Comparison of the Efficacy of Text-based vs Picture-based AAC Systems to Maximize Outcomes for Preschool Children with ASD

Over 40% of children with autism spectrum disorder (ASD) do not develop functional speech (CDC, 2007). Augmentative and alternative communication (AAC) is essential to support the language and communication development of these children (Ganz et al., 2012). AAC systems that prioritize text offer the greatest independence and generative capacity for communication (Koppenhaver, 2000). Furthermore, functional literacy skills are essential to maximize educational, social, and vocational opportunities (Light & McNaughton, 2013). Although the power of literacy skills – especially for those who communicate via AAC – is indisputable, children with ASD and complex communication needs (CCN) are overwhelmingly provided with picture symbol-based AAC systems (e.g., line drawings) and excluded from literacy instruction, despite the prevalence of emergent literacy skills in this population (Mirenda, 2003; Westerveld et al., 2017). However, there is a paucity of research comparing the learning and use of text versus picture-based symbols in AAC systems for children with ASD. Using a single subject alternating treatments experimental design (Barlow & Hayes, 1979; Kratochwill et al., 2010), the proposed study will investigate the comparative rate of learning and effectiveness of AAC symbol types (picture symbols vs. text), measured by the accurate identification and functional use of novel AAC symbols by preschool-age children with ASD and CCN. Deciding how to effectively represent a wide variety of concepts within an AAC system is an ongoing challenge for both clinicians and families of children with ASD who rely on AAC. The results of this study will offer new evidence-based clinical practice guidelines regarding the efficacy of text vs. picture symbols to optimize clinical decision making for AAC system design and personalization, enhance literacy outcomes, and contribute to improved educational, social, communication, and long-term vocational and independent living outcomes for children with ASD and CCN.