The Immersive AAC Classroom that my colleague Sam Lyle and I have developed and taught has been one of the most rewarding experiences from a therapeutic and research standpoint. Merging what we know about language learning, motor planning, novelty and joy enhancing neuroplasticity and aided language input to teach language skills in a classroom setting was a professional thrill, but this experience was enhanced significantly by the collaborative relationship we developed with Dr. Allison Bean Ellawadi from The Ohio State University and her research lab, The Autism and Child Language Learning Lab.

In addition to presenting our research at the American Speech-Language Hearing Association (ASHA) conference the last two years, the three of us presented findings from the data we collected from the participants in our class alongside those from our control group at the Assistive Technology Industry Association (ATIA) annual conference in Orlando this month. During the conference we felt energized by discussions around the various research projects we are working on. We made short- and long-term plans for our studies and excitedly discussed the “story” we are beginning to tell about the effectiveness of and best practices for using speech-generating devices for children with developmental disabilities.

Our “story” began in August of 2015 when Allison and I met over lunch at a local gastropub. I blabbed on about my poorly formed ideas for research projects and specific areas in AAC literature in which I perceived gaps. She impressed me immediately by taking my rambling and explaining how we (well, she) could form these ideas into well-designed and publishable research studies. We quickly pulled Sam into the projects and Allison offered some of our studies to be part of graduate theses of students in her lab.

We found an ultimate goal: identifying what we later came to call “the active ingredients” for successful AAC use for beginning communicators. One of the first ingredients we began to look at was buy-in from parents and teachers of children at Bridgeway Academy. We did this by conducting surveys as well as examining the actual frequency of device use by the children while they were at home and school using the Realize Language data analysis program. This study revealed something that surprised all of us: a parent’s or teacher’s operational competency (ability to program, troubleshoot, customize) was not a factor influencing buy-in, in fact there was a negative correlation between the two! The parents reported high levels of buy-in and operational competency but the children used their devices less at home while the teachers reported high levels of buy-in but low levels of operational competency with the children using their devices with significant more frequency.

This first chapter in our story gave us two questions in our search for “the active ingredients:” 1.) what is leading the teachers to have such high buy-in corresponding to frequent device use and 2.) how should training be adapted to parents to increase their children’s use of device at home?

To answer number one, we examined the training procedures that take place for the teachers at Bridgeway Academy. We described the three-pronged approach of: direct training with an accompanying manual, ongoing classroom-based support and an immersive AAC practice session we call the Chatterbox Challenge. This activity focuses on dedicated device dialogue to enable participants to better understand where vocabulary is located (to increase skills in modeling and prompting) as well as an opportunity to use the device in a social setting (to encourage device use for a variety of functions).  The Chatterbox Challenge ended up being a major factor in buy-in from parents and teachers and influenced us to dive a bit deeper into that part of our story. We are currently writing up our findings from this examination as well as clearly defining the methods and rationale for the Chatterbox Challenge.

To answer our second question, we developed a 6-week parent training course that focused on language development, Chatterbox Challenges, prompting strategies and most importantly – creating communication opportunities. We did not spend any time teaching operational competence. We collected data via pre- and post-treatment surveys, videos of parents interacting with their children in the home and language use by the children collected by the Realize Language program. The results of this study are still coming in but preliminary data are showing that this model was effective.

While teaching the parent training course, another chapter in our story began to unfold. While we were discussing prompting strategies we started to see how very nuanced the skill of physical prompting is. There is very little literature on effective prompting strategies for AAC and no research on how to effectively utilize and fade physical prompts. Teaching language through motor planning channels should consider physical prompts just as occupational and physical therapists teach motor planning. We are currently collaborating with a physical therapist to better define these prompts and how to effectively use and fade them.

One of the main themes in our research story is the effectiveness of the Immersive AAC Classroom. We are currently planning our third round of the class and are hoping to expand to different age groups. The data from the summer of 2017 mirrored those from 2016, showing us an exciting trend: compared to the control group, the participants in the Immersive Class showed a spike in language use once they returned to their regular classrooms at the start of the school year. These findings suggest that the Immersive Class model may “set the stage” for continued language development but also brings another major question to light: what are the “active ingredients” that influenced the trend. We are looking at several variables: the constant large-scale modeling; the slowed pace of the class; the emphasis on neuroplasticity-enhancing activities; the simple fact that the devices were constantly within arm’s reach and the focus on generalizing a small set of core vocabulary to set in motion the fast- and slow-mapping of vocabulary.

We are in the planning stages of teasing apart two of these variables: having the device in arm’s reach and vocabulary selection. As simple as it sounds, we are confident that merely having the device nearby will increase a child’s use of their device. While Allison laughs and calls it “low-hanging fruit,” she reminds us that research had also been conducted to say that hearing-impaired students showed better language outcomes when their devices were turned on. We are also developing a research-based tutorial for selecting vocabulary to target on an AAC device.

While at ATIA, we spent a lot of time planning future studies and setting action items. We have five papers to submit, three grants to apply for and four papers to submit to ASHA (one of which will be about the dynamic collaboration between clinicians and researchers) and we are anxiously awaiting acceptance of several papers to the International Society for AAC (ISAAC) conference later this year in Sydney, Australia, so… watch this space for our story to continue!

Edit 1: We have had 4 papers accepted to ISAAC!

Edit 2: I’d be remiss if I didn’t include our citations so far (we are hoping for this list to grow to include publications within the year):

Bean Ellawadi, A., Paden Cargill, L. & Lyle, S. (2018). Investigating the Effect of Parent Training on Increasing Children’s AAC Use. Poster presentation at ISAAC conference 2018. Gold Coast, Australia.

Bean Ellawadi, A., Paden Cargill, L. & Lyle, S (2018). A Preliminary Examiniation of Technical, Programming and Implementation Support in Full Communication AAC Apps. Poster presentation at ISAAC conference 2018. Gold Coast, Australia.

Bean Ellawadi, A., Paden Cargill, L., & Lyle, S (2018). Using an Immersive Classroom to Increase Vocabulary Learning and AAC Use in School-Age AAC Users. Poster presented at ISAAC conference 2018. Gold Coast, Australia.

Bean Ellawadi, A., Lyle, S., & Paden Cargill, L. (2018). The Relationship Between Parent and Teacher Buy-In, Operational Competency and Children’s AAC Use. Poster presentation at ISAAC conference 2018. Gold Coast, Australia.

Cargill, L., Lyle, S. & Ellawadi, A. (2018). Immersive AAC Classroom’s Effect on Vocabulary and AAC Use. Paper presented at ATIA conference 2018. Orlando, FL.

DeCarlo, J., Ellawadi, A., Cargill, L., Lyle, S. & David, A. (2016). Predictors of Augmentative & Alternative Communication in AAC Users with Developmental Disabilitities. Paper presented at ASHA conference 2016. Philadelphia, PA.

DeCarlo, J., Ellawadi, A., Cargill., L., Lyle, S., David, A. (2017). Predictors of Successful AAC Use: What Really Matters? Poster presentation at ASHA conference 2017. Los Angeles, CA.

Ellawadi, A., Lyle, S., Cargill, L. & David, A (2017). Working with Special Education Teachers to Support AAC Implementation in the Classroom. Poster presentation at ASHA conference 2017. Los Angeles, CA.

Neno, C., Ellawadi, A., Cargill, L., Lyle, S. & David, A. (2016). Vocabulary Development in School-Age Augmentative & Alternative Communication (AAC) Users. Poster presentation at ASHA conference 2016. Philadelphia, P.A.