Mona Pruett, M.S., OT/L
The Go Talk 32 is an example of a speech-generating device which will play a pre-recorded message.
Communication plays a vital role educationally, socially and vocationally for students with autism spectrum disorders (ASD). Providing speech generating devices (SGD), also known as voice output communication aids (VOCA), is a commonly used communication strategy for students on the autism spectrum. SGD are portable electronic devices that provide speech output through a recorded voice or an electronic voice. The devices incorporate symbols or pictures that represent phrases and words to be spoken. Students can activate the messages through direct input (hand, finger) or indirect input (switch or eye gaze system). SGD can range in complexity from a simple device that is programmed to play a prerecorded message (see Image 1) to the more complex device (see Image 2) that operates with a computer chip. Consequently, SGD can range in price from hundreds to thousands of dollars.
The evidence base for using SGD indicates that using devices can be effective for developing communication skills with students with ASD who have limited or no verbal language in the areas of initiation, expressive language, nonverbal skills, and conversational skills. From the research, we learn that the use of speech generating devices is effective for students from 3 to 20 years of age. Although the research studies conducted were based upon school or clinical use of the devices, it can only be assumed that use of SGD can be effective in the home as well (The National Professional Development Center on Autism Spectrum Disorders, 2009).
The SpringBoard Life from Prentke Romich Company is an example of a dynamic display SGD that operates with a computer chip.
Despite the evidence that the use of SGD is effective for developing communication skills in students with ASD, many times we do not always see the evidence with our students. Successful implementation of the SGD is key to a successful outcome. Having a team approach to selecting the device, introducing the device, identifying the environments in which the device will be introduced and selecting the vocabulary are essential components to implementation of an SGD. The National Professional Development Center on ASD has developed implementation steps [PDF] for using SGD.
One step in successful implementation is to select the appropriate device and set it up for successful integration into the environment. As stated previously, SGD vary in complexity. When selecting the device, the Individualized Education Program (IEP) team should carefully consider the student’s learning style and abilities, along with the amount of training and technical assistance that would be required for implementation of a device. Other factors to consider when choosing a device include how the symbols are displayed, the number of symbols that are available to the student and the characteristics of the student (e.g., attention span, fine motor abilities and experience with symbols). Initially, only a few symbols should be introduced on the chosen device. Leaving “open” spots on the device allows the student to discriminate between the symbol and the device for communicating. In addition, programming a desirable request with an undesirable request aids in the student’s ability to discriminate between symbols.
Choose wisely the environment in which the device will be utilized. Make sure that staff members are trained in its use and programming prior to introduction into the environment. The SGD should first be introduced during familiar events that allow for student participation. Familiar routines might include lunch, circle time, free play, morning meeting or literacy activities. Communicative opportunities are frequent during these times and allow the student to make requests, initiate social greetings or make comments. Words, vocabulary and symbols chosen for the device should be age-appropriate, meaningful and motivating to the student. Because of these factors, the entire team should be involved in the selection of the vocabulary.
Once programmed and introduced, the student should be given time to explore the device. Opportunities to use the device successfully should be encouraged within the natural environment at typically occurring times during the day. Setting up communication opportunities might also be required. These opportunities might be in the form of placing desirable objects out of reach or out of sight, or creating some form of environmental “sabotage” to motivate the student to communicate. To encourage success with the SGD, use frequent questioning. This may sound like, “What do you need?” followed by adequate wait time to allow for a response.
Prompting can also be a beneficial strategy when introducing a voice output device. When using prompting always begin from the least invasive (e.g., ask what the student wants or eye gaze toward the device) to the most invasive (physical assist) to ensure that more support is not provided than necessary. Some students may only require an eye gaze or a point toward a device while others will require hovering a hand over the desired symbol or shining a light over the desired symbol. For all students, plenty of pause time — in some instances up to 10 seconds — should be provided, thus giving the student adequate time to scan the symbols and make the desired selection.
Spontaneous use of an SGD can often be challenging because of the dependent forms of prompting or cuing used in the introduction of the device. Prompts should be reduced as soon as possible and replaced with natural prompts such as “What do you want to share?” or “What do you need?” Successful use of wait time should be employed. Modeling the use of SGD is another successful method of encouraging the student to use the device. Having all members of a small group use a device to request an item or grouping the student with peers who have been taught to use the device are examples of modeling to introduce the student to a device.
For all communication strategies, one of the most critical steps in successful implementation is to honor all communication attempts, at least initially. No matter what the student requests, through the use of the Picture Exchange Communication System or SGD, even if it is not a desired item, the student’s request should be granted or at least acknowledged. Initially, symbols or objects might need to be hidden when they are not available. In some instances, allowing the student to make choices to control his/her environment might be more beneficial than participating in routine activities. For instance, a student may request “computer” while the rest of the class is moving on to math. It might be beneficial to honor the communication intent and allow the student three or four minutes on a favorite computer activity before joining the rest of the class in math.
Allowing for a trial period with specific goals to be addressed and determining what data needs to be collected during that time will provide the information necessary to chart your success. The NPDC on ASD has provided an implementation checklist [PDF] as a way for team members to collect data to ensure that the communication strategy is being implemented with fidelity.
When selecting an evidence-based communication strategy, be sure to match your practices with the student’s communication needs. Implementing selected communication strategies with fidelity is vital to a successful outcome. Keep in mind that the entire IEP team’s input is crucial to meet those unique needs, and remind everyone that although the path may be long, communication is the key to success educationally, socially and vocationally.
The National Professional Development Center on Autism Spectrum Disorders. (2009). Evidence-based practices. Retrieved from http://autismpdc.fpg.unc.edu/content/evidence-based-practices
About this article
This article is the second in a series on evidence-based practices in the area of communication development for students with autism spectrum disorders. The National Professional Development Center on Autism Spectrum Disorders has currently identified four evidence-based practices that research has proven effective with children with autism. The first article in the series focused on the Picture Exchange Communication System.