECS symbol (Pyramid Educational Products, 2009)›MS using Makaton (Makaton New Zealand/Aotearoa, 1998-99)

Intervention Procedures

Systematic instruction› Time delay› Graduated guidance › Error correction› Tangible and social reinforcement

Generalisation

Non-teaching probes conducted pre- and post-intervention

1. In a novel (non-teaching) setting2. Using a novel person (not involved in

teaching)

Figure 1. Percentage of correct requests using each AAC system for each session for Pene, Mika, and Hemi

Figure 2. Percentage of correct requests using each AAC system for each session for Manu, Lomu, and Afasa

Figure 3. Total number of times each AAC system was chosen across study phases and across participants

Generalisation Results

Table 1. Percentage of correct requests using each AAC system in a novel setting

Pre-Intervention Post-Intervention

SGD PE MS SGD PE MS

Pene 20% 0% 0% 0% 100% 0%

Mika 20% 0% 0% 100% 80% 0%

0% 40% 0%

Hemi 20% 0% 0% 80% 0% 0%

100% 80% 0%

Afasa 40% 0% 0% 100% 100% 100%

40% 0% 0% 100% 100% 100%

Generalisation Results Table 2. Percentage of correct requests

using each AAC system with a novel person

Pre-Intervention Post-Intervention

SGD PE MS SGD PE MS

Pene 20% 0% 0% 0% 0% 0%

Mika 0% 0% 0% 100% 0% 0%

Hemi 0% 0% 0% 80% 60% 0%

80% 60% 0%

Afasa 80% 0% 0% 100% 100% 100%

80% 0% 0% 100% 100% 100%

Further Studies1. Couper et al. (2014)

› 9 participants2. McLay et al. (in progress)

› 6 participants3. van der Meer, Didden, et al. (2012)

› 4 participants4. van der Meer, Kagohara, et al. (2012)

› 4 participants5. van der Meer, Sutherland, et al. (2012)

› 4 participants

Overall Results 27 Participants

› 4 girls, 23 boys› Aged 4:2 – 13:2 (M = 7:3) years› ASD and a range of developmental disorders› Vineland-II (Sparrow et al., 2005) scores

≤ 2:5 years for expressive communication

Context› Requesting access to preferred stimuli with

SGD, PE, and MS

Figure 4. Percentage of participants who did not reach criterion for each AAC system

Figure 5. Mean number of trials to reach criterion for each AAC system

Figure 6. Mean percentage of times each AAC system was selected

Figure 7. Mean percentage of times each AAC system was selected across each phase of the study

Figure 8. Percentage of participants with high preference

(van der Meer, Sigafoos, O'Reilly, & Lancioni, 2011)

Summary

SGD and PE learned at comparable rates

MS slower to learn

Prefer AAC system that more proficient at using

Majority preferred SGD

Further Research Directions

Social communicative interactions

Preference-enhanced communication intervention

Social validity

Effects on other behaviours, communication skills, and speech

Conclusions

This choice-making approach appears useful in assessing children’s preferences for different AAC options

Children may be able to self-determine which AAC option they would like to use

Enhancing Communication Intervention for Children with Autism

Principal Investigators› Jeff Sigafoos, Ph.D. Victoria University of Wellington› Dean Sutherland, Ph.D. University of Canterbury

Collaborative Researchers› Laurie McLay, Ph.D. University of Canterbury› Larah van der Meer, Ph.D. Victoria University of Wellington

Contributors› Mark F. O’Reilly, Ph.D. The University of Texas at Austin, USA› Giulio E. Lancioni, Ph.D. University of Bari, Italy

Scholarship Students› Donna Achmadi, Victoria University of Wellington› Llyween Couper, University of Canterbury

Research Assistants› Martina Schaefer › Emma McKenzie› Debora Morita Kagohara› Michelle Stevens› Laura Roche› Amarie Carnett› Hannah Waddington› Ruth James

ReferencesCouper, L., van der Meer, L., Schafer, M. C. M., McKenzie, E., McLay, L., O'Reilly, M. F., . . . Sutherland, D. (2014). Comparing acquisition of and preference for manual signs, picture, exchange, and speech-generating devices in nine children with autism spectrum disorder. Developmental Neurorehabilitation. doi: 10.3109/17518423.2013.870244Lancioni, G. E., O’Reilly, M. F., Cuvo, A. J., Singh, N. N., Sigafoos, J., & Didden, R. (2007). PECS and VOCAs to enable students to make requests: An overview of the literature. Research in Developmental Disabilities, 28, 468-488.Makaton New Zealand/Aotearoa. (1998-99). Sign illustrations for Makaton core vocabulary. Auckland: Westprint.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.Osterling, J., Dawson, G., & McPartland, J. (2001). Autism. In C. E. Walker & M. C. Roberts (Eds.), Handbook of clinical child psychology (3rd ed.) (pp. 432-452). New York: John Wiley & Sons.Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales, Second Edition, Survey Forms Manual. Minneapolis: Pearson.Pyramid Educational Products Inc. (2009). PICS for PECS 2009. Newport: Author.van der Meer, L., Sigafoos, J., O'Reilly, M. F., & Lancioni, G. E. (2011). Assessing preferences for AAC options in communication interventions for individuals with developmental disabilities: A review of the literature. Research in Developmental Disabilities, 32, 1422-1431.van der Meer, L., Sutherland, D., O'Reilly, M. F., Lancioni, G. E., & Sigafoos, J. (2012). A further comparison of manual signing, picture exchange, and speech-generating devices as communication modes for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 6, 1247-1257. doi: 10.1016/j.rasd.2012.04.005van der Meer, L., Kagohara, D., Achmadi, D., O'Reilly, M. F., Lancioni, G. E., Sutherland, D., & Sigafoos, J. (2012). Speech-generating devices versus manual signing for children with developmental disabilities. Research in Developmental Disabilities, 33, 1658-1669. doi: 10.1016/j.ridd.2012.04.004van der Meer, L., Didden, R., Sutherland, D., O'Reilly, M. F., Lancioni, G. E., & Sigafoos, J. (2012). Comparing three augmentative and alternative communication modes for children with developmental disabilities. Journal of Developmental and Physical Disabilities, 24, 451-468. doi: 10.1007/s10882-012-9283-3