Reported Use of Augmentative/Alternative Communication By Pediatric Psychiatric Inpatients with Autism Spectrum Disorders

Background: In previous work, we found that, contrary to expectations, verbal ability was not strongly related to the severity of problem behaviors in pediatric psychiatric inpatients with autism spectrum disorders (ASD) (Williams, Siegel, & Mazefsky, 2017). The potential effect of augmentative/alternative communication (AAC) use by the individuals with ASD who were minimally verbal (MV) remained an unanswered question. Other research has suggested that introducing a form of AAC such as Picture Exchange Communication System (PECS; Frost & Bondy 2002) or a speech-generating device may be associated with a decrease in the occurrence of problem behaviors for MV children with ASD (Ganz et al. 2009; Mirenda 2003).

Objectives: This is an initial descriptive report of AAC use in our population of pediatric psychiatric inpatients with ASD, adding to the limited information available on the proportion of youth with ASD who use AAC, the forms used, and the user characteristics.

Methods: A questionnaire, adapted from one by Tager-Flusberg and colleagues, was used to gather information from family members about AAC use, the verbal abilities, and communicative functions of 641 pediatric psychiatric inpatients with ASD. Receptive vocabulary was measured with the Peabody Picture Vocabulary Test-4 (Dunn & Dunn, 2007) for a subset of 479 inpatients.

Results: 242 (37.8%) of the pediatric inpatients reportedly used some form of AAC. They did not differ from the 399 inpatients who were non-AAC users in mean age [12.90 (users); 12.83 (non-users), p = .807], age range (4 to 20 years), or gender distribution [AAC users = 202 Males (83.5%); 40 Females (16.5%); non-users = 315 Males (78.9%); 84 Females (21.1%), p = 0.180]. The types of AAC that were reported to be used by most of the inpatients were low-tech, picture-based formats, with only 45.5% reported to use some form of a voice output communication aid or speech-generating device. Thirty-three percent of the AAC users were reported to use complex sentences; 49.5% were reported to share thoughts at least sometimes, but most (93.4%) used their means of communication for basic functions of expressing wants/needs and making requests. The receptive vocabulary scores of the non-AAC users were significantly higher than the AAC users (83.07; 47.09, p > .0001). A subset of 28 children in the non-AAC group were reported to only use simple sentences some of the time (85.7%) or never (14.3%) and had PPVT standard scores that ranged from 20 to 100 with a mean of 52.86, suggesting that, whereas some of these children may be so severely affected they would have difficulty using AAC, others may be potential candidates.

Conclusions: The percentage who use AAC in this inpatient population is consistent with previously reported estimates of AAC use in other ASD samples (Wodka et al., 2013). Consistent with other reports, this inpatient population primarily used AAC for the basic communicative functions of expressing wants/needs and requesting (Ganz et al., 2012). Future research will use information from the AAC questionnaire to examine the relationship between the ability to communicate and severity of problem behaviors in this population.