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A Peer-Mediated Intervention for Preschoolers with Autism Using AAC: Effects on Presymbolic and Symbolic Communication
The Communication Complexity Scale (CCS; Brady et al., 2012) is a measure of prelinguistic and linguistic communication being validated for individuals with autism and other developmental disorders. It was developed to fill a gap in assessment of communication for individuals with complex communication needs who may have severe intellectual impairments. Often it is difficult to determine communication status for this population due to presymbolic means of communicating that may not be revealed on typical standardized assessments.
Objectives:
The purpose of this presentation is to describe how this scale is being used to measure treatment effects of a peer-mediated (PM) communication intervention for preschoolers with autism learning to use augmentative and alternative communication (AAC). The intervention teaches typically developing peers to use a speech generating device (i.e., iPad with voice output app) with a classmate with autism. Procedures of the peer-mediated AAC intervention will be described; as well as CCS outcomes for 17 children with autism in the control group and 18 children in the PM AAC treatment group.
Methods:
Each year for 3 years, 12 children with autism and 1-3 peers per child were recruited. We conducted a series of multiple baseline designs, within an embedded randomized control design with 6 children assigned to an iPad only condition (control) and 6 assigned to iPad + PM condition (treatment) each year. Effects of the intervention were assessed within groups (baseline to treatment) and between groups (control and treatment) for 35 children. We used the CCS to score a Structured Communication Sample: Adult Partner, and the same assessment with a Peer Partner, pre- and post-intervention. We adapted administration with a peer to provide a unique way of measuring effects of the intervention on changes in communication with peers, in addition to the typical adult assessment context. Twelve communicative temptations were presented to elicit behavior regulation and joint attention (JA).
Results:
On the CCS, children in both groups made significant changes with adult and peer partners. However, there were no differential treatment effects in score changes for children in the PM treatment compared to the control group. Calculation of effect sizes suggested a medium effect size (0.4) for changes with peer partners, compared to a small effect size (.2) with adults. Furthermore, 90% of children in the PM treatment and 75% of children in the control group improved from intentional non-symbolic to intentional symbolic communication. Closer analysis of JA behaviors revealed low rates and no significant changes for either group in JA with adults or with peers.
Conclusions:
Following a peer-mediated AAC intervention, we found treatment effects on communication complexity for preschoolers with autism using the CCS - a developmental scale assessing pre-intentional to intentional symbolic communication. Outcomes provide preliminary support that this tool can be used to assess early communication behaviors, and provide a means to measure effects of social communication interventions for this population. Further, early interventions that include peers should consider teaching JA within play, given the relationship of this early core skill to later social communication skills.