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Background: There is a critical need for effective interventions for children with ASD who remain nonverbal after the age of 5 (Kasari, Tager-Flusberg et al, 2013). The development of an innovative naturalistic intervention, JASP-EMT was examined in a randomized trial (Kasari et al, submitted). An important variation in this trial was the addition of Augmentative and Alternative Communication (AAC) has to determine if adding an augmented mode could increase expressive language for children that are minimally verbal (Olive et al., 2006). 

Objectives: This current study examined the use of Augmentative and Alternative Communication (AAC) and spoken langauge with a subset of minimally verbal children with Autism who participated in a randomized trial JASP-EMT.  Specifically, this study examined the  effects that JASP-EMT had with AAC use on spoken and AAC generated spontaneous social communication (SCU) during the course of the intervention as well compared results before and after intervention.  The following questions were addressed in this study: 1. What are the effects of JASP-EMT with AAC on spoken social communication? What are the effects on AAC use? 3. What is the relationship of AAC and spoken language use? 

Methods:  The participants in this study included 20 minimally verbal children with ASD ( less than 20 unique words) from the one site of the RTC. Children were on average 6.48 years old (SD=1.11) with a mean IQ of 63.43 (SD=22.9). Ten participants were randomly assigned to JASPER-EMT plus AAC and 10 were assigned to JASPER-EMT without AAC. In the first phase of intervention, participants received two 45 minute sessions/ week of JASP-EMT for 12 weeks. The two conditions differed only in the inclusion of the AAC device. Interventionists modeled target level language on the AAC device 50% of all utterances, and expanded child utterances on the AAC device 50% of all expansions. A 10-minute video sample was transcribed and coded from 25% (total 6) of intervention sessions. Spoken socially communicative utterances (SCU) and AAC use were measured in each session.  In addition, SCU and AAC were measured at the pre and post intervention sessions

Results:  Children in the AAC condition produced more socially communicative utterances (M=19.2, SD=29.3) at the end of intervention than children in the spoken language intervention only (M=5.5, SD=42.8, d=.373). As participants in the AAC condition increased their verbal social communication, AAC use decreased. On average, participants initiated only 2 AAC utterances per session (SD=1.06), however, they used more spoken language than children in the spoken language condition only.  Additional analysis will examine the sequential relationship between therapist use of AAC and child use of AAC and spoken language, and how the child responded when the adult activated the AAC. 

Conclusions: Minimally verbal children with Autism demonstrated greater gains in spoken social communication during a naturalistic intervention including AAC. AAC use did not maintain once children learned to use verbal communication.   Further research is required to understand if adult AAC models and generalized use of AAC across routines can help to increase number of different words (NDW).