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Manual of Articles Sections 8 - 19
Functional Communication Training
In a review of FCT studies published between 1985 and 1996 in which one or more AAC techniques were used (Mirenda, 1997), 8 of the 52 participants (15%) had autism (Bird, Dores, Moniz, & Robinson, 1989; Campbell & Lutzker, 1993; Day, Horner, & O'Neill, 1994; Horner & Budd, 1985; Horner & Day, 1991; Sigafoos & Meikle, 1996; Wacker et al., 1990). They ranged in age from 7 to 36 (four were 8 years old or younger) and engaged in one or more problem behaviors, including self-injurious behavior, aggression, crying, screaming, property destruction, tantrums, non-compliance, and self-stimulatory behavior, as well as the aforementioned grabbing and yelling. The "messages" or functions of their behaviors included "Pay attention to me" (attention), "I want x" (tangibles), and "I don't want to do this" (escape), with the majority (63%) in the latter group. A variety of AAC techniques were taught as alternatives to the challenging behaviors, including tangible symbols (1 participant), manual signs and/or gestures (6 participants), a card with printed words (e.g., "I want a BREAK") (1 participant), and line drawing symbols (1 participant). There was an immediate and substantial reduction in the frequency of problem behavior for all 8 participants after the FCT interventions were initiated, and this reduction was maintained for as long as I year (follow-up data were not provided for all participants). Since the Mirenda (1997) review was published, additional documentation of the successful use of FCT/AAC as one component of multielement interventions for young children with autism has also appeared in the literature (e.g., Dunlap & Fox, 1999; Thompson, Fisher, Piazza, & Kuhn, 1998). In addition, a recent study provided convincing evidence for the use of VOCAs in the context of FCT/AAC interventions with 5 children, 2 of whom had autism but were over the age of 8 (Durand, 1999). FCT/ AAC interventions have the clear advantage of "killing two birds with one stone," in that they teach individuals to communicate one or more functional messages while at the same time providing positive alternatives to their problem behavior(s).
Assistive Technology for Communication and Learning
Only one published research study has investigated the relative effectiveness of VOCA versus non-VOCA output in persons with autism. In this study, a 10-year-old boy was taught to spell words under three feedback conditions (Schlosser, Blischak, Belfiore, Bartley, & Barnett, 1998). In the auditory-visual condition, the participant received both synthetic speech (via the VOCA) and orthographic feedback. In the visual condition, he received only orthographic feedback; and in the auditory condition, he received only synthetic speech feedback. The participant reached criterion and maintained performance in all three conditions, but his performance was slightly more efficient in the auditory and auditory-visual conditions. It is important to note that this study did not include a condition in which natural speech (as opposed to synthetic speech) feedback was provided. Thus, although it appears that the provision of some type of auditory (i.e., spoken) feedback enhanced learning efficiency with regard to spelling, it is not clear whether ,synthetic speech feedback via a VOCA was essential in this regard.
An additional advantage of VOCAs is that because they provide speech output, they have the potential to be easily integrated into everyday environments with unfamiliar people. This was demonstrated in the aforementioned FCT/ AAC study by Durand (1999), in which 5 children (2 with autism) learned to use VOCAs to produce alternative communicative behaviors that served the same functions as their problem behaviors (e.g., "I need help," "I want more"). The study included empirical evidence that following initial instruction, all of the participants were able to use their VOCAs without prompting in novel community settings with untrained community members.
Finally, a third potential advantage of VOCAs is their ability to facilitate natural interpersonal interactions and socialization by virtue of the speech output they provide. Schepis, Reid, Behrmann, and Sutton (1998) investigated this issue in a study of 4 young children with autism (3-5years old) who had little or no functional speech and attended a self-contained classroom with 4 other children with autism. The participants were taught to use individual VOCAs with line drawing symbols to represent messages such as "I want a snack, please," "more," and" I need help." Each of the messages was activated by touching a single symbol on the display. Naturalistic teaching procedures, including child-preferred stimuli, natural cues such as expectant delay and questioning looks to elicit communication, and non-intrusive prompting techniques were used to teach the children to interact with classroom staff through their VOCAs. Over a 1- to 3-month period, all 4 children learned to use their VOCAs to request items, respond to questions, and make social comments (e.g., "thank you") during natural play and/or snack routines in the classroom. By the end of formal training, the majority of interactions by the children were spontaneous (i.e., unprompted) and contextually appropriate. In addition, classroom staff engaged in a higher frequency of communicative interactions with the children following naturalistic teaching with the VOCA; however, no such effects were seen with regard to child-child interactions (see Note 2). This study provides the first empirical demonstration of the potential of VOCA use for supporting the communicative interactions of children with autism.
Two more recent studies provided some evidence of the efficacy of CAI with regard to learning, although neither assessed the comparative effects of CAI versus human instruction. The first study, conducted by a Swedish research team (Heimann, Nelson, Tjus, & Gillberg, 1995), investigated the use of a Swedish version of Alpha (Nelson & Prinz, 1991), an interactive multimedia software program that has been used successfully to teach reading and language skills to children with severe hearing impairments. The study compared the use of Alpha with 11 children with autism (ages 6-14, mean = 9-4 years), 9 children with mental retardation and at least one motor or sensory impairment, and 10 typical preschoolers. Results indicated that children in ail three groups made significant gains in reading, phonological awareness, verbal behavior, and motivation over the course of the study (approximately 5 months). In the second study, an adult with mental retardation, a profound hearing impairment, and autism was exposed to a software program designed to teach basic spelling skills (Stromer, Mackay, Howell, McVay, & Flusser, 1996). The participant's spelling skills for 12 target words (3 letters each) improved both on the computer and during a written generalization task.
A related issue of interest is the use of computers with synthesized speech
to facilitate speech development or production. Only one study has investigated
this application of CAI to date; it involved six verbal children with autism,
ages 4-8 to 6-8 (Parsons & La Sorte, 1993). The children were exposed
to a computer with simple software programs for learning in two conditions:
synthesized speech ON and synthesized speech OFF. The children's spontaneous
verbal utterances were counted during teaching sessions under both conditions.
The results indicated marked increases in their spontaneous utterances in all
of the ON conditions, compared to both baseline (no computer) and OFF conditions.
These results suggest that CAI with synthesized speech may have a facilitative
effect on speech production for children with autism, although additional
research is clearly needed in this area.
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