Laurie McLay, University of Canterbury Larah van der Meer, Victoria University of Wellington

1. Comparing Picture Exchange, Manual Signs, and iPad™-based SGDs as AAC Options for Children with Autism Laurie McLay, University of Canterbury Larah van der Meer, Victoria University of Wellington New Zealand

2. Communication Impairment (Osterling, Dawson, & McPartland, 2001)

3. AAC Systems Manual Signs (MS) Speech-Generating Devices (SGD) Picture Exchange (PE)

4. A Frequent Question • Which AAC system is best suited to individuals with autism?

5. Comparative Studies • All three systems have been taught • No major or consistent differences (Lancioni et al., 2007; Mirenda, 2003)

6. Self-Determination • Can we let the child decide?

7. General Approach • Teach two or more systems • Ensure comparable experience • Provide opportunities to choose

8. Questions • Do individual children with autism show idiosyncratic preferences for MS v. PE v. SGD? • Can preferences be identified at the beginning stages of intervention? • Are preferences stable over time and across contexts? • Does preference influence how quickly and efficiently children learn to use AAC? • Does preference influence the maintenance of communication skills; that is, the extent to which children continue to use their newly acquired AAC skills after the intervention has ended?

9. Hypotheses • Children will show idiosyncratic preferences for different forms of alternative communication • Use of the child's most preferred option will improve the acquisition and maintenance of alternative communication skills

10. Experimental Design and Procedures • Multiple baseline across participants • Alternating treatments • Baseline • Opportunities to request, no prompting • Acquisition training • Prompted to use each system until acquisition criterion • Preference Assessment • All systems available to choose from

11. Example (McLay et al., in progress) • Assessments • Freeplay • Baseline • Intervention • Preference Assessment • Post-Intervention • Follow-Up

12. McLay and Colleagues • Participants • Six participants with autism (Sparrow, Cicchetti, & Balla, 2005)

13. Method • Context • General request for “more” toys • Materials • SGD using iPad Mini™ with Proloquo2Go™ • PE using PECS symbol (Pyramid Educational Products, 2009) • MS using Makaton (Makaton New Zealand/Aotearoa, 1998-99)

14. Intervention Procedures • Systematic instruction • Time delay • Graduated guidance • Error correction • Tangible and social reinforcement

15. Generalisation • Non-teaching probes conducted pre- and post-intervention • In a novel (non-teaching) setting • Using a novel person (not involved in teaching)

16. Figure 1. Percentage of correct requests using each AAC system for each session for Pene, Mika, and Hemi

17. Figure 2. Percentage of correct requests using each AAC system for each session for Manu, Lomu, and Afasa

18. Figure 3. Total number of times each AAC system was chosen across study phases and across participants

19. Generalisation Results • Table 1. Percentage of correct requests using each AAC system in a novel setting

20. Generalisation Results • Table 2. Percentage of correct requests using each AAC system with a novel person

21. Further Studies • Couper et al. (2014) • 9 participants • McLay et al. (in progress) • 6 participants • van der Meer, Didden, et al. (2012) • 4 participants • van der Meer, Kagohara, et al. (2012) • 4 participants • van der Meer, Sutherland, et al. (2012) • 4 participants

22. Overall Results • 27 Participants • 4 girls, 23 boys • Aged 4:2 – 13:2 (M = 7:3) years • ASD and a range of developmental disorders • Vineland-II (Sparrow et al., 2005) scores • ≤ 2:5 years for expressive communication • Context • Requesting access to preferred stimuli with SGD, PE, and MS

23. Figure 4. Percentage of participants who did not reach criterion for each AAC system

24. Figure 5. Mean number of trials to reach criterion for each AAC system

25. Figure 6. Mean percentage of times each AAC system was selected

26. Figure 7. Mean percentage of times each AAC system was selected across each phase of the study

27. Figure 8. Percentage of participants with high preference (van der Meer, Sigafoos, O'Reilly, & Lancioni, 2011)

28. Summary • SGD and PE learned at comparable rates • MS slower to learn • Prefer AAC system that more proficient at using • Majority preferred SGD

29. Further Research Directions • Social communicative interactions • Preference-enhanced communication intervention • Social validity • Effects on other behaviours, communication skills, and speech

30. Conclusions • This choice-making approach appears useful in assessing children’s preferences for different AAC options • Children may be able to self-determine which AAC option they would like to use

31. Enhancing Communication Intervention for Children with Autism • Principal Investigators • Jeff Sigafoos, Ph.D. Victoria University of Wellington • Dean Sutherland, Ph.D. University of Canterbury • Collaborative Researchers • Laurie McLay, Ph.D. University of Canterbury • Larah van der Meer, Ph.D. Victoria University of Wellington • Contributors • Mark F. O’Reilly, Ph.D. The University of Texas at Austin, USA • Giulio E. Lancioni, Ph.D. University of Bari, Italy • Scholarship Students • Donna Achmadi, Victoria University of Wellington • Llyween Couper, University of Canterbury • Research Assistants • Martina Schaefer • Emma McKenzie • Debora Morita Kagohara • Michelle Stevens • Laura Roche • Amarie Carnett • Hannah Waddington • Ruth James

32. References Couper, L., van der Meer, L., Schafer, M. C. M., McKenzie, E., McLay, L., O'Reilly, M. F., . . . Sutherland, D. (2014). Comparing acquisition of and preference for manual signs, picture, exchange, and speech-generating devices in nine children with autism spectrum disorder. Developmental Neurorehabilitation. doi:10.3109/17518423.2013.870244 Lancioni, G. E., O’Reilly, M. F., Cuvo, A. J., Singh, N. N., Sigafoos, J., & Didden, R. (2007). PECS and VOCAs to enable students to make requests: An overview of the literature. Researchin Developmental Disabilities, 28, 468-488. Makaton New Zealand/Aotearoa. (1998-99). Sign illustrations for Makaton core vocabulary. Auckland: Westprint. Mirenda, P. (2003). Toward functional augmentative and alternative communication for students with autism: Manual signs, graphic symbols, and voice output communication aids. Language,Speech, and Hearing Services in Schools, 34, 203-216. Osterling, J., Dawson, G., & McPartland, J. (2001). Autism. In C. E. Walker & M. C. Roberts (Eds.), Handbook of clinical child psychology (3rd ed.) (pp. 432-452). New York: John Wiley & Sons. Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales, Second Edition, Survey Forms Manual. Minneapolis: Pearson. Pyramid Educational Products Inc. (2009). PICS for PECS 2009. Newport: Author. van der Meer, L., Sigafoos, J., O'Reilly, M. F., & Lancioni, G. E. (2011). Assessingpreferences for AAC options in communication interventions for individuals with developmental disabilities: A review of the literature. Research in Developmental Disabilities, 32, 1422-1431. van der Meer, L., Sutherland, D., O'Reilly, M. F., Lancioni, G. E., & Sigafoos, J. (2012). A further comparison of manual signing, picture exchange, and speech-generating devices as communication modes for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 6, 1247-1257. doi: 10.1016/j.rasd.2012.04.005 van der Meer, L., Kagohara, D., Achmadi, D., O'Reilly, M. F., Lancioni, G. E., Sutherland, D., & Sigafoos, J. (2012). Speech-generating devices versus manual signing for children with developmental disabilities. Research in Developmental Disabilities, 33, 1658-1669. doi: 10.1016/j.ridd.2012.04.004 van der Meer, L., Didden, R., Sutherland, D., O'Reilly, M. F., Lancioni, G. E., & Sigafoos, J. (2012). Comparing three augmentative and alternative communication modes for children with developmental disabilities. Journal of Developmental and Physical Disabilities, 24, 451-468. doi: 10.1007/s10882-012-9283-3