Identifying an Optimal and Early Communication Modality for Students with Autism and Intellectual Disability

Abstract

Research evaluating augmentative and alternative communication (AAC) options shows general support for various strategies (e.g., manual sign, picture exchange) in teaching individuals with autism (ASD) and intellectual disabilities (ID) to request basic wants and needs. However, the overall quality and quantity of research is diluted by the diversity within and between theoretical approaches to communication, participant characteristics, interventions, and outcomes measured. The increased frequency of literature reviews and meta-analyses conducted over the past 6 years substantiates the need to answer fundamental questions surrounding the prescriptive use of various AAC options, and the lack of clear and objective guidelines for practitioners to make informed educational decisions. Specifically, few comparative studies have evaluated AAC options for early communicators with ASD or ID, and fewer focus the comparison on the mode of communication by controlling for methodological differences. Moreover, no studies have conducted these efforts within the school setting with education personnel implementing the interventions. This study addressed the question of whether a single intervention methodology would enable educators to make informed decisions regarding an optimal mode of communication for early communicators with ASD and ID. A single-subject alternating treatments design with a baseline phase and generalization probes was used to compare the effectiveness and efficiency of manual sign and picture intervention on the acquisition of requests and speech production of four children with ASD and/or ID. Consistent with prior research, results were mixed across participants, with higher independence using picture requests across participants and better vocalizations of manual sign requests for one participant. An optimal mode of communication was identified for three of four participants. With two hours of training and weekly consultation, intervention teams successfully collected data and implemented procedures with high intervention integrity and adequate interobserver agreement. Overall, this study replicates the idiosyncratic fit between different AAC options and individuals with ASD and ID, while extending the literature by suggesting that educators can empirically evaluate these effects to make informed decisions for individual students. Specific findings and limitations of this study are discussed along with implications for future research and practice.