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Monday, 10 June 2013

Communication and behaviour - Does AAC help?

Blogging about Research (and hoping it will give me some kind of super powers)

(Disclaimer: I am not the-world's-greatest-reader-of-research-papers and I am learning-as-I-go. With this in mind, please read this with a critical mind and a questioning eyes... then read the article yourself!)

Article: Effects of Augmentative and Alternative Communication on Challenging Behaviour: A Meta-Analysis. Virginia L. Walker & Martha E. Snell, 2013

Why did I choose this article?

In my work 'challenging behaviour' (or 'behaviours of concern') are very common. When supporting people with intellectual disability and those that care for them, behaviour becomes a regular part of conversations. Not all the time, but often.
This article, and the studies it analyses, help us to take steps towards providing better supports and having a better understanding.
The information I have learned from this article will not drastically change my practice, however there are gems of information that will definitely improve the quality of my practice (and the practices of the people I supervise). I also feel more confident about the way I provide supports to people with behaviours of concern!

Clinical bottom-line:

(In the words of the authors) "this review provides evidence that AAC intervention has positive effects in decreasing challenging behaviour for individuals with varying disabilities"
(In my own words...) Using AAC as part of intervention for people with challenging behaviours will give us a greater chance of addressing those behaviours. It is noted that for best results we need to start as early as possible and there should be a functional behaviour assessment (FBA) and also functional communication training (FCT).

The interesting bits (well I thought so, anyway...)

About the participants...

- There were 111 participants
- 71% of participants were male
- 70% were under the age of 12 years
- The most common diagnoses were intellectual disability or developmental disability and Autism spectrum disorder
- Before 37% used speech and 32% used non-symbolic communication
- Where people were using AAC before the study the most common type was unaided AAC (such as key word sign) and then aided AAC without speech output

About the interventions...

- the majority of interventions happened in classrooms, was 1:1 and included aided AAC without speech output 55% of the time
- Intervention was usually FCT (functional communication training - visit for information about FCT)
- The majority of studies didn't measure generalisation (changes outside the therapy situations) or maintenance (how long the changes lasted) or social validity (whether the intervention was acceptable and useful)

About the results...

- The effect of interventions overall was positive
- The effects were not influenced by participant, intervention or outcome characteristics
- AAC seems to be an effective intervention for many people who have behaviours of concern in many situations
- AAC might more likely to be successful for people who have better language skills, but more research is needed on this
- Success gets harder to achieve as people get older (over 12 years of age)
- It is important to consider the function of the behaviour!

What is a 'meta-analysis'?

Cochrane describe a meta-analysis as "... use of statistical methods to combine results of individual studies..."
This seems to be particularly helpful in groups where there is a lot of variation or diversity (heterogeneous populations), such as people with disabilities.
This meta-analysis looked at 54 studies (from a possible 355 articles originally identified by the inclusion criteria. After reading the abstracts of the 355 articles (almost my worst nightmare!) all but 81 were excluded. After reading the full text of those 81 articles another 27 were excluded.
All of the articles were single case experimental designs (SCEDs).

What is a SCED?

SCED = Single Case Experimental Design
aka, Single Case Research design
aka, N=1
Historically this type of study has not been highly regarded in rating scales, however with a well planned experimental designs (meeting criteria of high quality SCEDs) these studies are gaining credibility.
Here is more information about SCEDs if you're interested: (thanks to @BronwynHemsley for the link)


  1. Thanks for joining! Very interesting. It reminds me of working with a teenager (as a personal aid before graduate school). She had less than 12 words she produced verbally. She had an AAC device (Dynovox of some type). Unfortunately it wasn't well supported at home, especially when her challenging behaviors took the form of repeating something over and over on her device. Sometimes that resulted in the device being taken away for a brief period of time.

    1. Thanks Rachel! Glad to be joining in on 'research Tuesday'! That sounds heartbreaking. Hopefully articles like this can help avoid situations like that.

  2. Thank you for this review. I love any research which supports throwing open the floodgates of communication, by whatever means available. I'll definitely be checking out the article. Again, thanks.


    1. Thanks Rowan! I feel the same way and I hope that the 'blogging about research' initiative that Rachel has started gets more research into practice. Information from articles like this can make such a difference in the lives of people who don't use speech to communicate.
      Thanks for reading and for commenting :)

  3. The results that the interventions were overall positive reminds me of one of my professional mantras: Therapy is better than No Therapy. It seems that giving a student any form of communication is better than nothing. It doesn't have to be the fanciest, high-tech device available. I don't have a lot of experience in the AAC world, but have a professional goal to increase my AAC knowledge and experience. Thanks for this helpful overview of AAC vs. challenging behavior!

    Schoolhouse Talk!

    1. So glad this was helpful Abby :) As a profession, our knowledge about AAC practice is certainly growing and it will be so interesting to see more detail in the literature about what works and what works even better.