The Pennsylvania State University The Graduate School Communication Sciences and Disorders THE EFFECTS OF AIDED AAC MODELING ON THE EXPRESSION OF MULTI-SYMBOL MESSAGES BY CHILDREN WHO USE AUGMENTATIVE AND ALTERNATIVE COMMUNICATION A Thesis in Communication Sciences and Disorders by Cathy Ann Binger 2004 Cathy Ann Binger Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy December 2004 The thesis of Cathy Binger was reviewed and approved* by the following: Janice Light Professor of Communication Sciences and Disorders Thesis Advisor Chair of Committee Kathryn Drager Assistant Professor of Communication Sciences and Disorders Carol Miller Assistant Professor of Communication Sciences and Disorders Judith Kroll Liberal Arts Research Professor of Psychology and Linguistics Gordon Blood Professor of Communication Sciences and Disorders Head of the Department of Communication Sciences and Disorders *Signatures are on file in the Graduate School iii ABSTRACT Preschoolers who have severe communication disorders and who require the use of augmentative and alternative communication (AAC) systems (e.g., communication boards, computerized voice-output systems) are at risk for all aspects of development, including language development (e.g., Lund, 2001). One area of language development that is particularly challenging for preschoolers who use AAC is transitioning from the use of single- to multi-symbol messages (Smith & Grove, 2003). This critical stage of language development marks the beginning of the use of generative language (Paul, 1997). To address this critical problem, the current investigation evaluated the impact of using a modeling technique – specifically, aided AAC modeling – to support the production of early multi-symbol messages with preschoolers who use AAC within a child-centered approach to intervention. The study used a single subject multiple probe design across participants (McReynolds & Kearns, 1983). Five preschoolers (ages 3-5) who required AAC participated in the investigation. Three preschoolers who used voice output communication systems were in the first cohort of participants, with two additional preschoolers who used light tech communication boards comprising the second cohort. To provide aided AAC models, the investigator pointed to two symbols on the child’s aided AAC system and then provided a grammatically complete spoken model while engaging in play activities with the participants. Results indicated that four of the five preschoolers learned to consistently produce multi- symbol messages and used a range of vocabulary and semantic-syntactic categories to produce these messages. iv The fifth participant did not learn to consistently produce multi-symbol messages and demonstrated relatively low rates of symbolic message productions. The four preschoolers who met criterion all evidenced long-term use of symbol combinations and also demonstrated generalized use of symbol combinations to novel play routines. Results, clinical implications, and future research directions are discussed. v TABLE OF CONTENTS LIST OF FIGURES .....................................................................................................ix LIST OF TABLES.......................................................................................................x ACKNOWLEDGEMENTS.........................................................................................xi CHAPTER 1 Introduction and Review of the Literature............................................ 1 Early Multi-Symbol Messages .............................................................................2 Input-Output Asymmetry......................................................................................6 Modeling and Child Language Disorders.............................................................9 Types of Spoken Models...............................................................................9 Focus of Spoken Models ...............................................................................11 Adapting Models for Children who use AAC ......................................................12 Providing Models using Aided AAC....................................................................13 Definitions .....................................................................................................13 Modes Used within AAC Models .................................................................15 Timing of Aided AAC Models within Intervention Setting..........................16 Components of Aided AAC Models .............................................................16 Timing of Components within Aided AAC Models .....................................17 Purpose of Providing Models Using Aided AAC .........................................19 Context for the Intervention..................................................................................20 Modeling using Aided AAC: Research to Date ...................................................21 Aided Language Stimulation.........................................................................22 System for Augmenting Language................................................................24 Modeling using Aided AAC within Other Intervention Programs ...............26 Limitations of Past Research ................................................................................31 Research Questions...............................................................................................34 CHAPTER 2 Method..................................................................................................35 Research Design ...................................................................................................35 Participants ...........................................................................................................36 Criteria for Participation................................................................................36 Assessment of Participant Skills ...................................................................37 Speech Impairment.................................................................................37 Expressive Language..............................................................................38 Receptive Language ...............................................................................40 Comprehension of Graphic Symbols .....................................................41 Pool of Potential Participants ........................................................................42 Participant Demographics .............................................................................42 vi Participant Profiles ........................................................................................43 Valerie ....................................................................................................44 Timmy ....................................................................................................49 Robyn .....................................................................................................53 Nathan ....................................................................................................56 Richard ...................................................................................................59 Materials ...............................................................................................................61 Play Scenarios ...............................................................................................61 AAC Systems ................................................................................................62 Vocabulary .............................................................................................62 Graphic Representations ........................................................................63 Layout.....................................................................................................65 Voice Output versus Non-electronic Communication Boards ......................67 Procedures.............................................................................................................68 Baseline Phase...............................................................................................69 Instructional Phase.........................................................................................73 Generalization Phases....................................................................................76 Generalization Without Models (GEN W/O).........................................76 Generalization With Models (GEN W/).................................................77 Maintenance Phase ........................................................................................77 Procedural Reliability....................................................................................78 Measures...............................................................................................................78 Dependent Measures .....................................................................................78 Data Collection..............................................................................................79 Coding ...........................................................................................................80 Definition of a Symbol...........................................................................81 Definition of a Multi-Symbol Message..................................................81