RecruitingNot ApplicableNCT05743439

Early Augmentative and Alternative Communication (AAC) Intervention Delivered Via Hybrid Telehealth

Sponsor

Oregon Health and Science University

Enrollment

50 participants

Start Date

Jul 1, 2022

Study Type

INTERVENTIONAL

Conditions

Speech and Language Disorder Intellectual Disability

Summary

The goal of this mixed methods study aims to develop and pilot test an augmentative and alternative communication (AAC) intervention for toddlers with intellectual and developmental disabilities (IDD) and their families. The main question it aims to answer is: Will this AAC intervention improve caregivers' use of naturalistic AAC intervention strategies, leading to increases in children's communication? The investigators will employ qualitative methods to conduct interviews to determine caregiver and speech-language pathologist preferences regarding an AAC intervention. Findings from these interviews will inform the adaptation of the AAC intervention procedures, service delivery approach, and strategies to increase caregiver's treatment adherence. Next, the researchers will conduct six multiple baseline designs across behaviors (AAC strategies) to develop the AAC intervention and demonstrate preliminary efficacy when delivered to families in-person. Caregiver-child dyads will receive 24 in-person intervention sessions during which the therapist will provide AAC instruction and coaching on using AAC strategies to caregivers. Last, the investigators will pilot test the AAC intervention using a hybrid telehealth model with nine caregiver-child dyads. Caregiver-child dyads will receive 24 intervention sessions, eight sessions provided to families in-person, and 16 sessions provided to families via telehealth. Our long-term goal is to develop a socially valid and effective intervention to improve language outcomes for toddlers with IDD. The researchers propose developing and pilot testing a hybrid telehealth AAC intervention for toddlers with IDD and their families. Researchers employ an implementation science approach, using systematic qualitative methods to identify caregivers' preferences and single-case experimental design methods to assess the feasibility of the AAC intervention. The central hypothesis is that the intervention will improve caregivers' use of naturalistic AAC intervention strategies, leading to increases in children's communication.

Eligibility

Min Age: 24 Months

Inclusion Criteria23

Speech-Language Pathologists:
age > 18 years
full or part-time employment providing language intervention to children 24 - 36 months with IDD
has at least 1 child on their caseload who uses AAC
has 2 or more years of experience providing AAC to children with IDD
able to speak, understand, and read English.
Caregivers:
age > 18 years
parent, primary caregiver, or legal guardian of a child age 24 - 36 months with IDD
has at least 6 months of experience receiving early intervention, and
able to speak, understand, and read English.
Children:
age 24 - 36 months
diagnosis of IDD confirmed by caregiver or medical record
severe developmental delay, defined as a score of > 2 standard deviations below the mean on the Mullen Scales of Early Learning (MSEL) Early Learning Composite
severe expressive language impairment, defined as a score of < 12 months on the Expressive Language Subscale of the MSEL and expressive vocabulary and < 10 words (signs, or symbols) per caregiver report on the MacArthur-Bates Communicative Development Inventories Words and Gestures (MCDI-WG)
receptive vocabulary of at least 50 words, per caregiver report on MCDI-WG
use of intentional communication behaviors, defined as a score of > 7 on the Communication Complexity Scale
sufficient motor skills to sit upright with support, interact with toys provided during the assessment, and access the AAC system
hearing within normal limits, defined as 0 to 25 dbHL in at least one ear
vision within normal limits, defined as 20/80 visual acuity or better in at least one eye, and
exposure to English in the home or community.
Children with uncontrolled seizure disorders will be excluded.

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Interventions

BEHAVIORALEarly Augmentative and Alternative Communication (AAC) Intervention

Caregivers will receive 24, 50 min intervention sessions twice a week for three months. During each intervention session, the therapist provides instruction and coaching on using AAC and a set of evidence-based language support strategies. Strategies are taught sequentially in three phases: (1) Responding to all Communication, (2) Teaching Words, and (3) Creating Communication Opportunities. Caregivers practice using the AAC intervention strategies during three, five-minute routines with their children. Therapists coach the caregiver on using the targeted strategies during these routines, encouraging caregivers to reflect on their implementation, and developing a plan to use the AAC strategies during activities not practiced during the intervention session. The AAC intervention is provided to families using an evidence-based service delivery model, Family Guided Routines Based Intervention.