Introduction: Augmentative and alternative communication (AAC) intervention research is rarely focused on school-age beginning communicators, despite the urgent need to ensure individuals in this population have access to the fundamental human right of communication. Methods: Four school-age children with multiple disabilities who were primarily prelinguistic communicators participated in the current study. The study used a single-subject research design to explore the effects of two interaction approaches – a social routine approach and a directive approach – on prelinguistic communication, compared to independent play and to one another. This study then evaluated the added effects of high-tech AAC within the most effective interaction approach for each participant. Results: All participants demonstrated prelinguistic communication indicating positive affect most frequently when interacting within a social routine. Furthermore, all participants increased linguistic communication while either maintaining or increasing prelinguistic communication when high-tech AAC was added to the social routine interaction. Conclusions: Clinicians should consider building accessible, predictable, engaging, and age-respectful social routines into leisure contexts to promote prelinguistic communication from school-age beginning communicators. Clinicians should also provide access to linguistic communication through high-tech AAC while continuing to honor and promote prelinguistic communication.

1.
Light J, McNaughton D, Caron J. New and emerging AAC technology supports for children with complex communication needs and their communication partners: state of the science and future research directions. Augment Altern Commun. 2019 Mar;35(1):26–41.
2.
Romski MA, Sevcik R, Hyatt A, Cheslock M. A continuum of AAC language intervention strategies for beginning communicators. In: Reichle J, Beukelman D, Light J, editors. Exemplary practices for beginning communicators: implications for AAC. Baltimore, MD: Paul H. Brookes Publishing; 2002. p. 1–23.
3.
Ogletree B, Pierce K. AAC for individuals with severe intellectual disabilities: ideas for nonsymbolic communicators. J Dev Phys Disabil. 2010 Jun;22(3):273–87.
4.
Light J, Parsons AR, Drager K. “There’s more to life than cookies”: developing interactions for social closeness with beginning communicators who use AAC. In: Reichle J, Beukelman D, Light J, editors. Exemplary practices for beginning communicators: implications for AAC. Baltimore, MD: Paul H. Brookes Publishing; 2002. p. 187–218.
5.
Holyfield C, Caron J, Light J. Programing AAC just-in-time for beginning communicators: the process. Augment Altern Commun. 2019 Dec;35(4):309–18.
6.
Carter M, Iacono T. Professional judgments of the intentionality of communicative acts. Augment Altern Commun. 2002;18(3):177–91.
7.
Holyfield C, Light J, Drager K, McNaughton D, Gormley J. Effect of AAC partner training using video on peers’ interpretation of the behaviors of presymbolic middle-schoolers with multiple disabilities. Augment Altern Commun. 2018 Dec;34(4):301–10.
8.
Grove N, Bunning K, Porter J, Olsson C. See what I mean: interpreting the meaning of communication by people with severe and profound intellectual disabilities. J Appl Res Intellect Disabil. 1999 Sept;12(3):190–203.
9.
Olswang LB, Dowden P, Feuerstein J, Greenslade K, Pinder GL, Fleming K. Triadic gaze intervention for young children with physical disabilities. J Speech Lang Hear Res. 2014 Oct;57(5):1740–53.
10.
Iacono T, Carter M, Hook J. Identification of intentional communication in students with severe and multiple disabilities. Augment Altern Commun. 1998;14(2):102–14.
11.
Siegel E, Cress C. Overview of the emergence of early AAC behaviors: progression from communicative to symbolic skills. In: Reichle J, Beukelman D, Light J, editors. Exemplary practices for beginning communicators: implications for AAC. Baltimore, MD: Paul H. Brookes Publishing; 2002. p. 25–57.
12.
Dunst CJ, Raab M, Trivette CM. Characteristics of naturalistic language intervention strategies. J Speech Lang Pathol Appl Behav Anal. 2012;5(3–4):8–16.
13.
Wetherby AM, Prizant BM. Profiling communication and symbolic abilities in young children. J Child Commun Disord. 1993 May;15(1):23–32.
14.
Paul R. Facilitating transitions in language development for children using AAC. Augment Altern Commun. 1997;13(3):141–8.
15.
Warren SF, Brady NC. The role of maternal responsivity in the development of children with intellectual disabilities. Ment Retard Dev Disabil Res Rev. 2007 Nov;13(4):330–8.
16.
Division for Early Childhood (Internet). DEC recommended practices with examples. Available from: http://www.dec-sped.org/recommendedpractices.
17.
Jennings DJ, Hanline MF, Woods J. Using routines-based interventions in early childhood special education. Dimens Early Child. 2012;40:13–23.
18.
McWilliam RA. Routines-based early intervention: supporting young children and their families. Baltimore, MD: Paul H. Brookes Publishing; 2010.
19.
National Association for the Education of Young Children (Internet). Position statement on developmentally appropriate practice. Available from: https://www.naeyc.org/resources/position-statements/dap/contents.
20.
Pretti-Frontczak KL, Barr DM, Macy M, Carter A. Research and resources related to activity-based intervention, embedded learning opportunities, and routines-based intervention: an annotated bibliography. Topics Early Child Spec Educ. 2003;23(1):29–39.
21.
Cole KN, Dale PS, Mills PE. Individual differences in language delayed children’s responses to direct and interactive preschool instruction. Topics Early Child Spec Educ. 1991;11(1):99–124.
22.
Losardo A, Bricker D. Activity-based intervention and direct instruction: a comparison study. Am J Ment Retard. 1994 May;98(6):744–65.
23.
Holyfield C. Preliminary investigation of the effects of a prelinguistic AAC intervention on social gaze behaviors from school-age children with multiple disabilities. Augment Altern Commun. 2019 Dec;35(4):285–98.
24.
Holyfield C, Brooks S, Schluterman A. Comparative effects of high-tech visual scene displays and low-tech isolated picture symbols on engagement from students with multiple disabilities. Lang Speech Hear Serv Sch. 2019 Oct 10;50(4):693–702.
25.
Holyfield C, Caron JG, Drager K, Light J. Effect of mobile technology featuring visual scene displays and just-in-time programming on communication turns by preadolescent and adolescent beginning communicators. Int J Speech Lang Pathol. 2019 Apr;21(2):201–11.
26.
Holyfield C, Caron J, Light J, McNaughton D. Effect of video embedded with hotspots with dynamic text on single-word reading by children with multiple disabilities. J Dev Phys Disabil. 2019 May;31(6):727–40.
27.
Holyfield C, Lorah E. Effects of high-tech versus low-tech AAC on indices of happiness for school-aged children with multiple disabilities. J Dev Phys Disabil. 2023 Apr;35(2):209–25.
28.
Barlow DH, Hayes SC. Alternating treatments design: one strategy for comparing the effects of two treatments in a single subject. J Appl Behav Anal. 1979 Summer;12(2):199–210.
29.
Baer DM, Wolf MM, Risley TR. Some current dimensions of applied behavior analysis. J Appl Behav Anal. 1968;1(1):91–7.
30.
Kratochwill TR, Levin JR. Enhancing the scientific credibility of single-case intervention research: randomization to the rescue. Psychol Methods. 2010 Jun;15(2):124–44.
31.
Kratochwill TR, Hitchcock JH, Horner RH, Levin JR, Odom SL, Rindskopf DM, et al. Single-case intervention research design standards. Remedial Spec Edu. 2013 Feb;34(1):26–38.
32.
Light J, Wilkinson KM, Thiessen A, Beukelman DR, Fager SK. Designing effective AAC displays for individuals with developmental or acquired disabilities: state of the science and future research directions. Augment Altern Commun. 2019 Mar;35(1):42–55.
33.
O’Neill T, Wilkinson KM, Light J. Preliminary investigation of visual attention to complex AAC visual scene displays in individuals with and without developmental disabilities. Augment Altern Commun. 2019 Sep;35(3):240–50.
34.
Schlosser RW, Shane HC, Allen AA, Abramson J, Laubscher E, Dimery K. Just-in-time supports in augmentative and alternative communication. J Dev Phys Disabil. 2016 Feb;28(1):177–93.
35.
Parker RI, Vannest K. An improved effect size for single-case research: nonoverlap of all pairs. Behav Ther. 2009 Dec;40(4):357–67.
36.
Ingersoll B. The differential effect of three naturalistic language interventions on language use in children with autism. J Posit Behav Interv. 2011 Apr;13(2):109–18.
37.
Lorah ER, Holyfield C, Miller J, Griffen B, Lindbloom C. A systematic review of research comparing mobile technology speech-generating devices to other AAC modes with individuals with autism spectrum disorder. J Dev Phys Disabil. 2022 Apr;34(2):187–210.
38.
Brady NC, Bruce S, Goldman A, Erickson K, Mineo B, Ogletree BT, et al. Communication services and supports for individuals with severe disabilities: guidance for assessment and intervention. Am J Intellect Dev Disabil. 2016 Mar;121(2):121–38.
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