Elsevier

Research in Developmental Disabilities

Volume 33, Issue 5, September–October 2012, Pages 1658-1669
Research in Developmental Disabilities

Speech-generating devices versus manual signing for children with developmental disabilities

https://doi.org/10.1016/j.ridd.2012.04.004Get rights and content

Abstract

We compared speed of acquisition and preference for using a speech-generating device (SGD) versus manual signing (MS) as augmentative and alternative communication (AAC) options. Four children with developmental disabilities (DD), aged 5–10 years, were taught to request preferred objects using an iPod®-based SGD and MS. Intervention was introduced in a multiple-probe across participants design and SGD and MS conditions were compared in an alternating treatments design. A systematic choice-making paradigm was implemented to determine if the children showed a preference for using SGD or MS. All participants showed increased use of SGD when intervention was introduced, but only three learned under the MS condition. Three participants exhibited a preference for the SGD while the remaining participant demonstrated a preference for using MS. Results support previous studies showing that individuals with DD often show a preference for different AAC options and extend previous data by suggesting that acquisition and maintenance was better for the preferred option.

Highlights

► Four children with developmental disabilities were taught to request preferred snacks or toys using an iPod®-based speech-generating device (SGD) and manual signs (MS) ► Preference for using SGD versus MS was assessed during and after acquisition training ► The intervention led to acquisition of SGD and MS use and three participants demonstrated a preference for the SGD.

Introduction

Children with developmental disabilities (DD) often fail to develop the ability to speak (National, 2001, Peeters and Gillberg, 1999) and therefore need intervention to establish augmentative and alternative communication (AAC; Beukelman and Mirenda, 2005, Schlosser, 2003a). Various AAC options have been developed, including unaided approaches, such as gestures and manual signing (MS); and aided systems, which involve the use of external equipment to enable the individual to communicate. Examples of aided AAC include low-tech communication boards (Sigafoos & Iacono, 1993), the Picture Exchange Communication System (PECS; Bondy & Frost, 2001), and speech-generating devices (SGDs; Lancioni et al., 2007).

Two recent reviews, summarizing 58 studies, provide empirical support for the use of SGDs in communication interventions for individuals with DD (Rispoli et al., 2010, van der Meer and Rispoli, 2010). Results from these reviews support a conclusion that individuals with DD can learn to use a range of SGDs for functional communication. Similarly, several systematic reviews of the literature (e.g., Goldstein, 2002, Schlosser and Wendt, 2008a, Schlosser and Wendt, 2008b, Wendt, 2009) pertaining to the use of MS provide results from more than 20 studies demonstrating that MS use can also be taught to individuals with DD.

Despite this supporting evidence, there is considerable debate within the literature regarding which of the various aided and unaided AAC options is best suited to individuals with DD (Mirenda, 2003, Schlosser and Blischak, 2001). There does not appear to be one AAC system that is appropriate for all beginning communicators (Sigafoos, Drasgow, & Schlosser, 2003). For example, studies comparing the acquisition of different AAC options have revealed few major or consistent differences in terms of acquisition for PECS and MS (Adkins and Axelrod, 2001, Gregory et al., 2009, Rotholz et al., 1989, Tincani, 2004), as well as PECS and SGDs (Beck et al., 2008, Bock et al., 2005). However, few studies have compared SGDs and MS (Iacono and Duncum, 1995, Iacono et al., 1993, Sigafoos and Drasgow, 2001).

The lack of any major difference in these studies suggests that how quickly an individual acquires an AAC option may not be the most critical variable to examine when considering which AAC option to implement. Because individuals with DD are a heterogeneous group, general statements about successful or unsuccessful interventions could be seen as providing relatively less guidance when selecting an AAC approach for a specific person. Selecting a suitable AAC system for an individual can therefore be a difficult process that is more likely to depend on specific task demands and individual characteristics (Sigafoos et al., 2003, Ringdahl et al., 2009, Wendt, 2009). For example, an individual's preference for using one AAC option over another may be an important variable to consider when selecting an appropriate AAC system. Giving students the opportunity to self-select their most preferred AAC option could also be viewed as one way of promoting self-determination in AAC interventions (Sigafoos, 2006), and might significantly influence progress in learning to communicate.

Indeed, several studies have assessed personal preferences between AAC devices in communication interventions for individuals with DD (Cannella-Malone et al., 2009, Sigafoos et al., 2009b, Sigafoos et al., 2005, Son et al., 2006, Soto et al., 1993, Winborn-Kemmerer et al., 2009). These studies implemented a structured choice-making arrangement (e.g., Sigafoos, 1998) to identify a participant's preference for one mode of communication over another. The general approach used in these studies was to teach individuals to use two different AAC options for functional communication (e.g., requesting to play with a toy). The next step was to give the individual an opportunity to choose which AAC option (SGD versus PECS) to use. When one option was consistently chosen over another, it was considered to be the participant's preferred mode of communication.

Evidence from a systematic review of the literature (van der Meer, Sigafoos, O’Reilly, & Lancioni, 2011) pertaining to these studies indicated that, although individuals with DD did often demonstrate a preference for one AAC device over another, these studies were limited in a number of ways. Specifically, the choice-making preference assessments were post hoc in that they were undertaken only after learning to use each communication option. Also, only one of these studies (Soto et al., 1993) assessed the influence of preference on maintenance of communication skills. It therefore remains unclear whether preference can be identified during and incorporated into the beginning stages of AAC intervention and whether utilizing a learner's preferred AAC option might actually improve intervention outcomes in terms of maintenance of newly acquired communication skills.

In six of the seven studies synthesized by van der Meer, Sigafoos, et al. (2011), just two AAC options (PECS and SGD) were compared. Only one study (Iacono & Duncum, 1995) compared the use of MS and a SGD. In this latter study, however, instead of implementing a choice-making arrangement, the most effective treatment modality was considered to be participant's preferred AAC option. This may be due to some of the apparent difficulties in assessing preferences between aided and unaided AAC. Sigafoos et al. (2005) explained that it is probably more complex to assess preference for using MS versus a SGD, for example, because it would seem more difficult to present the MS option as concretely as one can present a SGD or a PECS board. They therefore suggested teaching the use of MS in the presence of one distinctive stimulus and the use of SGD in the presence of another distinctive stimulus. A choice condition could then be arranged by presenting both of these distinctive stimuli.

The present study aimed to employ such a procedure in order to assess preference for aided (SGD) versus unaided (MS) modes of AAC. Previous research highlighted the importance of utilizing more sophisticated AAC devices that allow for individuals to expand on their communication capabilities (Cannella-Malone et al., 2009), yet remain cost effective (Sigafoos et al., 2005). Therefore the present study used a new, empirically validated (Kagohara et al., 2010, van der Meer et al., 2011a), software application known as Proloquo2Go™ (Sennott & Bowker, 2009) run on an iPod®-based SGD, as well as signs from the Makaton (Makaton New Zealand/Aotearoa, 1998–1999) sign language vocabulary. In comparing preferences for this iPod®-based SGD versus MS, the current study also aimed to address some of the aforementioned limitations of AAC device preference studies. Specifically, we aimed to determine whether the participants made greater progress, showed increased communication ability, and showed better maintenance of the AAC system for which they showed a preference. It was hypothesized that acquisition and maintenance of the two AAC options would be better for the AAC option that the participants also showed a preference for using.

Section snippets

Participants

Four children were recruited from a special education unit in a public school. All four participants met the following criteria: (a) diagnosis of intellectual/developmental disability or ASD, (b) school aged children of less than 18 years of age, (c) very limited or no communication skills determined by an age level of 2.5 years or less in the Expressive Communication Domain of the Vineland Adaptive Behavior Scales (Vineland-II; Sparrow, Cicchetti, & Balla, 2005), (d) no auditory or visual

Results

Fig. 1 shows the percentage of correct requests during each session for both AAC modes across participants. Fig. 2 provides a summary of the results from the AAC preference assessments across each phase of the study. During baseline, participants never used MS to request snacks or toys. They did occasionally touch the MS card, pick it up, or play with it for a few seconds. Eli used the SGD to request toys or snacks on 20% of the baseline trials. It should be noted that many of these requests

Discussion

All four participants learned to make augmented requests and demonstrated a preference for using the SGD or MS. Specifically, three (David, Tom, and Eli) of the four boys reached criterion on use of both communication options to request preferred stimuli. The fourth boy (Zac) reached criterion for SGD use, but did not learn to use MS. Tom, Zac, and Eli demonstrated a preference for using the SGD, while David exhibited a slight preference for using MS. These results support findings from

Conflict of interest

The authors report no conflicts of interest. The authors alone are solely responsible for the content and writing of this paper.

Acknowledgments

Support for this research was provided from the New Zealand Government through the Marsden Fund Council, administered by the Royal Society of New Zealand; and by Victoria University of Wellington, The University of Canterbury, and The New Zealand Institute of Language, Brain & Behaviour.

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