Inside IES Research

Notes from NCER & NCSER

Types of Communication for Persons with Autism

Headshots of Drs. Ganz, Pustejovsky, and Reichle In honor of Autism Awareness Month, we took a deep look into NCSER-funded research on augmentative and alternative communication (AAC) for students with autism spectrum disorder (ASD) and/or moderate-to-severe intellectual disabilities (ID) who have complex communication needs. Principal investigators Drs. Ganz, Reichle, and Pustejovsky discussed their research on AAC (such as communication board or speech output device), which provides an alternative means of communication for persons who are nonverbal or minimally verbal and ensures they have the opportunity to communicate their wants and needs. This research team’s current IES project examines treatment intensity factors (how often or how long an intervention takes place) related to teaching AAC use. In the interview below, they discuss their current project and how it builds upon their previous research on AAC interventions.

What is the purpose of your current project?

Individuals with ASD and/or ID who have complex communication needs typically require intensive, costly, and individualized educational interventions to develop communication. However, there is little information to guide parents and instructional personnel in selecting the most effective dose and duration of treatment. Similarly, there is a lack of guidance about when and how treatment integrity and strategies for generalization (use in various contexts) and maintenance (sustaining treatment over time) affect treatment outcomes. The purpose of this current project is to examine the effects of various treatment intensity parameters on expressive communication outcomes for students with ASD and/or ID through a meta-analysis. This investigation aims to guide the development of protocols for instructional personnel and parents so they can implement efficient, acceptable, and effective treatment for improving communication for these students.

What motivated you to conduct this research?

Educational interventions to treat ASD can be costly. This can lead to disparities wherein wealthier families can access high-quality services while most Americans cannot. Social services—including educational and healthcare services—are typically underfunded, impeding the provision of quality services for this population. For example, behavioral experts have recommended 25-40 hours per week of intensive, one-on-one educational and behavioral services for young children with ASD. However, there has been limited research aimed at comparing the relative efficacy of interventions based on various factors associated with treatment intensity. Not all individuals will need the same level of treatment intensity, but more research is needed to understand how treatment intensity needs can be differentiated by student characteristics, intervention types, and service context. Interventions that are efficient and tailored to individual student need may allow them to be more accessible to a wider range of families. In addition to studying these factors, this project aims to develop a treatment integrity template that can be used by others in determining appropriate treatment intensity levels for a range of interventions and populations. Such investigations hold promise for significant improvements in intervention efficiency, potentially giving schools ways to effectively serve more individuals.

Our goal is to provide information to family members and practitioners to enable them to better individualize AAC interventions, allowing them to match treatment intensity needs to individual characteristics, precursor skills, background, and consumer preferences and needs. By doing so, we can provide guidance for the allocation of services where needs are greatest.

How does this project build upon your previous research in AAC?

In 2021, we completed a research project that examined AAC interventions using similar meta-analytic methods with the same population as those studied in our current research. In that project, we focused on the ways in which instructional features and contexts are associated with learner performance. We found that AAC interventions are commonly implemented in school, home, and community settings with no significant differences in learner outcomes based on the setting. This tells us that AAC use does not need to be limited to one setting and can include caregivers and family members in this process. Across studies, a wide range of instructional strategies were used to teach AAC use, with behavioral and naturalistic strategies the most common.

Similarly, there was a range of teaching formats used during instruction. We looked at instructor- versus child-led, contrived versus naturalistic, and one-on-one versus group contexts, with structured approaches (one-on-one instruction, instructor-led, and contrived learning opportunities) the most common. However, just as with settings, no significant differences in outcomes were observed across instructional strategies or formats, indicating that there is no “one-size-fits-all” approach to AAC use and it can be individualized to the needs of each learner. The current grant offers a close examination of treatment intensity factors—such as how many sessions of intervention per week, how many minutes per session, and how many communicative opportunities the learner has during each session—and their potential effect on learner performance. Overall, the study asks, “what is the association between AAC dosage and successful learner outcomes?”

What can your research tell us about the relationship between education outcomes and AAC use for students with ASD and ID

We are hopeful that it will provide clarity for successful intervention protocols by specifying aspects of treatment intensity. Factors of treatment intensity and related intervention characteristics we are looking at include dosage rate, duration, form, and frequency; total intervention duration; degree that the treatment is implemented with integrity; and implementation of generalization and maintenance strategies. Additionally, we will explore possible associations between key skills that are important for students with ASD and ID to develop (such as imitation and matching) and choice of treatment intensity parameters.

Communication is the basis for most other learning, including social skills, literacy, and other functional life skills; thus, improving and increasing communication production and comprehension for individuals with ASD and ID who are minimally verbal or nonverbal will build a foundation for further academic and functional progress.

What do families and caregivers need to know about AAC use?

We believe that families should encourage communication in a range of modalities, including aided AAC, but also natural gestures, speech, and speech approximations. Although there is a myth that AAC use discourages speech, research has shown that individuals often learn speech simultaneously with AAC learning. Further, by increasing fluent communication, frustration and challenging behavior are often decreased. Communication in all forms must be targeted across people, settings, and vocabulary to provide minimally verbal and nonverbal individuals with opportunities to learn and use new language.

We hope to provide information to family members and practitioners that better enables them to individualize AAC interventions, allowing them to match treatment intensity needs to individual characteristics, precursor skills, background, and consumer preferences and needs. By doing so, we will be able to target services where needs are greatest and preserve resources for those in most need.

Many thanks to Drs. Ganz, Reichle and Pustejovsky for sharing their work with our readers!

Joe Reichle serves as the PI for this project and is a former Department Chair and current Professor Emeritus in the Department of Communication Disorders at the University of Minnesota.

J. Birdie Ganz is a professor of Special Education at Texas A&M University and serves as current Project Director and co-PI for this project.

James Pustejovsky is an associate professor in the School of Education at the University of Wisconsin-Madison and serves as co-PI for this project.

This blog was written by Shanna Bodenhamer, virtual student federal service intern at IES and graduate student at Texas A&M University. She also serves as a research assistant on this project.