Communication and behaviour - Does AAC help?

Blogging about Research (and hoping it will give me some kind of super powers)

(Disclaimer: I am not the-world's-greatest-reader-of-research-papers and I am learning-as-I-go. With this in mind, please read this with a critical mind and a questioning eyes... then read the article yourself!)

Article: Effects of Augmentative and Alternative Communication on Challenging Behaviour: A Meta-Analysis. Virginia L. Walker & Martha E. Snell, 2013
http://informahealthcare.com/doi/abs/10.3109/07434618.2013.785020

Why did I choose this article?

In my work 'challenging behaviour' (or 'behaviours of concern') are very common. When supporting people with intellectual disability and those that care for them, behaviour becomes a regular part of conversations. Not all the time, but often.
This article, and the studies it analyses, help us to take steps towards providing better supports and having a better understanding.
The information I have learned from this article will not drastically change my practice, however there are gems of information that will definitely improve the quality of my practice (and the practices of the people I supervise). I also feel more confident about the way I provide supports to people with behaviours of concern!

Clinical bottom-line:

(In the words of the authors) "this review provides evidence that AAC intervention has positive effects in decreasing challenging behaviour for individuals with varying disabilities"
(In my own words...) Using AAC as part of intervention for people with challenging behaviours will give us a greater chance of addressing those behaviours. It is noted that for best results we need to start as early as possible and there should be a functional behaviour assessment (FBA) and also functional communication training (FCT).

The interesting bits (well I thought so, anyway...)

About the participants...

- There were 111 participants
- 71% of participants were male
- 70% were under the age of 12 years
- The most common diagnoses were intellectual disability or developmental disability and Autism spectrum disorder
- Before 37% used speech and 32% used non-symbolic communication
- Where people were using AAC before the study the most common type was unaided AAC (such as key word sign) and then aided AAC without speech output

About the interventions...

- the majority of interventions happened in classrooms, was 1:1 and included aided AAC without speech output 55% of the time
- Intervention was usually FCT (functional communication training - visit http://www.scopevic.org.au/index.php/cms/frontend/resource/id/622/ for information about FCT)
- The majority of studies didn't measure generalisation (changes outside the therapy situations) or maintenance (how long the changes lasted) or social validity (whether the intervention was acceptable and useful)

About the results...

- The effect of interventions overall was positive
- The effects were not influenced by participant, intervention or outcome characteristics
- AAC seems to be an effective intervention for many people who have behaviours of concern in many situations
- AAC might more likely to be successful for people who have better language skills, but more research is needed on this
- Success gets harder to achieve as people get older (over 12 years of age)
- It is important to consider the function of the behaviour!

What is a 'meta-analysis'?

Cochrane describe a meta-analysis as "... use of statistical methods to combine results of individual studies..." http://www.cochrane-net.org/openlearning/html/mod12-2.htm
This seems to be particularly helpful in groups where there is a lot of variation or diversity (heterogeneous populations), such as people with disabilities.
This meta-analysis looked at 54 studies (from a possible 355 articles originally identified by the inclusion criteria. After reading the abstracts of the 355 articles (almost my worst nightmare!) all but 81 were excluded. After reading the full text of those 81 articles another 27 were excluded.
All of the articles were single case experimental designs (SCEDs).

What is a SCED?

SCED = Single Case Experimental Design
aka, Single Case Research design
aka, N=1
Historically this type of study has not been highly regarded in rating scales, however with a well planned experimental designs (meeting criteria of high quality SCEDs) these studies are gaining credibility.
Here is more information about SCEDs if you're interested: http://ies.ed.gov/ncee/wwc/documentsum.aspx?sid=229 (thanks to @BronwynHemsley for the link)