Kristin S. Bowman, PhD, CCC-SLP, BCBA-D
Endicott College & Grace Effect Therapy Services

Examples: Sign language, pictures, speech-generating device, voice output communication aid

Description

Autism Treatments SummaryAccording to the American Speech-Language Hearing Association (ASHA), Augmentative and Alternative Communication (AAC) is an umbrella term that encompasses all communication modalities other than vocal-verbal communication (i.e., talking; ASHA, n.d.-a). As the name implies, AAC may be used to augment vocal communication or as an alternative to vocal speech.

Depending on the tools required, the communication modalities encompassed under AAC are classified as unaided or aided types (ASHA, n.d.-b, Aydin & Diken, 2020; Lorah et al., 2021; Pak et al., 2023; Reichle et al., 2023). Unaided AAC forms involve communication with the physical body only and generally include simple, no-tech modes such as facial expressions, gestures, and manual signs. Conversely, aided AAC types require the use of external tools. No-tech and low-tech aided options include pictures, drawings, audio recordings, and written and electronic text. Higher-tech aided forms, typically referred to as speech-generating devices or voice output communication aids, are computers capable of generating synthesized or digitized speech. An individual’s AAC system may consist of any one mode, or multiple modes used in combination, according to communication strengths, adaptive skills, personal preferences, and context (ASHA, n.d.-a, n.d.-b). Because communication needs and abilities may change over time, an individual’s AAC system, and the specific communication modalities used, may also change over time (ASHA, n.d.-a, n.d.-b). Some individuals may use AAC permanently throughout life, whereas others may use AAC temporarily, such as while learning to communicate vocally (ASHA, n.d.-a, n.d.-b; White et al., 2021).

Research Summary

Concerns that AAC may hinder vocal communication are not uncommon (White et al., 2021). However, there is no evidence that speech production decreases as a result of AAC intervention and some studies have reported increased vocalizations following AAC use (White et al., 2021; see also Bishop et al., 2020; Carbone et al., 2010; Ganz & Simpson, 2004; Tincani, 2004). Although AAC is a broad category of various communication modalities, it is important to note that scientific investigations of AAC in autism have focused almost exclusively on the use of manual signs, pictures, and speech-generating devices (Aydin & Diken, 2020). The National Autism Center (2015) evaluated intervention research in autism and, while they identified studies that demonstrated favorable outcomes with AAC, they called for additional high-quality research to validate these findings. That is, based on the available scientific research, they did not conclude that AAC is effective for individuals on the autism spectrum. However, in a similar and more recent analysis, Hume et al. (2021) identified numerous qualitative studies which demonstrated the efficacy of AAC interventions and consequently determined that the level of empirical support was sufficient to classify AAC as an evidence-based practice.

AAC research in autism has increased over the past 10+ years and the results suggest that AAC may be an effective intervention for those with communication challenges (Hume et al., 2021; Sievers et al., 2018). Yet, this research is a compilation of scientific studies examining different communication modalities (e.g., unaided, aided, high-tech, low-tech), each with varying levels of evidence, across a heterogeneous population of individuals on the autism spectrum who have diverse skills, preferences, and challenges (Sievers et al., 2018). For these reasons, AAC research in autism has yielded significant variability across individual participants. Consequently, consumers are encouraged to consider the scientific support for specific communication modalities, the instructional methodologies used to teach AAC, the expertise of the treating provider, and the needs and values of the recipient (Lorah et al., 2021; Sievers et al., 2018). Specific AAC modes commonly used for individuals on the autism spectrum are further described in the sections to follow.

Manual Signs

Manual signs typically consist of hand shapes, positions, and movements that represent words and expressions (Frolli et al., 2022). The specific hand configurations may be original, iconic gestures, or specific signs taken from visual-gestural linguistic systems such as American Sign Language (Frolli et al., 2022; Lorah et al., 2021; Pak et al., 2023). As an unaided, affordable AAC form, manual signs may be commonly recommended for individuals on the autism spectrum who exhibit challenges with vocal communication (Pak et al., 2023). Using manual signs, individuals on the autism spectrum have successfully learned to label objects/pictures (Carr et al., 1978; Remington & Clarke, 1983; Schepis et al., 1982), request preferred items (Achmadi et al., 2014; Carr & Kologinsky, 1983; Schepis et al., 1982; van der Meer et al., 2013), and answer yes/no questions (Schepis et al., 1982; van der Meer et al., 2013).

Despite these findings, manual signs are a relatively understudied area of AAC research in autism and the available research is experimentally weak (Ganz, 2015; Reichle et al., 2023). Many of those who participated in these studies learned only a small number of manual signs after considerable effort and treatment time (Ganz, 2015; see also Achmadi et al., 2014; Carr et al., 1978; Carr & Kologinsky, 1983; Remington & Clarke, 1983; Schepis et al., 1982; van der Meer et al., 2013). Moreover, the use of manual signs may impose restrictions not associated with other AAC types. For example, social interactions in the community may be limited by the use of manual signs (Brodhead et al., 2020). Novel communication partners may not understand when communication includes manual signs, whereas other AAC forms (e.g., pictures or speech-generating devices) may be more readily understood by a variety of people (Brodhead et al., 2020). Learning to produce the complex handshapes and movements necessary for manual signs may also be particularly difficult for individuals on the autism spectrum who often experience motor coordination challenges and difficulty imitating modeled actions (Bremer & Cairney, 2018; Seal & Bonvillian, 1997). The existing research, coupled with these potential limitations, provide minimal support for the use of manual signs to improve communication for individuals on the autism spectrum, especially when compared to other AAC forms (Aydin & Diken, 2020; Brodhead et al., 2020; Schwartz & Nye, 2006; Seal & Bonvillian, 1997).

Pictures

Pictures as an AAC mode typically include graphic symbols, drawings, photographs, or similar depictions displayed on individual cards or in an array on a picture board (ASHA, n.d.-b; Couper et al., 2014). As a no-tech, aided AAC mode, pictures offer an affordable option for communication while minimizing motor demands (Aydin & Diken, 2020). Individuals communicate simply by touching a picture(s) or handing a picture(s) to their communication partner (Achmadi et al., 2014; Couper et al., 2014; Mclay et al., 2015, 2017; van der Meer et al., 2013). The research in this area is mostly limited to the selection and/or exchange of a single picture to make requests (Ganz, 2015; see also Achmadi et al., 2014; Couper et al., 2014; Mclay et al., 2015, 2017; van der Meer et al., 2013). As such, picture-based AAC modes lack sufficient scientific support to be considered an evidence-based practice (Lorah et al., 2021). A critical exception, however, is a well-established, manualized AAC intervention known as the Picture Exchange Communication System (PECS) which follows a specific instructional protocol based on the principles of applied behavior analysis and has been classified as an evidence-based treatment (Ganz, 2015; Hume et al., 2021; Lorah et al., 2021). Consumers are cautioned that simply using pictures to communicate is not equivalent to PECS. For more information on PECS please see the Picture Exchange Communication System Treatment Summary and Is there Science Behind That? Picture Exchange Communication System.

Speech-Generating Devices

Speech-generating devices are portable electronic devices that produce digitized or synthesized speech (Aydin & Diken, 2020; Ganz et al., 2014; Schlosser & Kohl, 2015) and offer several advantages over other AAC modes. For example, speech-generating devices are durable, simple to operate, and utilize sound output for communication, as opposed to manual signs and pictures which are visual systems (Aydin & Diken, 2020). Additionally, integrating communication technology into smartphones and electronic tablets through software applications may be a more discreet AAC option in communities where personal devices are common (Ganz, 2014; Schlosser & Kohl, 2015). Even with these advantages, speech-generating devices can be heavier and less portable than other AAC forms, are typically the most expensive, and require access to a power supply in order to function (e.g., electricity, battery; Aydin & Diken, 2020).

Using speech-generating devices, individuals on the autism spectrum have successfully learned to make requests (Achmadi et al., 2014; Agius & Vance, 2016; Boesch et al., 2013; Couper et al., 2014; Gevarter et al., 2017; Hill & Flores, 2014; Lorah, 2016; McLay et al., 2017; van der Meer et al., 2013), respond to questions (Chen et al., 2016) and spell words (Schlosser & Blischak, 2004). Although several studies have shown the effectiveness of speech-generating devices, it is important to consider that this research includes many different devices (e.g., iPod Touch, iPad, Logan Proxtalker), software applications (e.g., Proloquo2Go, SoundingBoard), and presentations (e.g., single icon, 2×3 grid), and focuses almost exclusively on requesting (Aydin & Diken, 2020; Pak et al., 2023).

Ineffective and Untested AAC Modes

Consumers are cautioned against the use of AAC modes which lack scientific validity, namely Facilitated Communication and the Rapid Prompting Method (Celiberti & Daly, 2020; Daly & Celiberti, 2021; Holehan & Zane, 2020). Facilitated Communication is a harmful, pseudoscientific treatment that has been discredited by the American Speech-Language Hearing Association, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association, and the American Association on Intellectual and Developmental Disabilities due to evidence that verbal messages are falsely authored by a facilitator (American Academy of Child and Adolescent Psychiatry, 2008; American Association on Intellectual and Developmental Disabilitiesmerican Psychological Association, 2020; ASHA, 2018a; Hyman et al., 2020). The Rapid Prompting Method is untested and utilizes many of the same “facilitator-dependent techniques” as Facilitated Communication, raising concerns about its safety and efficacy (ASHA, 2018b). The American Association on Intellectual and Developmental Disabilities (2019) warned that both Facilitated Communication and the Rapid Prompting Method potentially silence individuals using AAC rather than allowing them to express their own thoughts, feelings, needs, and preferences because the messages are influenced by a facilitator.

Recommendations

AAC has been classified as an evidence-based intervention (Hume et al., 2021) and may be an effective means to improve the communication of individuals on the autism spectrum (Ayden & Diken, 2020; Lorah et al., 2021; Pak et al., 2023), but consumers and practitioners should consider several factors before selecting and implementing AAC.

First, AAC is an expansive category of non-vocal communication and the research in this area has evaluated multiple AAC types, each with varied levels of scientific support. Pictures and speech-generating devices, for example, have produced comparable, positive communication outcomes whereas manual signs have proven less effective (Aydin & Diken, 2020; Lorah et al., 2021; Pak et al., 2023). Other AAC interventions such as the Rapid Prompting Method are untested and utilize dubious instructional approaches (ASHA, 2018b). Still, others such as Facilitated Communication have not only been proven ineffective but have demonstrated harm, including false allegations of sexual misconduct and other abuse American Academy of Child and Adolescent Psychiatry, 2008; American Association on Intellectual and Developmental Disabilitiesmerican Psychological Association, 2020; ASHA, 2018ab; Hyman et al., 2020. When selecting an AAC modality, consumers and practitioners should pursue only those validated through scientifically rigorous investigations (e.g., PECS, speech-generating devices), and avoid those lacking sufficient support (e.g., manual signs, Rapid Prompting Method).

Second, even though many individuals on the autism spectrum have complex communication needs, the available AAC research has focused almost exclusively on requesting (Aydin & Diken, 2020; Lorah et al., 2021; Pak et al., 2023). Little is known about the effects of AAC in establishing more advanced language skills and researchers are encouraged to investigate these areas. In the meantime, consumers and practitioners should consider these limitations and understand that while AAC may benefit those who have difficulty requesting vocally, it may not be suitable for individuals interested in acquiring more advanced social interactions, grammatical structures, or academic language functions.

Third, it is critical that AAC interventions employ effective, scientifically validated instructional strategies (Lorah et al., 2021). Simply providing access to an AAC form, in the absence of evidence-based instruction, has not yielded improvements in communication (Lorah et al., 2021). Parents interested in AAC for their children on the autism spectrum are strongly encouraged to seek out practitioners such as speech-language pathologists, Board-Certified Behavior Analysts, or other specialists with expertise and training in AAC interventions.

Finally, an individual’s preferences, context, and resources must be considered when selecting an AAC mode. Interestingly, preferred modes of communication have been associated with improved outcomes and increased efficiency (Pak et al., 2023). That is, when using a preferred AAC mode, individuals have demonstrated greater language gains in less time, than when using an unpreferred mode (Pak et al., 2023). Several studies found that many individuals on the autism spectrum preferred aided AAC modes, speech-generating devices in particular, over unaided AAC types (Achmadi et al., 2014; Agius & Vance, 2016; Aydin & Diken, 2020; Couper et al., 2014; Lorah, 2016; McLay et al., 2015, 2017; Pak et al., 2023). While aided AAC modes may better facilitate communicative exchanges with general audiences and are less motorically demanding, they may be cumbersome, costly, and prone to breakage (Aydin & Diken, 2020; Brodhead et al., 2020). Determining the most appropriate communication modality is a multi-faceted process that warrants a collaborative approach from individuals, their families, and practitioners across disciplines.

Systematic Reviews and Task Forces

Aydin, O., & Diken, I. (2020). Studies comparing augmentative and alternative communication systems (AAC) applications for individuals with autism spectrum disorder: A systematic review and meta-analysis. Education and Training in Autism and Developmental Disabilities, 55(2), 119–141. https://www.jstor.org/stable/27077906

Ganz, J. B., Rispoli, M. J., Mason, R. A., & Hong, E. R. (2014). Moderation of effects of AAC based on setting and types of aided AAC on outcome variables: An aggregate study of single-case research with individuals with ASD. Developmental Neurorehabilitation, 17(3), 184–192. https://doi.org/10.3109/17518423.2012.748097

Hume, K., Steinbrenner, J. R., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2021). Evidence-based practices for children, youth, and young adults with autism: Third generation review. Journal of Autism and Developmental Disorders, 51(11), 4013–4032. https://doi.org/10.1007/s10803-020-04844-2

Lorah, E. R., Holyfield, C., Miller, J., Griffen, B., & Lindbloom, C. (2021). A systematic review of research comparing mobile technology speech-generating devices to other AAC modes with individuals with autism spectrum disorder. Journal of Developmental and Physical Disabilities, 34(2), 187-210. https://doi.org/10.1007/s10882-021-09803-y

National Autism Center. (2015). Findings and conclusions: National Standards Project, Phase 2. https://nationalautismcenter.org/national-standards/phase-2-2015/

Pak, N. S., Bailey, K. M., Ledford, J. R., & Kaiser, A. P. (2023). Comparing interventions with speech-generating devices and other augmentative and alternative communication modes: A meta-analysis. American Journal of Speech-Language Pathology, 32(2), 786–802. https://doi.org/10.1044/2022_AJSLP-22-00220

Reichle, J., Pustejovsky, J. E., Vannest, K. J., Foster, M., Pierson, L. M., Wattanawongwan, S., Chen, M., Fuller, M. C., Haas, A. N., Bhat, B. H., Sallese, M. R., Smith, S. D., Yllades, V., Rodriguez, D., Yoro, A., & Ganz, J. B. (2023). Systematic review of variables related to instruction in augmentative and alternative communication implementation: Group and single-case design. American Journal of Speech-Language Pathology, 32(4), 1734–1757. https://doi.org/10.1044/2023_AJSLP-22-00314

Schlosser, R. W., & Koul, R. K. (2015). Speech output technologies in interventions for individuals with autism spectrum disorders: A scoping review. AAC: Augmentative & Alternative Communication, 31(4), 285–309. https://doi.org/10.3109/07434618.2015.1063689

Sievers, S. B., Trembath, D., & Westerveld, M. (2018). A systematic review of predictors, moderators, and mediators of augmentative and alternative communication (AAC) outcomes for children with autism spectrum disorder. AAC: Augmentative and Alternative Communication, 34(3), 219–229. https://doi.org/10.1080/07434618.2018.1462849

White, E. N., Ayres, K. M., Snyder, S. K., Cagliani, R. R., & Ledford, J. R. (2021). Augmentative and alternative communication and speech production for individuals with ASD: A systematic review. Journal of Autism and Developmental Disorders, 51(11), 4199–4212. https://doi.org/10.1007/s10803-021-04868-2

Selected Scientific Studies

Achmadi, D., Sigafoos, J., van der Meer, L., Sutherland, D., Lancioni, G. E., O’Reilly, M. F., Hodis, F., Green, V. A., McLay, L., & Marschik, P. B. (2014). Acquisition, preference, and follow-up data on the use of three AAC options by four boys with developmental disability/delay. Journal of Developmental and Physical Disabilities, 26(5), 565–583. https://doi.org/10.1007/s10882-014-9379-z

Agius, M. M., & Vance, M. (2016). A comparison of PECS and iPad to teach requesting to pre-schoolers with autistic spectrum disorders. AAC: Augmentative & Alternative Communication, 32(1), 58–68. https://doi.org/10.3109/07434618.2015.1108363

Bishop, S. K., Moore, J. W., Dart, E. H., Radley, K., Brewer, R., Barker, L., Quintero, L., Litten, S., Gilfeather, A., Newborne, B., & Toche, C. (2020). Further investigation of increasing vocalizations of children with autism with a speech‐generating device. Journal of Applied Behavior Analysis, 53(1), 475–483. https://doi.org/10.1002/jaba.554

Boesch, M. C., Wendt, O., Subramanian, A., & Hsu, N. (2013). Comparative efficacy of the Picture Exchange Communication System (PECS) versus a speech-generating device: Effects on requesting skills. Research in Autism Spectrum Disorders, 7(3), 480–493. https://doi.org/10.1016/j.rasd.2012.12.002

Brodhead, M. T., Brouwers, L. F., Sipila-Thomas, E. S., & Rispoli, M. J. (2020). A comparison of manual sign and speech generating devices in the natural environment. Journal of Developmental and Physical Disabilities, 32(5), 785–800. https://doi.org/10.1007/s10882-019-09720-1

Carbone, V. J., Sweeney-Kerwin, E. J., Attanasio, V., & Kasper, T. (2010). Increasing the vocal responses of children with autism and developmental disabilities using manual sign mand training and prompt delay. Journal of Applied Behavior Analysis, 43(4), 705–709. https://doi.org/10.1901/jaba.2010.43-705

Chen, C. H., Wang, C. P., Lee, I. J., & Su, C. C. C. (2016). Speech-generating devices: Effectiveness of interface design—a comparative study of autism spectrum disorders. SpringerPlus, 5(1), 1-10. https://doi.org/10.1186/s40064-016-3181-6

Couper, L., van der Meer, L., Schäfer, M. C. M., McKenzie, E., McLay, L., O’Reilly, M. F., Lancioni, G. E., Marschik, P. B., Sigafoos, J., & Sutherland, D. (2014). Comparing acquisition of and preference for manual signs, picture exchange, and speech-generating devices in nine children with autism spectrum disorder. Developmental Neurorehabilitation, 17(2), 99–109. https://doi.org/10.3109/17518423.2013.870244

Frolli, A., Ciotola, S., Esposito, C., Fraschetti, S., Ricci, M. C., Cerciello, F., & Russo, M. G. (2022). AAC and autism: Manual signs and PECS, a comparison. Behavioral Sciences, 12(10), 359. https://doi.org/10.3390/bs12100359

Ganz, J., & Simpson, R. (2004). Effects on communicative requesting and speech development of the Picture Exchange Communication System in children with characteristics of autism. Journal of Autism and Developmental Disorders, 34, 395–409. https://doi.org/10.1023/B:JADD.0000037416.59095.d7

Gevarter, C., O’Reilly, M. F., Kuhn, M., Watkins, L., Ferguson, R., Sammarco, N., Rojeski, L., & Sigafoos, J. (2017). Assessing the acquisition of requesting a variety of preferred items using different speech generating device formats for children with autism spectrum disorder. Assistive Technology: The Official Journal of RESNA, 29(3), 153–160. https://doi.org/10.1080/10400435.2016.1143411

Hill, D. A., & Flores, M. M. (2014). Comparing the Picture Exchange Communication System and the iPadTM for communication of students with autism spectrum disorder and developmental delay. TechTrends: Linking Research and Practice to Improve Learning, 58(3), 45–53. https://doi.org/10.1007/s11528-014-0751-8

Lorah, E. (2016). Comparing teacher and student use and preference of two methods of augmentative and alternative communication: Picture exchange and a speech-generating device. Journal of Developmental and Physical Disabilities, 28(5), 751-767. https://doi.org/10.1007/s10882-016-9507-z

McLay, L., Schäfer, M. C. M., van der Meer, L., Couper, L., McKenzie, E., O’Reilly, M. F., Lancioni, G. E., Marschik, P. B., Sigafoos, J., & Sutherland, D. (2017). Acquisition, preference and follow-up comparison across three AAC modalities taught to two children with autism spectrum disorder. International Journal of Disability, Development and Education, 64(2), 117–130. https://doi.org/10.1080/1034912X.2016.1188892

McLay, L., van der Meer, L., Schäfer, M. C. M., Couper, L., McKenzie, E., O’Reilly, M. F., Lancioni, G. E., Marschik, P. B., Green, V. A., Sigafoos, J., & Sutherland, D. (2015). Comparing acquisition, generalization, maintenance, and preference across three AAC options in four children with autism spectrum disorder. Journal of Developmental and Physical Disabilities, 27(3), 323–339. https://doi.org/10.1007/s10882-014-9417-x

Remington, B., & Clarke, S. (1983). Acquisition of expressive signing by autistic children: An evaluation of the relative effects of simultaneous communication and sign-alone training. Journal of Applied Behavior Analysis, 16(3), 315–327. https://doi.org/10.1901/jaba.1983.16-315

Schepis, M. M., Reid, D. H., Fitzgerald, J. R., Faw, G. D., Van Den Pol, R. A., & Welty, P. A. (1982). A program for increasing manual signing by autistic and profoundly retarded youth within the daily environment. Journal of Applied Behavior Analysis, 15(3), 363–379. https://doi.org/10.1901/jaba.1982.15-363

Schlosser, R. W., & Blischak, D. M. (2004). Effects of speech and print feedback on spelling by children with autism. Journal of Speech, Language, and Hearing Research, 47(4), 848–862. https://doi.org/10.1044/1092-4388(2004/063)

van der Meer, L., Kagohara, D., Roche, L., Sutherland, D., Balandin, S., Green, V. A., O’Reilly, M. F., Lancioni, G. E., Marschik, P. B., & Sigafoos, J. (2013). Teaching multi-step requesting and social communication to two children with autism spectrum disorders with three AAC options. Augmentative and Alternative Communication, 29(3), 222–234. https://doi.org/10.3109/07434618.2013.815801

Other References

American Academy of Child and Adolescent Psychiatry. (2008). Facilitated Communication. https://www.aacap.org/AACAP/Policy_Statements/2008/Facilitated_Communication.aspx

American Association on Intellectual and Developmental Disabilities. (2019). Facilitated Communication and Rapid Prompting Method: Position statement of the AAIDD board of directors. https://www.aaidd.org/news-policy/policy/position-statements/facilitated-communication-and-rapid-prompting-method?fbclid=IwAR2futUBpErm5OmeQfy6o393qRDGXq7OB0ayOTmWYLEqwLfiRf3p0kjcVYw

American Psychological Association. (2020). Chapter XI: Scientific affairs. https://www.apa.org/about/policy/chapter-11

American Speech-Language-Hearing Association. (2018a). Facilitated Communication [Position Statement]. https://www.asha.org/policy/ps2018-00352/

American Speech-Language-Hearing Association. (2018b). Rapid Prompting Method [Position Statement]. https://www.asha.org/policy/ps2018-00351/

American Speech-Language Hearing Association. (n.d.-a). Augmentative and alternative communication (AAC). https://www.asha.org/public/speech/disorders/aac/

American Speech-Language Hearing Association. (n.d.-b). Augmentative and alternative communication (Practice Portal). https://www.asha.org/practice-portal/professional-issues/augmentative-and-alternative-communication/#collapse_4

Bremer, E., & Cairney, J. (2018). The interrelationship between motor coordination and adaptive behavior in children with autism spectrum disorder. Frontiers in Psychology, 9, 2350. https://doi.org/10.3389/fpsyg.2018.02350

Carr, E. G., Binkoff, J. A., Kologinsky, E., & Eddy, M. (1978). Acquisition of sign language by autistic children. I: Expressive labelling. Journal of Applied Behavior Analysis, 11(4), 489–501. https://doi.org/10.1901/jaba.1978.11-489

Carr, E. G., & Kologinsky, E. (1983). Acquisition of sign language by autistic children. II: Spontaneity and generalization effects. Journal of Applied Behavior Analysis, 16(3), 297–314. https://doi.org/10.1901/jaba.1983.16-297

Celiberti, D., & Daly, K. (2020). A treatment summary of Facilitated Communication. Science in Autism Treatment, 17(8). https://asatonline.org/for-parents/learn-more-about-specific treatments/facilitated-communication/

Daly, K., & Celiberti, D. (2021). A treatment summary of Rapid Prompting Method. Science in Autism Treatment, 18(1). https://asatonline.org/for-parents/learn-more-about-specific-treatments/rapid-prompting-method-rpm/

Ganz, J. B. (2015). AAC interventions for individuals with autism spectrum disorders: State of the science and future research directions. Augmentative and Alternative Communication, 31(3), 203–214. https://doi.org/10.3109/07434618.2015.1047532

Holehan, K. M., & Zane, T. (2020). Facilitated Communication reincarnated: Is there science behind that?. Science in Autism Treatment, 17(5). https://asatonline.org/for-parents/becoming-a-savvy-consumer/is-there-science-behind-that-facilitated-communication/

Hyman, S. L., Levy, S. E., Myers, S. M., Kuo, D. Z., Apkon, S., Davidson, L. F., Ellerbeck, K.A., Foster, J. E., Noritz, G. H., Leppert, M. O., Saunders, B.S., Stille, C., Yin, L., Weitzman, C. C., Childers, D. O., Levine, J. M., Peralta-Carcelen, A. M., Poon, J. K., Smith, P. J., … Bridgemohan, C. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1), e20193447. https://doi.org/10.1542/9781610024716-part01-ch002

Schwartz, J. B., & Nye, C. (2006). Improving communication for children with autism: Does sign language work? EBP Briefs, 1(2), 1-17. https://www.pearsonassessments.com/content/dam/school/global/clinical/us/assets/ebp-briefs/1-2-aug-2006.pdf

Seal, B. C., & Bonvillian, J. D. (1997). Sign language and motor functioning in students with autistic disorder. Journal of Autism and Developmental Disorders, 27(4), 437–466. https://doi.org/10.1023/a:1025809506097

Citation for this article:

Bowman, K. (2023). Augmentative and alternative communication (AAC): A treatment summary. Science in Autism Treatment, 20(11).

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