AAC: Attention, Exploration and Response in Children with Autism

Background: Augmentative and Alternative Communication (AAC) is a commonly prescribed intervention for pre- and minimally- verbal children with Autism Spectrum Disorder (ASD). Despite widespread use and emerging evidence for its effectiveness, little research exists examining the mechanisms underpinning individual differences in response to AAC intervention. Variability in outcomes may be related to the complex social-communication needs of the children, given that AAC is generally prescribed to those with the most significant needs. However, differences in response to this intervention may also partly be related to visual attention to, and propensity to spontaneously engage with the AAC system.
Objectives: The aims of this study were to look at the relationship between (a) visual attention to, and (b) physical exploration of, a picture-based AAC system upon first exposure, and subsequent response to instructions provided by a teacher using a picture-based AAC system in a simulated activity.
Methods: Participants were children with a diagnosis of ASD between the ages of two and five years at intake to a community-based early intervention program. The extent to which children visually attended to and physically explored AAC was gathered from a free play activity, during which children were given the opportunity to interact with a picture-based AAC system for 1 minute. Five second interval coding was used to code for the presence/absence of these behaviours. Children’s responses to the picture-based AAC system were determined by their ability to carry out a set of 8 instructions delivered to them using AAC in a simulated teaching activity (e.g., “I want you to pick up the [object] and put it in the [container]”). Children received 1 point for collecting the correct item and attempting to insert it in the correct container, for a maximum of 8 points.
Results: The participants in this study visually attended to, and physically explored, the AAC system during an average of 79.39% (SD 27.33%, range 8% to 100%) and 79.38% (SD 23.78%, range 25% to 100%) of intervals, respectively. Average performance score (i.e., ability to follow instructions delivered using AAC) was 2 (25%; SD 3.01, range 0 to 8), with only two children (14.3%) achieving the highest possible score of 8. Using Spearman’s correlation coefficient, we found no relationship (r = -.030, p = .918) between visual attention to AAC during free play and subsequent performance, and no relationship (r = .066, p = .822) between physical exploration of AAC and subsequent performance.
Conclusions: Preliminary findings suggest no link between visual attention to, and exploration of, AAC, and subsequent task performance on first exposure to the system. It remains to be tested whether initial response to AAC is associated with response to interventions in which AAC is either a primary or central component in the longer term.