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