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In the broadest sense, the goal of augmentative and alternative communication (AAC) interventions is to assist individuals with severe communication disorders to become communicatively competent today in order to meet their current communication needs and to prepare them to be communicatively competent tomorrow in order to meet their future communication needs (Beukelman & Mirenda, 1998). AAC assessment involves the processes by which information is gathered and analyzed so that users of AAC systems and those who assist them can make informed decisions about the adequacy of current communication, communication needs, AAC systems and equipment, instruction, and outcomes.
Many of the published studies of the use of visual-spatial symbols for expressive communication with individuals with autism have incorporated Picture Communication Symbols (PCSs; Mayer Johnson Co., 1994) to represent messages (e.g., Hamilton & Snell, 1993; Mirenda & Santogrossi, 1985; Rotholz, Berkowitz, & Burberry, 1989). Others have reported the use of photographs (Stiebel, 1999), rebuses + Pictograms (Reichle & Brown, 1986), or non-specific graphic symbols (e.g., Garrison-Harrell, Kamps, & Kravits, 1997; Sigafoos, 1998). The studies have explored various aspects of instruction related to AAC instruction; in most cases, the fact that the participant(s) were on the autism spectrum was incidental to the purpose of the study. One exception was a case study by Mirenda and Santogrossi, who successfully used a "prompt-free" instructional strategy that was specifically designed to teach communication symbol use to an 8-year-old gift with autistic-like characteristics who was overly reliant on instructional cues. The second study was an investigation of the effects of a peer network strategy on the duration of social interaction and social-communicative skills (Garrison-Harrell et al., 1997). In this study, typical peers were successfully taught to engage in social-communicative interactions with three 6- to 7-year-old students with autism via "low-tech" (i.e., nonelectronic) visual symbol displays. The results showed increased interaction time for all 3 students with autism and increased expressive language for 2 of them.
The remaining studies, all of which involved individuals with autism or PDD-NOS, have documented the following:
The papers reviewed so far in this section were designed to investigate a wide range of visual-spatial symbols as techniques for expressive communication. In addition, several papers are related to two specific techniques for communicative output, the Picture Exchange Communication System (PECS) and functional communication training (FCT). These will be summarized and reviewed in the sections that follow.
Picture Exchange Communication System
Most of the published data on PECS are anecdotal in nature and are based on the cumulative experiences of the PECS authors at the Delaware Autistic Program (Bondy & Frost, 1994). Bondy and Frost (1998) reported on the use of PECS with a group of preschoolers from this program who had no functional speech or previous AAC systems. Of 19 children who used PECS for less than 1 year, 2 acquired independent speech and 5 developed some functional speech while using PECS. The remaining 12 children used PECS as their sole communication modality. Among 66 children who used PECS for more than 1 year, 39 developed independent speech (59%), 20 others used speech + PECS (30%), and the remaining 7 used only PECS (11%) (Bondy & Frost, 1998). Thus, a total of 89% of the children in the latter group developed at least some functional speech after 1 to 5 years of PECS instruction.
There is also one published study on the use of PECS with participants outside of the Delaware program (Schwartz, Garfinkle, & Bauer, 1998). The study involved 31 children who attended an integrated, university-affiliated preschool; 16 of the children (52%) had autism or PDD-NOS. The study was conducted over a 4-year period, during which the 31 children were exposed to PECS instruction. Over an average of 14 months, all of the children learned to use PECS with both adults and peers in the preschool. They required, on average, 11 months to learn to spontaneously discriminate and exchange "I want + symbol' sentence strips with adults, and an additional 3 months to learn to do this with peers. In a subsample of 18 of these children (11 of whom had autism), 8 (44%) developed robust verbal skills after learning PECS; 6 of these "talkers" had autism. The remaining 10 children (56%) acquired very little speech but continued to use PECS as their primary communicative mode at school; 5 of this group (50%) had autism. From these data, which are generally congruent with those provided by Bondy and Frost (1994,1998), it appears that PECS can be used successfully to teach at least beginning communication symbol use, and that its use may facilitate speech development when used with children on the autism spectrum under the age of 6. Data regarding the co-development of speech in older children are not currently available (Bondy & Frost, 1998).
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