Towards Advancing Knowledge Translation of AAC Outcomes Research for Children and Youth with Complex Communication Needs

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Table I. Themes, Abstracts, and Recommendations for Future Research from Invited Speakers.

Research topic, invited speaker and affiliation	Abstract	Key research and development directions
Supporting communication, language, and literacy development of children with complex communication needs Janice Light, PhD, Department of Communication Sciences and Disorders, Penn State University	Two significant challenges were considered to maximize outcomes for children with complex communication needs: (a) investigating how to improve the design of AAC apps/ technologies and interventions in order to better meet the breadth of communication needs for the diverse population of children with complex communication needs, and (b) ensuring the effective translation of these evidence-based AAC interventions to the everyday lives of children so that the possible becomes the probable. The session included a summary of the state of the science and proposed directions for future research and development.	• Determine visual, cognitive, language, and motor processing/development of children with complex communication needs. • Design AAC interventions that respond to children's needs. • Compare effectiveness of AAC interventions. • Determine effective strategies to enhance public awareness of AAC. • Investigate the everyday lives of children with complex communication needs and their families across society. • Investigate AAC interventions that are easy and quick to implement and compatible with everyday life. • Investigate strategies required to support long-term infusion of practices in everyday lives.
Successful transitions for youth and young adults who use AAC David McNaughton, PhD, Department of Educational Psychology, Counseling, and Special Education, and the Department of Communication Sciences and Disorders, Penn State University	A successful transition to adult life requires attention to four major goals: having a safe and supportive place to live, participating in meaningful activities, maintaining access to needed services, and developing friendships and intimate relationships. Access to AAC plays a critical role in the achievement of these valued outcomes for young adults with complex communication needs. This session presented what is known about the use of AAC to support communication and participation by young adults, and identified areas for future research and development in AAC technology to support this successful transition.	• Develop AAC technologies that are understood by different people in a variety of situations and environments. • Develop technology that is understood by other devices and supports individual preferences. • Explore technology to support virtual participation in the workplace (e.g., telework). • Improve accessibility of mainstream technology. • Develop more efficient retrieval techniques to enhance turn taking and topic changes. • Study access to technology for people with cognitive challenges and specialized access. • Research the advancement of language and communication skills needed to develop intimate relationships and achieve individual identity.
Participation in developmentally favorable environments Beata Batorowicz, PhD(c), School of Rehabilitation Science, McMaster University	This session considered participation of children and youth in typical childhood activities and places in the following domains: (a) research related to participation outcomes for children with complex communication needs, with a focus on recreation and leisure participation, (b) current thinking about the construct of participation, highlighting the experiential aspects and meaningfulness of participation experiences for children and youth, and (c) implications for AAC outcome measurement, suggesting mechanisms of child-environment interaction and interventions that build capacity within children and their social environments.	• Study the objective and subjective experiences of children using AAC in everyday activity settings. • Examine child- and family-reported meaningfulness of involvement in environments. • Study psychosocial engagement in the moment and over time. • Evaluate the effect on child and family members of opportunities, supports, and resources within social environments. • Measure the long-term effects of participation-level interventions on child development and health.
Advances in AAC technologies and clinical decision making Jeff Higginbotham, PhD, Communicative Disorders and Sciences, State University of New York	This session was about the continual and ever-increasing change in assistive technologies organized around the following themes: technology flow, joint interaction, deconstruction, and redistribution – small, and personal. Content areas for this presentation included the augmented voice, designing the person into the technology, the Arduino revolution, and small data – large issues.	• Develop AAC making use of the increasing availability of accessible computer languages and programmable technologies. • Create evidence using a variety of AAC data (e.g., word frequency, diversity, target usage, utterances, and frequency of device use). • Conduct longitudinal studies to explore the impact of AAC intervention on the everyday functioning of children with complex communication needs in domains of participation, activity, and body function.
Challenging beliefs about AAC interventions for children and youth with autism spectrum disorders Pat Mirenda, PhD, Department of Educational and Counselling Psychology and Special Education, University of British Columbia	This session challenged thinking about what we know about and how our current knowledge affects the way we provide language/ communication supports to individuals with autism spectrum disorder. Specifically, the talk focused on past and current understandings about ASD in general, ASD and speech development, and both AAC and literacy interventions for this population.	• Identify predictive factors in people with ASD who are independent and competent communicators through the use of AAC. • Evaluate the impact of instructional techniques that align with the principles of motor learning on AAC acquisition. • Study evidence-based literacy instruction on the development of language, communication, and literacy skills.
Measuring outcomes of AAC interventions Nancy Thomas-Stonell, MSc, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, and Department of Speech-Language Pathology, University of Toronto	Outcome measures must have demonstrated reliability, validity, and responsiveness within the AAC population before being adopted into clinical use. Furthermore, measures need to be relevant to the goals of AAC intervention and reflect real-world changes that are important to clients, families, and clinicians. This session highlighted five different outcome measures that have evidence of validity for AAC intervention in children and youth with complex communication needs.	• Study the impact of AAC interventions on children's quality of life and participation. • Evaluate real world changes that are important to the child, parent, and clinician. • Evaluate outcomes using measures that have acceptable levels of reliability and validity and can detect change in individual and groups of children. • Develop new sound measurement scales to evaluate the impact of AAC interventions in children with complex communication needs.

Table II. Elements of PESICO Model with Discussion Group Probes.

PESICO element	Details	Sample probes
Person (P)	Describe the person most directly affected by the construct under study	• Who are the individuals or groups most directly affected by the proposed construct? They could be children or youth with complex communication needs; or parents, siblings, and other familiar and unfamiliar communication partners. Alternatively, a service or collective of services could be selected as the “persons” directly impacted. • What distinguishes the individual's or group's membership, for example, developmental level (preschool, early school age, late school age, early teenage, young adult); diagnosis; functional level for communicative competence (consider linguistic, operational, social, and strategic skills); and motor and cognitive functioning level, where relevant.
Environment (E)	Describe the environment and partner skills and attitudes	• What are the person's current or future environments that will provide the context for the research investigation? Recall that environmental factors are not within the person's control and make up the physical, social, and attitudinal environment in which people live and conduct their lives. • What attitudes do communication partners possess that may influence the study outcome?
Stakeholders (S)	Describe the stakeholders who may influence the outcomes	• Refer to same sample probes for Person above.
Intervention (I)	Describe the intentional steps to change an outcome	• Both intervention and exposure fit under this element. Intervention includes the intentional steps taken to change behaviors or attitudes of persons, interactions, procedures, events and environments to change an outcome. Whereas, exposure is the development of change in behavior or attitudes of the same that occur naturally through the presence of a stimuli or event rather than something intentional. • Can you describe clearly the intervention (or exposure) being studied?
Comparison (C)	Describe the comparison intervention	• Can you describe the comparison intervention or exposure being studied? This could be standard of care or wait-list controls. • Do you anticipate any ethical concerns? That is, the comparison intervention should offer participants no less than standard of care. • What would be physical, psychosocial, or other developmental risks associated with being part of the comparison group?
Outcome (O)	Describe the primary outcome of interest.	• Describe one or more of the key constructs that may be important to measure. From these constructs, identify a primary outcome of interest. • Is the primary outcome related to any or all of the categories of communicative competence? Is the primary outcome related to intervention effectiveness or efficiency? How? Is it related to other functional outcomes such as participation? • What health measurement scales may be appropriate to measure these outcomes?

Table III. PESICO Elements by Assigned Topic Area.

PESICO element	Group 1: Communication, language, literacy	Group 2: Successful transitions	Group 3: Childhood participation	Group 4:Children with ASD	Group 5: New technologies and clinical decision making	Group 6: Outcomes of interventions
Person of interest	Preschoolers aged 3–5 years	Non-ambulatory youth aged 16–21 years with CP	Children aged 8–12 years	Children with ASD, aged 5–8 years	Primary school children aged 6–9 years	Preschoolers with CP, aged 3–5 years
Environment	Inclusive nursery school program	Accessible work environment	After school leisure program	Social play time	School-based, social environment	Nursery school
Stakeholders	Family, preschool, and future school team	Volunteers, coworkers, service providers	Peers, community partners, parents	Families, IBI staff, service providers	School facilitator, peers, service providers	One-to-one support person, parents, service providers
Intervention	Distance training	Supportive conversation	Group peer training in communication strategies	Aided language stimulation with SGD	Practitioner delivered	InterAACt^™ Footnote1 language framework
Comparison	Focused literacy training	Communication passport	No training	SGD, no aided language stimulation	Facilitator delivered, client facilitated	Workshop
Outcome measurement	Improved literacy in key areas, stakeholder attitude and perception	Activity performance (COPM), experiences of activity settings (SEAS), conversational analyses	Frequency and quality of opportunities to communicate and experiences	Number of contextually- appropriate comments, multimodal turn taking, engagements	GAS and time spent to achieve level of communicative competence	Increase in utterances, positive communication behaviors, functional outcomes (FOCUS)

Note. ASD = autism spectrum disorder; COPM = Canadian Occupational Performance Measure; CP = cerebral palsy; FOCUS = Focus on Outcomes Under Six (FOCUS); GAS = goal attainment scaling; IBI = intensive behavioral intervention; SEAS = Self-Reported Measure of Activity Settings (SEAS); SGD = speech-generating device.

Table IV. Research Questions Derived from PESICO Elements by Topic Area.

Group	Topic area	Research question
1	Communication, language, and literacy	Compared to interventionist distance training, do preschoolers with complex communication needs, aged 3–5 years, who are in inclusive nursery school programs show improvements in literacy and parent/educator attitudes and perceptions following focused literacy training?
2	Successful transitions	Do independent communicators with cerebral palsy, aged 16–21 years, using supportive conversation in an accessible work environment, report meaningful improvements in satisfaction and performance of individualized goals (as measured by the COPM, and improved experiences as measured by the SEAS), compared to using a communication passport in the same setting?
3	Childhood participation	Compared to no training, does a peer group training program in communication strategies for children aged 8–12 years in an after-school leisure program show greater frequency and improvement in the quality of opportunities to communicate, as well as improved childhood experiences, according to their peers, parents, and community partners?
4	Children with autism spectrum disorder (ASD)	Do emerging communicators with ASD, aged 5–8 years, demonstrate change in positive social behaviors with service providers and family members (as measured by the number of contextually-appropriate comments and turn-taking exchanges while playing games using an SGD) with 1 month of training through aided language stimulation compared to no training?
5	New technologies and clinical decision making	Compared to facilitator-delivered, client-facilitated interventions, do practitioner-delivered interventions in school-based social settings reduce the time spent to achieve individualized communicative competence goals (as measured by GAS) in children with complex communication needs, aged 6–9 years?
6	Outcomes of interventions	Do non-speaking preschoolers with CP, aged 3–5 years, using the InterAACt language framework, show positive communicative behaviors and meaningful improvements in communicative participation (as measured by the FOCUS) compared to traditional approaches, according to their parents, service providers, and one-to-one support persons?

Note. ASD = autism spectrum disorder; COPM = Canadian Occupational Performance Measure; CP = cerebral palsy; FOCUS = Focus on Outcomes Under Six; GAS = Goal Attainment Scaling; SEAS = Self-Reported Measure of Activity Settings; SGD = speech-generating device