A Community-Based Randomized-Controlled Trial of High- and Low-Tech AAC Approaches

Background: Methods for teaching individuals with autism spectrum disorders (ASD) to engage in social and communicative behavior have traditionally employed low-tech approaches. Among these, the Picture Exchange Communication System (PECS) has extensive support as an approach for effectively teaching these skills. New and evolving technology (i.e., tablets, applications) has resulted in cheaper and more affording forms of speech-generating devices (SGD) and these SGD are increasingly used in practice. Despite early adoption of these newer methods, there are relatively few guidelines for using these devices to teach social and communicative behavior. To date, no studies have rigorously compared the relative effectiveness of high-tech and low-tech Augmentative and Alternative Communication (AAC) with randomized assignment, and it is also unclear as to whether a particular device may be better matched to certain individuals.

Objectives: A mobile application and associated custom teaching protocol was developed and systematically compared to PECS in a community-based randomized controlled trial (RCT). The objectives of the trial were to: 1) compare the effectiveness of high-tech and low-tech AAC approaches for teaching requesting skills; 2) compare the effectiveness of high-tech and low-tech AAC approaches for teaching queried requesting skills; and, 3) compare the effectiveness of high-tech and low-tech AAC approaches for teaching queried social responding.

Methods: Thirty-five school-aged participants assigned randomly to either a high-tech or low-tech AAC group. AAC intervention was provided in the schools of participants and trained therapists provided participants with either high-tech (n = 18) or low-tech (n = 17) forms of communication training. Trial participants were assessed before and following four months of AAC intervention. This trial was developed to examine the relative effectiveness of both types of AAC intervention for teaching social and communicative behavior to individuals with ASD. A repeated measures analysis of variance was used to systematically compare improvements in the two approaches. Time was included as a within-subjects factor and Type (i.e., high-tech, low-tech) was included as a between-subjects factor.

Results: The results from repeated measures analyses of variance indicated significant effects for Time for both types of requesting, but not for general social behavior. There was no significant effect for Type in any form of communication. These results indicate that the two approaches produced substantial benefit and that the benefits of these two approaches did not differ significantly.

Conclusions: The results from this community-based RCT suggest that high-tech AAC approaches, when implemented with a comprehensive teaching protocol, can be effective for teaching social and communicative impairments to children with ASD. While these results are supportive of the use of high-tech AAC with ASD, additional study is required to confirm similar outcomes when participants have more greater levels of impairment (i.e., ASD with comorbid intellectual disability). The results of this trial highlight how open-sourced technology can be combined with clinician-driven assessments and individualized intervention.