by Julia Wynne, MA, CCC-SLP (Speech-Language Pathologist); NWACS Contributor

Many school-aged children with multiple disabilities are in the early stages of language development or beginning communicators. There are many factors that may be limiting language learning, such as reduced time with peers and on academic tasks, as well as motor difficulties that hold them back from manipulating the world around them. This limited language learning may result in low levels of engagement. Augmentative and Alternative Communication (AAC) provides these children who have limited speech and language skills with a means to explore and engage with the world.

There is wide variation in how language is taught to beginning communicators. One method is to point to or exchange low-tech isolated picture symbols, usually color line drawings depicting words and concepts. Another option is the use of high-tech visual scene displays (VSDs), which use computer-based technologies that depict scenes from real life. This summary will take a look at research comparing the level of engagement for early communicators between these two very different methods of AAC.

Below you will find definitions of some key terms. Keywords will be bolded throughout this summary. You’ll find the research question, the importance of the research, a summary of the findings, followed by the most important takeaways from the research article below. Enjoy!

Comparative Effects of High-Tech Visual Scene Displays and Low-Tech Isolated Picture Symbols on Engagement From Students With Multiple Disabilities

High-Tech: electronic devices (such as iPads or dedicated devices) which store messages, many of which allow speech output

Isolated picture symbols: a symbol depicting a line drawing of an item or concept that is presented on one (usually laminated) square

Low-Tech: communication aids that are not electronic or battery operated, such as a book of symbols that can be used to communicate

Visual Scene Displays: real life photos or pictures containing “hot spots” that people can use to communicate messages to others

The researchers were looking to answer the following 3 essential questions:

1. How do levels of engagement compare between the two types of AAC (low tech isolated symbols and visual scene displays) as measured by gaze?

2. How do the levels of engagement with communication partners compare between the two AAC systems?

3. How do the two AAC systems compare on expressive communication?

These two technologies - low-tech isolated picture symbols and high-tech visual scene displays (VSDs) - are very distinct. They differ on the level of technology (low vs. high tech) and representation (drawings vs. real life photos). The VSDs tend to be much larger (the size of a tablet screen) versus a few inches. VSDs allow for voice output, while the picture symbols do not. Given these distinctions, it is no surprise that individuals with multiple disabilities might engage with these technologies much differently. Many clinicians, however, choose to trial low-tech AAC technologies before high-tech ones. Knowing the most engaging way to teach language to early communicators, who are susceptible to low levels of engagement, is vital to know where to start children who will be using AAC to communicate.

The study included 3 elementary-age participants. Each of the participants was provided a touchscreen tablet with an AAC app containing a color photo that was unique to each person. The images depicted them engaging in a preferred activity. They were also presented with a color-printed isolated picture symbol, which showed the preferred objects. The researchers found that students gazed longer at the high-tech VSD technology. Low levels of gaze towards the communication partner were present in both conditions. There was no significant effect on expressive AAC use for any participants. Overall, the students demonstrated higher rates of gaze toward high-tech VSDs, compared with low-tech isolated picture symbols. 

The results of this study indicate that students with multiple disabilities may be more engaged with one AAC technology over another without significant effects on their use of that technology. Therefore, even when beginning communicators do not yet use AAC technologies consistently, there are differences in how engaging these technologies are. The results of this study are limited due to the small number of participants. However, the results of the study suggest that clinicians should consider trialing high-tech VSD technology even with beginning communicators, as this technology may be meaningful and motivating for these AAC learners.

Please comment with any thoughts or questions!  

Full article link:  https://doi.org/10.1044/2019_LSHSS-19-0007

Images include Boardmaker PCS. The Picture Communication Symbols ©1981–2018 by Mayer-Johnson LLC. All Rights Reserved Worldwide. Used with permission.

Reference

Holyfield, C., Brooks, S., & Schluterman, A. (2019). Comparative Effects of High-Tech Visual Scene Displays and Low-Tech Isolated Picture Symbols on Engagement From Students With Multiple Disabilities. Language, Speech, and Hearing Services in Schools, 50(4), 693–702. doi: 10.1044/2019_lshss-19-0007

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