Healthcare Training Institute - Quality Education since 1979
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Severe communication deficits have long been associated with the syndrome of autism (Kanner, 1943, 1946). Reported impairments have ranged from atypical nonverbal and nonsymbolic communication (Baron-Cohen, 1989; Curcio, 1978; Ogletree, 1992; Prizant & Duchan, 1981; Prizant & Rydell, 1984; Wetherby, 1986; Wetherby & Prutting, 1984) to oral language that differs from the norm both quantitatively and qualitatively (Baltaxe, 1977; Fay & Schuler, 1980; Rutter, 1979; Tager-Flusberg, 1996, 1997; Twachtman, 1995). Deficits have been pervasive across all domains of communication and language but have been thought to be most notable in the areas of semantics (i.e., meaning) and pragmatics (i.e., use). In fact, the disruption of communication is so common in people with autism that communication and language impairment has become widely accepted as a central feature of the syndrome (Rutter, 1979).
Since the 1970s, the communicative deficits of individuals with autism have been addressed, in part, through the application of AAC. Mirenda and Erickson (2000), in a comprehensive yet brief historical review, note that early AAC efforts focused upon the use of tangible symbols, lexograms, and manual signs. Traditional orthographic symbols were also used throughout the 1970s and 1980s, with applications specific to facilitated communication extending well into the 1990s. In the 1980s and beyond, visuospatial symbols such as photographs and line drawings emerged as the symbol choice of many practitioners. Finally, Mirenda and Erickson note that voice-output communication aids and computer software programs became prominent communication options for many persons with autism by the 1980s and 1990s. They also reported that AAC became a method of choice to facilitate language comprehension (augmented input) and to address challenging behavior (functional communication training).
Although AAC has found its way into various communication interventions for persons with autism, the dearth of literature specific to this application and its efficacy is astounding. In 1989, Mirenda and Schuler reported limited and mixed evidence supporting AAC use with persons with autism and suggested that no firm conclusions regarding efficacy could be made. In a subsequent writing Mirenda and Erickson (2000) expressed surprise that since 1989 "no summary or review article has appeared in any journal indexed by Psychological Abstracts--certainly, though both the fields of AAC and autism have changed dramatically!" (p. 333).
In the next article, Jeff Sigafoos and Erik Drasgow classify AAC systems as either aided or unaided systems, and they describe the conditional use of each type of system with individuals with autism. In addition to providing a comprehensive review of extant literature, the authors offer a clinical case demonstration that consolidates and underscores the primary points raised in the earlier sections of the article.
Koul, Schlosser, and Sancibrian extend the discussion of aided and unaided AAC systems by critically examining the variables that appear to operate in symbol acquisition by individuals with autism spectrum disorders. Through a series of anecdotal vignettes, they place the variables under discussion into real-world contexts.
In their contribution, Schlosser and Blischak provide a comprehensive examination of state-of-the-art speech output intervention with individuals with autism. When discussing synthetic speech, the authors note that its monotonic, limited-affect quality may be preferable in speech output AAC systems for children with autism. This is an intriguing finding, particularly in light of Fay and Schuler's (1980) report that the natural speech of children with autism is characteristically monotone and lacks affective expression. Emerging from the Sohlosser & Blischak review are directions for future investigations involving speech output.
Cafiero presents a practical discussion of a "total immersion augmentative communication intervention." Using a case study approach, she demonstrates the efficacy of presenting visual and verbal stimuli throughout all activities in the day of an adolescent with developmental disabilities. She reports desirable outcomes, including increases in receptive vocabulary, expressive vocabulary, and positive behaviors.
In the final article in this issue, Nigam makes the case for applying a dynamic assessment model in evaluating the potential of individuals with autism to acquire and use multiple graphic symbol combinations for communicative purposes. After defining dynamic assessment as an emerging concept, he illustrates its application through case study descriptions. He also discusses two categories of intervention strategies that coherently follow from a dynamic assessment model. Throughout the article, he draws upon published studies, including his own empirical investigations involving individuals with autism.
In their contribution to this issue, Sigafoos and Drasgow note that most individuals with autism do not have any associated physical or sensory impairment that would preclude the use of certain types of AAC systems. Also in this issue, Koul, Schlosser, and Sancibrian highlight the relatively stronger visual-spatial abilities among individuals with autism, a finding consistent with Cafiero's (1998,this issue) observation that "children with autism have demonstrated interests and abilities in activities involving visual stimuli" (Cafiero, 1998, p. 113). In light of these findings, it is not surprising that interventionists have employed an array of visual-based communication systems with children with autism. However, the relative strength of children with autism in visual-spatial abilities may be at least partly mitigated by a profound disturbance of joint attention skill development (Loveland & Landry, 1986; Mundy, Sigman, & Kasari, 1990). It has long been reported by interventionists that children with autism look less at other people's faces than do typically-developing, children (Kanner, 1943). What are the consequences of a child's profound impairment in joint attention for an interventionist attempting to introduce a visual-based AAC system? How can one facilitate acquisition of visual symbols in children who do not typically follow an interventionist's line of regard? The well-documented finding of impaired joint attention in children with autism has received little mention in AAC literature pertaining to autism. One exception is Cafiero's (1998) discussion of a program aimed at teaching picture symbols, where she makes the following observation: "Children who are able to establish joint attention and are able to point can handle as many as SO symbols on a language board. Children who have not as yet established joint attention can use two- to six-symbol language boards" (p. 114). Clearly much remains to be done to measure the impact of impaired joint attention on children's use of AAC systems.
In conclusion, as editors we hope that readers will find the contributions of this issue to be both informative and applied. Clearly, questions remain unanswered. Accordingly, we encourage researchers and practitioners to continue to promote, document, and report effective AAC practices for persons with autism.
Reflection Exercise #5