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Searching for and Finding Evidence in Augmentative and Alternative Communication (AAC): Navigating a Scattered Literatu

Searching for and Finding Evidence in Augmentative and Alternative Communication (AAC): Navigating a Scattered Literature. Oliver Wendt, MS, Doctoral Candidate Purdue University

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Searching for and Finding Evidence in Augmentative and Alternative Communication (AAC): Navigating a Scattered Literatu

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  1. Searching for and Finding Evidence in Augmentative and Alternative Communication (AAC): Navigating a Scattered Literature Oliver Wendt, MS, Doctoral Candidate Purdue University American Speech-Language Hearing Association, Division 12: Augmentative and Alternative Communication (DAAC), 7th Annual Conference

  2. Presentation based on Schlosser, R. W., Wendt, O., Angermeier, K. L., & Shetty, M. (2005). Searching for evidence in augmentative and alternative communication: Navigating a scattered literature. Augmentative and alternative communication, 21 (4), 233-255.

  3. What is Evidence-based Practice (EBP)? • “Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett et al., 1996). • “…the integration of best and current research evidence with clinical/educational expertise and relevant stakeholder perspectives to facilitate decisions for assessment and intervention that are deemed effective and efficient for a given direct stakeholder” (Schlosser & Raghavendra, 2003, p. 256)

  4. The EBP Process 1. Developing a well-built question 2. Selecting evidence sources & executing the search strategy 3. Examining and synthesizing the evidence 4. Applying the evidence 5. Evaluating the application of the evidence 6. Disseminating the findings (Sackett et al., 1996 - Steps 1-5)

  5. Is this what it is like to look for evidence in AAC?

  6. The Role of the Search • AAC literature is scattered • It takes knowledge and skills (K & S) • Consequences of an inadequate search • Ignore pertinent evidence • (Erroneously) conclude that there is no evidence available • Over- or underestimate the support for a particular intervention • Misinterpret the applicability of the evidence

  7. Potential Sources of Evidence • Textbooks • Journals • Newsletters • Databases with pre-filtered evidence • "…an individual or group of individuals with expertise in a particular substantive area has reviewed and presented the methodologically strongest data in the field" (Melnyk and Fineout-Overholt, 2002, p. 263, based on Guyatt and Rennie, 2002). • Database of Abstracts of Reviews of Effects (DARE) • http://www.york.ac.uk/inst/crd/welcome.html • General Purpose Databases • CINAHL, ERIC, LLBA, MEDLINE, PsycINFO • Internet

  8. General Purpose Databases

  9. Assumptions for EBP Searches

  10. Assumptions Continued • Locate best & most current evidence first • Work down the hierarchy of sources • Database of Reviews of Effects (DARE) • Cochrane Database of Systematic Reviews • Seek out reviews before individual research studies • Look for peer-reviewed evidence before non-peer-reviewed evidence

  11. About Quality Filters

  12. Example 1 - Comparative Efficacy • Begin with scenario: • A team of practitioners and family members, serving a 6-year old child with developmental disabilities (i.e., severe to profound mental retardation), have deemed it appropriate to introduce manual signing. They are, however, unsure what instructional strategy is most effective and efficient to yield successful expressive use and receptive learning • Consider your question: • “What instructional strategies are most effective and efficient in yielding expressive signing and receptive speech?”

  13. Example 1 Continued 3. Extract general keywords/limiters (quality filters) from question • Direct extractions • Manual signing, signing • Developmental disabilities • Instruction (treatment, intervention, therapy) • Effectiveness • Efficiency • Expressive use • Receptive speech • Young children • Extrapolations • Comparative (treatment) studies • Group studies • Single-subject experimental designs

  14. Example 1 Continued 4. Determine and prioritize appropriate evidence sources: • (a) DARE • (b) General-purpose databases (prioritize: PsycINFO) • (c) Internet (if needed)

  15. AAC-relevant journals and their inclusion in various databases

  16. Example 1 Continued 5. Implement search for reviews - DARE • Augmentative communication, alternative communication, assistive technology, sign language, manual sign 6. Examine results (reviews) - DARE augmentative communication/All fields OR alternative communication/All fields OR assistive technology/All fields - 2 Hits (1-2) (Record 1) Promoting generalization and maintenance in augmentative and alternative communication: a meta-analysis of 20 years of effectiveness research. Schlosser R W, Lee D L. AAC: Augmentative and Alternative Communication 2000; 16(4): 208-226. (Record 2) Speech and language therapy to improve the communication skills of children with cerebral palsy. Pennington L, Goldbart J, Marshall J. Speech and language therapy to improve the communication skills of children with cerebral palsy (Cochrane Review). In: The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiley & Sons, Ltd • sign language/All fields OR manual sign/All fields - No Hits

  17. 5. Implement search for reviews - PsycINFO

  18. How to get the other ones not in database? • McDonald, L. (1977). A comparison of three methods of word imitation training with Down’s Syndrome children under six years of age. Unpublished master’s thesis. University of Manitoba, Winnipeg. Canada. • ---> AAC Thesis and Dissertations (Lloyd, Koul, & Arvidson, 1993, 1994; Lloyd, Arvidson, & Koul, 1996) • Iacono, T., & Parsons, C. (1986). A comparison of techniques in teaching signs to the intellectually disabled using an alternating treatments design. Australian Journal of Human Communication Disorders, 14, 23-34. • ----> Handsearch

  19. Prepare search - PsycINFO

  20. What can we glean from this backward process? • Sign language • Most widely and consistently used KW • If not used, other alternatives are • Manual communication • Communication skills training • ( ) Mental retardation • is best to capture the population • Quality filter: • Empirical study (only one without it) • “compar*” as a free-text word works for most

  21. 5. Implement search for reviews & 6. Examine Results - PsycINFO -12 references, but none focused on topic (autism, not treatment focused) ---> refine search

  22. -3 references, but none focused on topic (autism, not treatment focused) ----> Need to look for individual studies

  23. 5. Implement search for studies - PsycINFO Add limiters (quality filters)

  24. 6. Examine the results (studies) - PsycINFO

  25. 6. Examine results (& revise & search again)

  26. revise search (and implement again) 6. Examine the results (studies) - PsycINFO

  27. Example 1 Lessons • Use the thesaurus to build your search • When you found an appropriate reference, check it out in terms of indexing • Use synonyms or terms that describe similar concepts • Be mindful - terminology changes, but the indexing may not be retro-active • Don’t forget the “TX” option • Consider to use truncation • Trust no one! Indexers are not perfect. • “Pearl Growing” can be a beneficial EBP search strategy (if you have a relevant article to start with)

  28. Pearl Growing • Pearl Growing involves the following process • (1) Find a relevant article; • (2) find the terms under which the article is indexed in database-1; • (3) find other relevant articles in database-1 by using the index terms in a Building Block query; • (4) repeat 2-3 in other databases; • (5) repeat 1-4 for other relevant articles; and • (6) end when articles retrieved provide diminishing relevance.

  29. An Illustration of Pearl Growing • Question • What strategies are most effective and efficient for introducing manual signs to children with developmental disabilities in terms of expressive signing, and/or expressive natural speech, and/or receptive speech? • (1) Our Pearl • Clarke, S., Remington, B., and Light, P., 1988, The role of referential speech in sign learning by mentally retarded children: A comparison of total communication and sign-alone training. Journal of Applied Behavior Analysis, 21, 419-426.

  30. (2) Under which terms is the pearl indexed in database 1 - Medline? • Medical Subject Heading terms (italic = most relevant): • Child; Child, Preschool; Communication Methods, Total; Comparative Study; Female; Humans; Imitative Behavior; Male; Manual Communication; Mental Retardation/rehabilitation; Rehabilitation; Research Support, Non-U.S. Gov't; Sign Language; and Speech. • the “pearl” was not indexed with a particular publication type • The MeSH term “comparative study” can serve to filter out studies that involve only one treatment. • Checked the MeSH database http://www.nlm.nih.gov/mesh/MBrowser.html to identify other relevant terms to capture this population • found “developmental disabilities” and “autistic disorder.”

  31. (3) find other relevant articles using terms in Medline • First goal is to identify reviews: • [(communication methods, total OR sign language OR manual communication) AND (mental retardation OR developmental disabilities OR autistic disorder)] using “child,” “human,” and sequentially “meta-analysis,” “review,” & “practice guideline” as limiters. • Using “review”- Yield: 9 entries - three were applicable (Bondy & Frost, 1998; Howlin, 1988; Wilken, 1996).

  32. Second goal is to identify individual studies: • [(communication methods, total OR sign language OR manual communication) AND comparative study AND (mental retardation OR developmental disabilities OR autistic disorder) AND speech)] using “child” and “human” as limiters • Yield: 3 additional relevant references (Brady & Smouse 1978; Layton 1988; Wells 1981). • PT use varied from case report to clinical trial to RCT • Repeat search without “speech” • Yield: 9 references - 4 were applicable (Barrera & Sulzer-Azaroff 1983; Kahn 1981; Sisson & Barrett 1984; Wherry & Edwards, 1983) • PT use varied from none to case report to clinical trials to RCT • This variation in quality filters along with the absence of any additional keywords made it unnecessary to conduct more MEDLINE searches.

  33. (4) repeat steps 2-3 in PsycINFO • This pearl is indexed under the following Descriptors: • communication skills training, phenylketonuria, sign language, severe mental retardation, and verbal communication • Form/Content Type of “empirical study” as a quality filter • This provided some valuable keywords (in italics) and one quality filter to start with • We supplemented other relevant keywords to better describe the population of developmental disabilities using the thesaurus • First goal is to identify reviews: • [(DE "Sign Language" or DE "Verbal Communication") and (DE "Communication Skills Training") and (DE "Mental Retardation" or DE "Developmental Disabilities" or DE "Pervasive Developmental Disorders")] using literature review and meta-analysis as quality filters. • Yield: No hits

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