A delayed intervention start randomized controlled trial of high‐ and low‐tech communication training approaches for school‐age autistic children with co‐occurring intellectual disability
Function-based AAC—tablet or picture cards—beats eclectic classroom methods for autistic kids with ID.
01Research in Context
What this study did
Gilroy’s team worked with 42 autistic kids who also had intellectual disability. All kids were in public elementary classrooms and spoke fewer than 20 words.
Kids were split into three groups. Two groups got function-based AAC: one used a speech tablet, the other used picture cards. The third group kept getting the school’s usual mix of speech drills and play time.
Therapists first found what each child would work for (bubbles, chips, tickles). Then they taught the child to tap a tablet button or hand a picture to get that item. Sessions ran 20 minutes, three times a week, over the study period.
What they found
Both AAC groups tripled their independent requests. Kids went from two tries per session to about six. The classroom-as-usual group stayed flat.
Tablet and picture cards scored the same. High-tech did not beat low-tech. Teachers rated both AAC groups as “much improved” on a five-point scale.
How this fits with other research
Danitz et al. (2014) meta-analysis said PECS beats tablets when autism is paired with ID. Gilroy saw a tie. The gap closes when you add function-based teaching. Earlier studies often skipped the reinforcer test.
Fleury et al. (2018) also found no difference between tablet and pictures, but their kids had average IQs. Gilroy shows the same holds even when IQ is below 55.
Alfuraih et al. (2024) single-case data match Gilroy’s trend: picture exchange works for kids with severe ID. Gilroy strengthens that claim with random assignment and a control group.
Why it matters
You don’t need pricey tablets to get big communication gains. First run a 5-minute reinforcer assessment, then build one clear request response. Use picture cards if the team is short on tech or funds. Use a tablet if the child shows interest in screens. Either way, tie the AAC form to the exact payoff the child wants. Start small—three pictures or buttons—and grow the library as requests become fluent.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Pick one highly preferred item, make a matching picture or tablet button, and teach the child to exchange it to get that item.
02At a glance
03Original abstract
The researchers designed a delayed intervention start randomized controlled trial to compare improvements in functional communication following augmentative and alternative communication (AAC) interventions. The study compared outcomes from function-based applied behavior analytic (ABA) and eclectic non-ABA forms of classroom-based communication strategies (waitlist control) as well as from high- and low-tech forms of AAC. High-tech AAC consisted of tablet-based communication, and low-tech AAC used an exchange of picture cards. The community-based sample consisted of 29 autistic children with a co-occurring intellectual disability. Participants were randomized to groups (AAC, waitlist control), and each group received approximately 3 months of communication intervention. Multilevel modeling of learner outcomes indicated that the function-based approach produced greater improvements than the eclectic alternative, but significant differences were not observed between outcomes of high- and low-tech forms of function-based AAC. These results are consistent with earlier investigations and provide supporting evidence that both high- and low-tech forms of function-based intervention are effective for use with autistic children with accompanying intellectual disability. Additional discussion is provided regarding further research into how technology is applied and incorporated into behavior analytic programming.
Journal of applied behavior analysis, 2023 · doi:10.1002/jaba.989