University of Miami Mailman Center for Child Development's iCan Chat Project Creates Meaningful Language Experiences for Children with Autism and Their Families

December 10, 2013

The iCan Chat project was a collaborative demonstration project funded by the CVS CAREMARK Charitable Trust at the University of Miami Mailman Center for Child Development from January 1, 2012 to May 31, 2013. We collaborated with several agencies in the community: the Debbie School's Inclusive Early Childhood Program, the Center for Autism and Related Disabilities and the Florida Alliance for Assistive Services and Technology (FAAST) on the dissemination of information and recruitment of children to the project.

The primary goal of the project was to improve the communication skills of children with autism and related disabilities having little or no speech by providing direct interventions using the iPad® as an assistive communication device. A major component of the project included coaching and training parents to become more effective communication partners. Parents were coached to use strategies to promote their child's use of the device. These strategies included how to use core vocabulary, model the use of the device, create opportunities for communication, and reinforce communication attempts.

The Center for Disease Control estimates that approximately fifty percent of children do not develop speech or develop limited speech and language abilities (CDC, 2007). Although research has shown benefits associated with the use of assistive communication devices (Gancz, et al., 2012; Millar et al., 2006) there is a high degree of underuse among parents due to cost, complexity, and stigma. The iPad® offers an affordable, non‐stigmatizing, and accessible alternative for emergent communicators (Kagohara, et al., 2013). However, parents need training and support to maximize use of the iPad® and other assistive devices for the purpose of communication (Schladant, 2011). Therefore, the purpose of the iCan Chat project was to explore the use of the iPad® as a viable option for parents and their children to communicate.

Recruitment for the iCan Chat project began in September, 2012; fifty families were enrolled and targeted intervention sessions were initiated on September 18, 2012. Forty‐two families (8 families dropped out) completed the program by May 31, 2013. Each family received three targeted sessions including direct interventions with the children and parent coaching to use specific strategies and the iPad® as an assistive communication device for the purposes of requesting, rejecting, and commenting. For Spanish‐speaking parents, coaching sessions were conducted in Spanish and written reports were translated in Spanish.

Targeted sessions utilized a hybrid model incorporating elements from three evidence‐based approaches ‐ Early Start Denver (e.g., parent involvement, shared engagement, naturalistic), Milieu Model (e.g., child interests, prompting, modeling), and Language Acquisition through Motor Planning‐LAMP that emphasizes the use of speech generating devices, hide and show to teach core words, and use of consistent motor plans to access vocabulary on the device (Banjee, et al., 2003; Blischak, et al., 2003; DeThorne, et al., 2009; and Rogers, et al., 2012). Sessions were child focused in terms of preferences and interests, emphasized everyday activities (e.g., playtime, snack time, story time) using naturalistic strategies (e.g., core words, modeling, prompting, reinforcing) and AAC tools. AAC tools included the use of visual supports (e.g., choice boards, schedules, visual cues), the iPad® with guided access, and a variety of communication applications from basic to more dynamic.

All sessions were videotaped and coded using the Communication Complexity Scale (CCS). After 3 sessions, parents completed checklists on parent efficacy, satisfaction, and quality of life. The CCS was developed by Nancy Brady at the University of Kansas to provide a measure of early communication beginning with pre‐intentional behaviors (e.g., crying, smiling), followed by intentional/non symbolic behaviors (eye gaze, gesturing, vocalizing directed at another person), to symbolic communication, typically spoken but incorporating AAC symbol selections (Brady etal., 2012).

Overall, the iCan Chat project was highly successful. The project provided targeted interventions using the iPad® as an assistive communication device for 42 children with autism and related disabilities ages 2 to 12. The majority of children were Hispanic (70%), boys (81%), nonverbal (71%), and had a primary diagnosis of autism (70%). All children showed progress in meeting their communication goals. Consumer satisfaction data for those that completed the survey (26 respondents) revealed positive attitudes towards AAC (79% highly satisfied, 21% satisfied) and increased knowledge (100%). In addition, 81% (n = 21) of parents indicated that the iPad® met their child's communication needs, 4% (n = 1) felt that it would not, and 11% (n =3) were undecided.

Preliminary analysis of coded videotapes suggests that the iPad® can be used as an assistive communication device to teach different communicative skills (requesting, directing people's actions, and protesting/rejecting) in children not yet using spoken language. Child outcomes included improved joint attention, increased initiation and increased engagement. Qualitatively, we learned the importance of core words, direct modeling, and responding. For example, a young girl with Angelman syndrome displayed a variety of potentially communicative behaviors (e.g., reaching, touching hand, eye gaze). Although she did not learn to use the device independently in three sessions, she did demonstrate a variety of communicative behaviors such as activating the iPad® and looking to objects or person to make requests. Feedback from the parents of 26 children in the 3‐week intervention revealed that a majority of parents indicated that the device met their child's communication needs. Feedback from the mother of the child with Angelman syndrome was overwhelmingly positive (" us hope that she will be able to 'talk'...").

Lessons learned included: AAC works but differently for different individuals, AAC can work with any interests, in any environment, and strategies (engagement) are just as important, if not more important than a specific device. However, more research is needed, particularly with children and families who are linguistically and culturally diverse, regarding AAC use (i.e., bilingual households and single language devices).


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