Oliver Wendt is a researcher and innovator in the field of Augmentative and Alternative Communication (AAC) with a particular interest in autism.
Dr Wendt has served as Assistant Professor in the Faculties of Speech, Language, and Hearing Sciences and Educational Studies at Purdue University.
With his company SPEAK MODalities he set out to provide high-quality evidence-based AAC solutions for developing communication, speech, and language skills in individuals with autism and/or severe communication disorders.
Dr Wendt is the first editor of the textbook “Assistive Technology. Principles and Applications for Communication Disorders and Special Education” (Emerald Publishing). The book presents the theoretical underpinning and a plethora of practical evidence-based solutions and applications of assistive technology.
ASDTech was particularly happy when Oliver Wendt accepted the invitation for an interview, as we share the same values regarding evidence-based practice, high quality experimental designs and support for children with developmental disorders.
Oliver Wendt (OW): Many parents and caretakers are afraid that when introducing AAC, particularly in the form of high technology devices, the child will become dependent on the device. Research has demonstrated that this myth is not true (e.g., Schlosser & Koul, 2015). AAC devices or applications on a mobile platform provide the minimally-verbal child with an immediate means to develop functional communication skills and gain control over his or her immediate environment. Over time, AAC technology and proper intervention increase the child’s emerging speech, language, and social interaction skills to allow better participation in education and society. Establishing even basic levels of communication is an immediate and crucial need for young children with autism to take part in daily life; AAC is an integral part of autism treatment and service delivery to attain this goal.
When selecting AAC devices and applications it is however important to implement solutions that can grow with the learner as needs and capabilities grow. AAC intervention in autism may start with teaching individuals to exercise some control over their environment by requesting desired objects (e.g., foods, toys) and activities (e.g., play, toilet). Once such outcomes are accomplished, AAC intervention should move from these initial results to more conventional language systems that can be used to convey multiple communication functions beyond requesting (e.g., commenting, labeling). AAC interventions should be regularly evaluated to adapt to new learning goals, and technologies should be chosen that are flexible enough to accommodate to the developmental trajectory in autism.
When these principles are followed, it is not uncommon that children on the autism spectrum, who initially had a diagnosis of “severe, non-verbal” autism, make such strong gains in communication, speech, and language acquisition that AAC is needed only occasionally using its “augmentative” dimension, meaning the technology supplements natural speech and makes learning new concepts easier through visual supports, but is no longer the one and only communication channel for the learner. As such developmental milestones are accomplished, the autism diagnosis may change from a severe label to milder forms.
OW: My first suggestion would be to find a qualified speech-language therapist or behaviour therapist who specialises in AAC. It is nearly impossible for a parent or caretaker to keep an overview on the AAC app market and filter out those solutions that have some level of research support or clinical validation. Because there is no “one-size-fits-all” solution for AAC devices and applications, it is important that the AAC specialist engages in a so-called “feature matching” approach: the systematic application of assessment procedures to compare and match a client’s current and future strengths, abilities, and needs with currently available tools and technologies (Shane & Costello, 1994; for examples click here)
You can watch an introductory video about Feature Marching here.
It is important to understand that AAC interventions are highly individualised, especially for people on the autism spectrum, and that apps and mobile devices may not always be the best starting point. Sometimes a low tech approach such as a graphic symbol communication board or a mid-tech solution such as a talking board with digitised speech output may be best suited to start AAC intervention, before transitioning to a high tech solution. Again, these decisions should be part of a thorough assessment process guided by a qualified clinician, who takes an evidence-based approach and actively seeks client, family, and other stakeholder input.
When it comes to searching for the most suitable AAC apps, the following resources might be helpful:
OW: Children with severe developmental disabilities often show similar needs when it comes to appropriate app user interfaces that take into account the specific learning characteristics of these individuals. Four aspects in particular deserve careful attention when identifying AAC apps for this population:
Individuals with severe developmental disabilities are often “beginning communicators” at the start of an AAC intervention. Initial communication goals typically include establishing reliable yes-no responses, indicating basic wants and needs, and training choice-making. Examples for AAC apps that can serve these purposes and that offer “light” (free) versions for a trial during AAC assessments might be Sounding Board, Verbal Me, or Comm Boards. Again, the market is huge and clinicians and caretakers should explore all available options as part of a feature matching process.
OW: Yes, that is definitely true. AAC intervention typically starts with teaching functional communication including the ability to request for desired items. Once requesting skills are established the intervention goals shift towards increasing symbol (word) vocabulary and transitioning the learner from single word to multiple word utterances. The communicative repertoire needs to grow to convey multiple communicative functions such as rejecting, labeling, and commenting. AAC professionals now apply specific intervention approaches including language modeling techniques such as aided language stimulation (Goossens’, 1989) or aided language modeling (Binger & Light, 2007) to initiate further language growth. Language modeling strategies follow the notion that the child can observe and mimic a trainer using correct symbol utterances and combinations on the display of the child’s communication device. Again, it is important to implement AAC apps that provide enough flexibility to arrange these types of displays.
As language skills through the AAC modality increase, it is also critical to target early literacy learning at the same time. Many autistic learners, even those with an initial diagnosis of severe autism, possess emerging strengths in identifying letters and recognising sight words. Early literacy intervention can help to fully unlock this potential. A fun and engaging intervention strategy to engage in is
Shared Storybook Reading as demonstrated in this video clip.
For further information, I would recommend the Autism Speaks blog article on “Autism and speech devices: Helping kids advance skills as they mature”.
OW: This is indeed a very good question. It is important to understand the current status of the evidence base for AAC in autism. While there are several systematic reviews and meta-analyses providing ample support for both PECS (e.g., Flippin, Reszka, & Watson, 2010; Ganz, Davis, Lund, Goodwyn, & Simpson, 2012) and speech-generating devices (Morin et al., 2018; Schlosser & Koul, 2015) as stand-alone interventions, we still have a dearth of comparative efficacy research directly comparing the relative advantages and disadvantages of one method versus the other. Such a situation prevents us from drawing definite conclusions as to speech-generating devices being more or less efficient than PECS. In the meantime, the meta-analysis by Ganz and colleagues (2012) provides a good amount of clinically relevant information: This research synthesis included 8 primary studies on speech-generating devices, 9 on PECS, and 7 on low-tech graphic symbol board solutions. The average effect size estimates were around 99% (indicative of a large effect) for both SGDs and PECS, whereas other graphic symbol-based, low tech solutions only yielded 61% (indicative of a small effect). We might infer that both SGDs and PECS are viable solutions for AAC in autism and superior to less structured, low-tech graphic symbols-only approaches.
Schlosser, R. W., & Koul, R. K. (2015). Speech output technologies in interventions for individuals with autism spectrum disorders: A scoping review. Augmentative and Alternative Communication, 31(4), 285-309.
Gosnell, J., Costello, J., & Shane, H. (2011). Using a clinical approach to answer “What communication apps should we use?”. Perspectives on Augmentative and Alternative Communication, 20(3), 87-96.
Shane, H., & Costello, J. (1994, November). Augmentative communication assessment and the feature matching process. Mini-seminar presented at the annual convention of the American Speech-Language-Hearing Association, New Orleans, LA.
Binger, C., & Light, J. (2007). The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication, 23(1), 30-43.
Goossens’, C. (1989). Aided communication intervention before assessment: A case study of a child with cerebral palsy. Augmentative and Alternative Communication, 5(1), 14-26.
Flippin, M., Reszka, S., & Watson, L. R. (2010). Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal of Speech-Language Pathology, 19(2), 178-195.
Ganz, J. B., Davis, J. L., Lund, E. M., Goodwyn, F. D., & Simpson, R. L. (2012). Meta-analysis of PECS with individuals with ASD: Investigation of targeted versus non-targeted outcomes, participant characteristics, and implementation phase. Research in developmental disabilities, 33(2), 406-418.
Morin, K. L., Ganz, J. B., Gregori, E. V., Foster, M. J., Gerow, S. L., Genç-Tosun, D., & Hong, E. R. (2018). A systematic quality review of high-tech AAC interventions as an evidence-based practice. Augmentative and Alternative Communication, 34(2), 104-117.