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Augmentative and alternative communication (AAC) techniques and strategies have provided communication opportunities for children with autism who are unable to use speech. Previous research has indicated that some children with autism are able to communicate using graphic symbols. A goal for many children with autism who have learned to communicate using single graphic symbols will be the transition to multisymbol use. This article offers potential teaching strategies that can be used during dynamic assessment that may help a speech language pathologist to assess the potential for acquiring and using multiple graphic symbol combinations for communicative purposes by children with autism.
Language milestones play an important role in the assessment and diagnosis of autism in children. Most parents report that something is wrong with their child when they notice delay or regression in development of communication skills (Short & Schopler, 1988). Often the delay is obvious; for example, approximately 50% of children with autism fail to develop expressive language skills or useful speech (Lord & Paul, 1997). Other communication, speech, and language differences may be subtle. For example, research has demonstrated that compared to typically developing children, verbal children with autism show similar developmental patterns in lexical growth (Tager-Flusberg, 1985) and acquire grammatical abilities in the same order (Tager-Flusberg, Calkins, Nolin, Baumberger, Anderson, & Chadwick-Dias, 1990; Tager-Flusberg & Calkins, 1990). However, when matched by language level, significant differences are apparent in the communicative abilities of children with autism (e.g., initiation of joint attention and showing or pointing; Mundy, Sigman, & Kasari, 1990).
Clearly, children with autism present communicative impairments requiring intervention. For many of these children, augmentative and alternative communication (AAC) systems may promote communicative competence. This article provides a brief review of AAC applications with persons with autism and discusses dynamic assessment as an innovative clinical practice with this population. It also presents matrix strategy and milieu teaching as useful tools for examining the potential for emergent, multisymbol combinations during dynamic assessment.
AAC and Children with Autism
Development of effective AAC systems for children with autism requires extensive, ongoing assessment. Light, Roberts, Dimarco, and Greiner (1998) presented a theoretical model for AAC assessment and intervention through a case report of a 6-year-old boy with autism who had severe expressive and receptive language impairments. This model recommended the assessment of skills specific to AAC, such as receptive language, expressive communication, natural speech, symbol representation, literacy, cognitive organization, positioning and access, and sensory perceptual skills. Beukelman and Mirenda (1998) noted that these types of abilities are best evaluated through a dynamic process. Such a process results in the selection or modification of the AAC system only after considerable exposure to the potential user and after significant periods of trial teaching. Recently, the field of speech-language pathology has embraced the notion of trial teaching in evaluation. This process has been referred to as "dynamic assessment."
Static assessment procedures focus on determining a child's independent performance at a particular point in time. In contrast to static or traditional assessment procedures that often reveal product (e.g., a child's current level of performance), dynamic assessment provides information about the learning process (Lidz, 1991). Dynamic assessment identifies a child's developmental abilities and limitations in relation to her learning context (Missiuna & Samuels, 1989) and encourages enthusiastic participation by both the clinician and the child.
Dynamic assessment provides the child an opportunity to complete a task that would be too difficult to accomplish without guidance. A pretest-intervene-posttest format using instructional and other informal procedures characterizes dynamic assessment. However, the clinician can use sections or certain tasks from standardized assessment tools that are within the child's ZPD. The child should be able to complete these tasks with the clinician's assistance, and the results can be reported descriptively to augment the standardized test scores (Kublin, Wetherby, Crais, & Prizant, 1998). Inclusion of intervention into the assessment procedure is a significant component of the dynamic assessment.
To summarize, dynamic assessment provides information about: (a) the child-as-learner that includes the approach or method used during a particular task, error patterns, and the aptitude to self-correct; (b) the child's inclination to change in response to the intervention and the intensity of effort required to facilitate such changes; and (c) probable effective goals for intervention. Dynamic assessment helps clinicians gather information about the child's learning potential and determine intervention strategies that might improve the child's performance on a task (Lidz & Pena, 1996).
Because traditional assessment procedures using standardized tests do not provide information about the child's learning potential, the concept of dynamic assessment is becoming more common in the field of communication disorders, special education, and other behavioral sciences. Clinicians have long faced difficulties assessing the AAC possibilities for children with little or no functional speech because standardized tests often require either verbal responses or pointing skills. The use of dynamic assessment provides a solution for this dilemma in that assumptions about children's abilities and potential are based upon an ongoing pretest-intervene-posttest paradigm where the child's performance is supported by the examiner.
With fire adoption of dynamic assessment as an evaluative alternative for persons with autism, clinicians are left to determine which informal procedures and intervention strategies might be most helpful within the pretest-teach-posttest paradigm.
Reflection Exercise #9