No access
Research Article
18 May 2021

Spoken Vocabulary Outcomes of Toddlers With Developmental Delay After Parent-Implemented Augmented Language Intervention

Publication: American Journal of Speech-Language Pathology
Volume 30, Number 3
Pages 1023-1037

Abstract

Purpose

Early intervention using augmentative and alternative communication (AAC) supports both receptive and expressive language skills. However, many parents and clinicians still worry that augmented language intervention might delay or impair speech development. This study aimed to (a) characterize and analyze the speech sound development of toddlers with developmental delay who participated in a parent-implemented language intervention; (b) examine the accuracy of speech sounds among toddlers who participated in an augmented language intervention using speech-generating devices and toddlers who participated in a traditional, spoken language intervention; and (c) examine the relationship between baseline factors (i.e., receptive and expressive language skills, vocal imitation, and number of unintelligible utterances) and the number of spoken target vocabulary words after intervention.

Method

This study used extant data from two randomized control trials of parent-implemented language interventions using AAC or spoken language. Out of 109 children who completed the intervention, 45 children produced spoken target vocabulary words at the end of the intervention. We identified and phonetically transcribed spoken target vocabulary words for each child and then classified them based on Shriberg and Kwiatkowski's (1982) developmental sound classes.

Results

Children's speech sound accuracy was not significantly different across intervention groups. Overall, children who produced more words had more speech sound errors and higher baseline language scores. Intervention group and baseline receptive and expressive language skills significantly predicted the number of spoken target vocabulary words produced at the end of intervention.

Conclusions

Participation in AAC intervention resulted in significantly more spoken target vocabulary words and no statistically significant differences in speech sound errors when compared to children who received spoken language intervention without AAC. Results support using AAC interventions for very young children without the fear that it will delay speech or spoken language development.

Supplemental Material

Get full access to this article

View all available purchase options and get full access to this article.

References

Allison, K. M., Annear, L., Policicchio, M., & Hustad, K. C. (2017). Range and precision of formant movement in pediatric dysarthria. Journal of Speech, Language, and Hearing Research, 60(7), 1864–1876.
Barker, R. M., Romski, M. A., Sevcik, R. A., Adamson, L. B., Smith, A. L., & Bakeman, R. (2019). Intervention focus moderates the association between initial receptive language and language outcomes for toddlers with developmental delay. Augmentative and Alternative Communication, 35(4), 263–273.
Barton, A., Sevcik, R. A., & Romski, M. A. (2006). Exploring visual–graphic symbol acquisition by pre-school age children with developmental and language delays. Augmentative and Alternative Communication, 22(1), 10–20.
Bauman-Waengler, J. (2012). Articulatory and phonological impairments: A clinical focus (4th ed.). Pearson.
Beukelman, D. R., & Light, J. C. (2020). Augmentative and alternative communication: Supporting children and adults with cognitive communication needs (5th ed.). Brookes.
Blischak, D., Lombardino, L., & Dyson, A. (2003). Use of speech-generating devices: In support of natural speech. Alternative and Augmentative Communication, 19(1), 29–35.
Boesch, M. C., Wendt, O., Subramanian, A., & Hsu, N. (2013). Comparative efficacy of the Picture Exchange Communication System (PECS) versus a speech-generating device: Effects on social-communicative skills and speech development. Augmentative and Alternative Communication, 29(3), 197–209.
Brady, N. C. (2000). Improved comprehension of object names following voice output communication aid use: Two case studies. Augmentative and Alternative Communication, 16(3), 197–204.
Branson, D., & Demchak, M. (2009). The use of augmentative and alternative communication methods with infants and toddlers with disabilities: A research review. Augmentative and Alternative Communication, 25(4), 274–286.
Buschak, D. M. (1999). Increases in natural speech production following experience with synthetic speech. Journal of Special Education Technology, 14(2), 44–53.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Erlbaum.
Dunn, L., & Dunn, L. (1981). The Peabody Picture Vocabulary Test–Revised. American Guidance Service.
Dyches, T. T. (1998). Effects of switch training on the communication of children with autism and severe disabilities. Focus on Autism and Other Developmental Disabilities, 13(3), 151–162.
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191.
Fenson, L., Marchman, V. A., Thal, D. H., Dale, P. S., Reznick, J. S., & Bates, E. (2007). MacArthur–Bates Communicative Development Inventories, Second Edition. Brookes.
Fielding-Gebhardt, H., & Warren, S. F. (2019). Early predictors of later expressive language in boys with fragile X syndrome. American Journal on Intellectual and Developmental Disabilities, 124(1), 11–24.
Hedrick, D. L., Prather, E. M., & Tobin, A. R. (1984). Sequenced Inventory of Communication Development. University of Washington Press.
Hustad, K. C., & Beukelman, D. R. (2001). Effects of linguistic cues and stimulus cohesion on intelligibility of severely dysarthric speech. Journal of Speech, Language, and Hearing Research, 44(3), 497–510.
Hustad, K. C., Mahr, T. J., Broman, A. T., & Rathouz, P. J. (2019). Longitudinal growth in single-word intelligibility among children with cerebral palsy from 24 to 96 months of age: Effects of speech-language profile group membership on outcomes. Journal of Speech, Language, and Hearing Research, 63(1), 32–48.
IBM Corp. (2016). IBM SPSS Statistics for Windows (Version 24) .
Kagohara, D. M., van der Meer, L., Achmadi, D., Green, V. A., O'Reilly, M. F., Lancioni, G. E., Sutherland, D., Lang, R., Marschik, P. B., & Sigafoos, J. (2012). Teaching picture naming to two adolescents with autism spectrum disorders using systematic instruction and speech-generating devices. Research in Autism Spectrum Disorders, 6(3), 1224–1233.
Kaiser, A. P., & Roberts, M. Y. (2011). Advances in early communication and language intervention. Journal of Early Intervention, 33(4), 298–309.
Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R., Murphy, S., & Almirall, D. (2014). Communication interventions for minimally verbal children with autism: A sequential multiple assignment randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53(6), 635–646.
Kent, R. D., & Vorperian, H. K. (2013). Speech impairment in Down syndrome: A review. Journal of Speech, Language, and Hearing Research, 56(1), 178–210.
King, M. L., Takeguchi, K., Barry, S. E., Rehfeldt, R. A., Boyer, V. E., & Mathews, T. L. (2014). Evaluation of the iPad in the acquisition of requesting skills for children with autism spectrum disorder. Research in Autism Spectrum Disorders, 8(9), 1107–1120.
Kumin, L. (1994). Intelligibility of speech in children with Down syndrome in natural settings: Parents' perspective. Perceptual and Motor Skills, 78(1), 307–313.
Kumin, L. (1996). Speech and language skills in children with Down syndrome. Mental Retardation and Developmental Disabilities Research Reviews, 2(2), 109–115.
Leech, E. R. B., & Cress, C. J. (2011). Indirect facilitation of speech in a late talking child by prompted production of picture symbols or signs. Augmentative and Alternative Communication, 27(1), 40–52.
Madley-Dowd, P., Hughes, R., Tilling, K., & Heron, J. (2019). The proportion of missing data should not be used to guide decisions on multiple imputation. Journal of Clinical Epidemiology, 110, 63–73.
Masso, S., Baker, E., McLeod, S., & Wang, C. (2017). Polysyllable speech accuracy and predictors of later literacy development in preschool children with speech sound disorders. Journal of Speech, Language, and Hearing Research, 60(7), 1877–1890.
McCleery, J. P., Tully, L., Slevc, L. R., & Schreibman, L. (2006). Consonant production patterns of young severely language-delayed children with autism. Journal of Communication Disorders, 39(3), 217–231.
Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49(2), 248–264.
Miller, J., & Chapman, R. (2000). Systematic analysis of language transcripts (6th ed.). University of Wisconsin Language Analysis Lab.
Mullen, E. M. (1995). Mullen Scales of Early Learning. AGS.
Olive, M. L., de la Cruz, B., Davis, T. N., Chan, J. M., Lang, R. B., O'Reilly, M. F., & Dickson, S. M. (2007). The effects of enhanced milieu teaching and a voice output communication aid on the requesting of three children with autism. Journal of Autism and Developmental Disorders, 37(8), 1505–1513.
Parsons, C. L., & La Sorte, D. (1993). The effect of computers with synthesized speech and no speech on the spontaneous communication of children with autism. Australian Journal of Human Communication Disorders, 21(1), 12–31.
Romski, M. A., & Sevcik, R. A. (1996). Breaking the speech barrier: Language development through augmented means. Brookes.
Romski, M. A., & Sevcik, R. A. (2005). Augmentative communication and early intervention myths and realities. Infants & Young Children, 18(3), 174–185.
Romski, M. A., Sevcik, R. A., Adamson, L. B., Barton-Hulsey, A., Smith, A., Barker, R. M., Whitmore, A., & Bakeman, R. (2021). Assessing the effects of parent-coached early augmented language intervention for toddlers with developmental disabilities. Manuscript in preparation.
Romski, M. A., Sevcik, R. A., Adamson, L. B., Cheslock, M., & Smith, A. (2007). Parents can implement AAC interventions: Ratings of treatment implementation across early language interventions. Early Childhood Services, 1, 100–115.
Romski, M. A., Sevcik, R. A., Adamson, L. B., Cheslock, M., Smith, A., Barker, R. M., & Bakeman, R. (2010). Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents. Journal of Speech, Language, and Hearing Research, 53(2), 350–364.
Romski, M. A., Sevcik, R. A., Barton-Hulsey, A., Fisher, E. L., King, M., Albert, P., Kaldes, G., Walters, C., & Evans, C. (2020). Supporting emerging communication and language during early development. In K. Wilkinson & L. Finestack (Eds.), Multimodal augmentative and alternative communication for individuals with Down syndrome across the lifespan (pp. 93–120). Brookes.
Romski, M. A., Sevcik, R. A., Cheslock, M., & Barton, A. (2017). The system for augmenting language: AAC and emerging language intervention. In R. McCauley, M. Fey, & R. Gillam (Eds.), Treatment of language disorders in children: Conventional and controversial intervention (2nd ed., p. 165). Brookes.
Schlosser, R. W., & Blischak, D. M. (2001). Is there a role for speech output in interventions for persons with autism?: A review. Focus on Autism and Other Developmental Disabilities, 16(3), 170–178.
Schlosser, R. W., & Koul, R. K. (2015). Speech output technologies in interventions for individuals with autism spectrum disorders: A scoping review. Augmentative and Alternative Communication, 31(4), 285–309.
Schlosser, R. W., Sigafoos, J., Luiselli, J. K., Angermeier, K., Harasymowyz, U., Schooley, K., & Belfiore, P. J. (2007). Effects of synthetic speech output on requesting and natural speech production in children with autism: A preliminary study. Research in Autism Spectrum Disorders, 1(2), 139–163.
Schlosser, R. W., & Wendt, O. (2008). Effects of augmentative and alternative communication intervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology, 17(3), 212–230.
Sevcik, R. A., Romski, M. A., & Wilkinson, K. M. (1991). Roles of graphic symbols in the language acquisition process for persons with severe cognitive disabilities. Augmentative and Alternative Communication, 7(3), 161–170.
Shriberg, L. D. (1993). Four new speech and prosody-voice measures for genetics research and other studies in developmental phonological disorders. Journal of Speech and Hearing Research, 36(1), 105–140.
Shriberg, L. D., & Kwiatkowski, J. (1982). Phonological disorders. I: A diagnostic classification system. Journal of Speech and Hearing Disorders, 47(3), 226–241.
Smith, A. L., & Hustad, K. C. (2015). AAC and early intervention for children with cerebral palsy: Parent perceptions and child risk factors. Augmentative and Alternative Communication, 31(4), 336–350.
Sommers, R., Reinhart, R. W., & Sistrunk, D. A. (1988). Traditional articulation measures of Down syndrome speakers, ages 13–22. Journal of Childhood Communication Disorders, 12(1), 93–108.
Sparrow, S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales: Survey interview form/caregiver rating form. Pearson.
Stoel-Gammon, C. (2001). Transcribing the speech of young children. Topics in Language Disorders, 21(4), 12–21.
Stoel-Gammon, C., & Dunn, C. (1985). Normal and disordered phonology in children. University Park Press.
Thal, D. J., Oroz, M., & McCaw, V. (1995). Phonological and lexical development in normal and late-talking toddlers. Applied Psycholinguistics, 16(4), 407–424.
Thistle, J. J., & Wilkinson, K. M. (2013). Working memory demands of aided augmentative and alternative communication for individuals with developmental disabilities. Augmentative and Alternative Communication, 29(3), 235–245.
Walters, C. (2018). Spoken vocabulary outcomes of toddlers with developmental delay receiving parent-coached augmented language intervention: A phonetic description and analysis [Unpublished master's thesis, Georgia State University].
Widaman, K. (2006). Missing data: What to do with or without them. Monographs of the Society for Research in Child Development, 71(3), 42–64.
Yoder, P. J., & Layton, T. L. (1988). Speech following sign language training in autistic children with minimal verbal language. Journal of Autism and Developmental Disorders, 18(2), 217–229.
Yoder, P., Watson, L. R., & Lambert, W. (2015). Value-added predictors of expressive and receptive language growth in initially nonverbal preschoolers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45(5), 1254–1270.

Information & Authors

Information

Published In

American Journal of Speech-Language Pathology
Volume 30Number 3May 2021
Pages: 1023-1037
PubMed: 33789437

History

  • Received: Apr 16, 2020
  • Revised: Jul 29, 2020
  • Accepted: Dec 17, 2020
  • Published online: Mar 31, 2021
  • Published in issue: May 18, 2021

Permissions

Request permissions for this article.

Authors

Affiliations

Department of Psychology, Georgia State University, Atlanta
Department of Psychology, Georgia State University, Atlanta
Department of Psychology, Georgia State University, Atlanta
Department of Communication, Georgia State University, Atlanta

Notes

Disclosure: The authors have declared that no competing interests existed at the time of publication.
Correspondence to Casy Walters: [email protected]
Editor-in-Chief: Julie Barkmeier-Kraemer
Editor: Katherine C. Hustad

Metrics & Citations

Metrics

Article Metrics
View all metrics



Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Citing Literature

  • Prescribing Assistive Technology: Focus on Children With Complex Communication Needs: Clinical Report, Pediatrics, 10.1542/peds.2025-072216, (2025).
  • Empowering Parents for AAC: a training and coaching intervention to support parents to implement a core board with fringe vocabulary with their children in New Zealand, Augmentative and Alternative Communication, 10.1080/07434618.2025.2458856, (1-13), (2025).
  • Exploring core competencies for language facilitation in parent training programs in AAC, Disability and Rehabilitation: Assistive Technology, 10.1080/17483107.2024.2429687, 20, 4, (1035-1043), (2024).
  • Parents' Perspectives of Augmentative and Alternative Communication: From Assessment to Implementation, Perspectives of the ASHA Special Interest Groups, 10.1044/2023_PERSP-23-00110, 9, 1, (201-214), (2023).
  • Augmentative and Alternative Communication Services During the COVID-19 Pandemic: Contextual Determinants of the Parent–Speech-Language Pathologist Partnership, American Journal of Speech-Language Pathology, 10.1044/2023_AJSLP-23-00139, 32, 6, (2889-2907), (2023).
  • Experiences of Parents Supporting Their Young Children Who Use Speech-Generating Devices, Journal of Early Intervention, 10.1177/10538151231199898, 46, 4, (562-583), (2023).
  • A scoping review of communication outcomes measures in augmentative and alternative communication, Assistive Technology, 10.1080/10400435.2023.2251041, (1-22), (2023).
  • CDK13-related disorder: a deep characterization of speech and language abilities and addition of 33 novel cases, European Journal of Human Genetics, 10.1038/s41431-022-01275-8, 31, 7, (793-804), (2023).
  • Home and School Literacy Experiences in Preschool-Age Children With Developmental Disabilities: Identifying Relationships Between Speech, Language, and Early Literacy Skills, Perspectives of the ASHA Special Interest Groups, 10.1044/2022_PERSP-22-00026, 7, 6, (1585-1605), (2022).
  • It's Never Too Late: Debunking Myths About Communication and Adults With Severe Disabilities, Intellectual and Developmental Disabilities, 10.1352/1934-9556-60.5.416, 60, 5, (416-425), (2022).

View Options

Sign In Options

ASHA member? If so, log in with your ASHA website credentials for full access.

Member Login

View options

PDF

View PDF

Full Text

View Full Text

Figures

Tables

Media

Share

Share

Copy the content Link

Share