Comparisons of intervention components within augmentative and alternative communication systems for individuals with developmental disabilities: a review of the literature.
Errorless teaching and video models speed up first requests far more than fancier symbols or speech output.
01Research in Context
What this study did
The team read every single-case study that compared pieces of picture-based AAC for people with developmental disabilities.
They looked for trials that swapped out symbols, added speech output, or changed how the pictures were taught.
The goal was to see which tweaks actually speed up first requests, not just which device looks nicer.
What they found
Teaching tricks won the race. Errorless learning and short video models cut the time to first independent mand.
Switching from colored line drawings to photos, or turning the voice on or off, barely moved the needle.
In plain words: how you teach the picture exchange matters more than which pictures or sounds you pick.
How this fits with other research
Leaf et al. (2012) ran the numbers first and showed PECS and speech tablets give big communication gains. Gevarter et al. (2013) zoomed in and told us why: the teaching method, not the gadget, drives the gain.
Gevarter et al. (2013) seems to clash with their own twin paper from the same year. The second review says "no single AAC is best—individualize." The difference is lens: the twin paper compared whole systems; this one compared parts inside each system. Both can be true.
Johnson et al. (2021) later showed AAC can also spark new spoken words, but speech never overtakes AAC use. Together the story is: teach with errorless steps, keep the system, and speech may follow as a bonus.
Why it matters
Stop shopping for the perfect icon set or voice. Spend your energy on clean errorless teaching and quick video models. Start each session with a brief video of the exchange, then guide hands without errors. The learner gets to requesting faster, and you get to reinforcement sooner.
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02At a glance
03Original abstract
Decisions regarding augmentative and alternative communication (AAC) for individuals with developmental disabilities (e.g. what AAC to use and how to teach a person to use a specific AAC modality) should involve consideration of different intervention component options. In an effort to elucidate such decisions and options, this review synthesized 14 studies, published between 2004 and 2012, comparing different AAC intervention components including different symbol sets, instructional strategies, or speech output within aided AAC systems, and different verbal operants within unaided AAC. Evidence supported the following: (a) different instructional strategies such as building motivation, using errorless learning, or adding video models to picture exchange interventions may improve the acquisition or rate of acquisition of picture exchange mands, (b) limited data supports training mimetic (imitated) or mand signs over tacts and (c) differences in symbol sets and speech output levels appeared to have little effect on AAC-based mand acquisition, but listener-based differences should be considered. These findings have implications for future research and clinical practice.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.09.018