An exploration of factors to improve outcomes in the area of AAC interventions for children with ASC

Agius, May (2019) An exploration of factors to improve outcomes in the area of AAC interventions for children with ASC. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Many children with a diagnosis of autism spectrum condition fail to develop functional speech. For these children, augmentative and alternative communication (AAC) is often considered as an intervention to support expressive communication. Research has shown that children with autism spectrum condition can learn to use aided AAC systems to request although there are still gaps in the knowledge base to support clinicians to make decisions about AAC interventions. This research aims to answer the overarching question pertaining to how can speech and language therapists can improve clinical outcomes when providing AAC interventions for children with ASC. To answer this question, a multi-faceted view of the AAC assessment and intervention process was taken. Specifically, this research sought to answer three questions; firstly, how do two visual display layouts: a visual scene display or a grid display, impact on how minimally verbal children with ASC learn to request using a VOCA? Secondly, how do the individual characteristics of children with ASC impact on their learning to use VOCAs? And thirdly, what aspects of AAC interventions should be considered during the decision-making process for children with ASC? A mixed methods research methodology was chosen to answer the overarching question. This included a series of four studies. Studies 1 and 2 were single case experimental designs in which a total of eight young children with ASC were taught to request using a voice output communication aid. A comparison was made between two types of vocabulary layout; a grid display and a visual scene display. In Study 2, in addition to the AAC intervention, sensory processing interventions were also provided as all the participants also had a diagnosis of sensory processing difficulties. Study 3 was a qualitative study in which the occupational therapist who supported the provision of interventions in Study 1 and Study 2 was interviewed. Study 4 was a mixed methods study consisting of another single case experimental design in which a further four children were taught to request with a voice output communication aid using AAC intervention combined with sensory processing interventions. The qualitative strand was a focus group of AAC clinicians who observed the interventions and which therefore served to provide insights into how interventions were provided. The results indicated that there was similar progress in learning to request with a VOCA regardless of which vocabulary layout was used. When child characteristics were examined, children who had a hypo-reactive or seeking sensory processing pattern appeared to take the longest to learn to use to request. Furthermore, these children also had the lowest levels of adaptive functioning, receptive language, and social communicative skills at the outset of the study. The results also indicated that the bond between clinician and child was important and that the clinician needed to adapt according to the child’s individual characteristics. Clinical implications of the research point to the need to provide interventions according to the child’s characteristics including sensory processing. Further clinical implications of the results refer to the AAC device itself, and suggestions as to how the interventions can be implemented. Further research on how sensory processing difficulties impact learning to use AAC systems is recommended. It is also suggested that research on how clinicians bond with children with ASC during the AAC intervention process is needed.