Peer-Mediated AAC Intervention for Children with Autism: Effects on Communication

描述（由申请人提供）：许多自闭症幼儿有复杂的沟通需求，许多人没有发展功能性语言。在互惠的社会互动和限制或重复发挥的缺陷也在这种发展障碍的核心。 交流互动涉及每个交流伙伴之间的互惠或互让;因此，能否成功使用AAC在很大程度上取决于每个伙伴的技能（肯特-沃尔什和麦克诺顿，2005年）。AAC系统使儿童能够独立沟通;然而，迄今为止，大多数报告AAC有效性的研究涉及成年伴侣，很少包括没有残疾的同龄人。本项目的目的是研究社会沟通干预的非语言或最低限度的语言学龄前自闭症儿童，整合同伴中介（PM）的方法与替代和增强沟通（AAC）的指令，称为PM-AAC。鉴于经验的支持，培训同行响应通信合作伙伴，并报告使用AAC教功能性通信的有效性，整合PM和AAC的方法是一个合乎逻辑的和创新的下一步，以推进这一人群的干预研究。方法将针对和改善自闭症核心特征的发展过程-社会互惠，沟通和游戏技能。我们将研究PM-AAC在包容性环境中对患有和不患有自闭症的学龄前儿童之间的沟通和社会互动的影响，以及技能如何在非治疗环境中推广和维持。将使用多基线（MB）比较AB设计，根据认知能力进行区组随机化，每年将12名自闭症儿童随机分配至PM-AAC治疗组（n=6）或AAC对照组（n=6），评价有效性。MB设计将在四年内总共四个队列的12名自闭症受试者中重复进行（总共n=48），并对治疗组和对照组收集功能性沟通的重复测量，以便在第4年结束时分析组间差异。每个自闭症儿童将有三个受过训练的同伴，总共n=144个没有残疾的同伴。受过训练的同龄人将从已出版的学前教育计划中学习响应性社会策略，以及如何使用选定的AAC系统。教师和同伴执行的忠诚度，同伴行为的质量和技能的概括也将被测量。一个结构化的沟通样本和一个结构化的游戏样本将被用来评估二次增加的沟通复杂性和发展与同龄人的游戏行为。结果将是一个同伴介导的AAC干预开发，以提高成果的核心发展领域的非语言或最低限度的语言自闭症儿童，并出席同伴的特点。将制作一本治疗实施手册，并将制作一套供家长和教师培训的录像带。这项工作将为随后的RCT研究提供强有力的基础，比较PM- AAC干预方法与自闭症儿童的替代沟通干预方法。

DESCRIPTION (provided by applicant): Many young children with autism have complex communication needs, and many do not develop functional speech. Deficits in reciprocal social interactions and restricted or repetitive play are also at the core of this developmental disorder. Communicative interactions involve reciprocity or give-and-take between each communication partner; thus, the success of using AAC is highly reliant on the skills of each partner (Kent- Walsh and McNaughton, 2005). AAC systems allow children the ability to communicate independently; however, to date, the majority of studies reporting AAC effectiveness involves adult partners and rarely includes peers without disabilities. The purpose of this project is to examine a social communication intervention for nonverbal or minimally verbal preschool children with autism that integrates peer-mediated (PM) approaches with alternative and augmentative communication (AAC) instruction, called PM-AAC. Given the empirical support for training peers to be responsive communication partners, and the reported effectiveness of using AAC to teach functional communication, integrating PM and AAC approaches is a logical and innovative next step to advance intervention research for this population. Approaches will target and improve the course of development in core features of autism - social reciprocity, communication, and play skills. We will examine the effects of PM-AAC on communication and social interactions between preschoolers with and without autism in inclusive settings, and how skills generalize and maintain in non-treatment settings. Effectiveness will be evaluated using a multiple-baseline (MB) comparative AB design using block randomization based on cognitive abilities to randomly assign 12 children with autism each year to a PM-AAC treatment group (n=6) or an AAC comparison group (n=6). The MB design will be replicated across a total of four cohorts of 12 participants with autism over four years (n=48 total), with repeated measures on functional communication collected for both treatment and comparison groups allowing for analysis of between group differences at the end of year 4. Each child with autism will have three trained peer partners, for a total of n=144 peers without disabilities. Trained peers will learn responsive social strategies from a published preschool program, and how to use a selected AAC system. Fidelity of teacher and peer implementation, quality of peer behaviors, and skill generalization also will be measured. A structured communication sample and a structured play sample will be used to evaluate secondary increases in communication complexity and developmental play behaviors with peers. Outcomes will be a peer-mediated AAC intervention developed to enhance outcomes in core developmental areas for nonverbal or minimally verbal children with autism, and that attends to peer characteristics. A manual for treatment implementation will be produced, as will a compilation of videos for parent and teacher training. This work will provide a strong basis for a subsequent RCT study comparing PM- AAC intervention approach to alternative communication interventions for children with autism.