Howard C. Shane

Purpose: In this commentary, we respond to an article written by autism parent David Kaufer and entitled “WHY MESSAGE-PASSING IS INVALID: The Test Designed to Fail Nonspeaking Autistic People.” Method: We analyzed the claims made by Kaufer through a human rights lens and from the viewpoint of the authors having extensive disciplinary knowledge across linguistics, speech-language pathology, and educational psychology in the fields of autism, language, behavior, augmentative and alternative communication, and motor speech disorders. Three have provided expert testimony in several legal or educational cases involving authorship testing, and all have recently published guidance on authorship testing in support of human rights for minimally or nonspeaking individuals. Results: Kaufer offers no confirming or disconfirming evidence for his claims in opposition to authorship testing, and his article is erroneous and of concern in repeatedly mischaracterizing authorship tests. Authorship tests are not psychological tests and do not measure psychological states, cognition, language skills, or motor planning skills. Rather, authorship tests are a commonsense way to determine who the author of messages constructed using Facilitated Communication (FC), Spelling to Communicate, or other variants. Furthermore, a speech, limb, or body apraxia in an autistic person—even if present—would not prevent that person from being able to reliably point to answer questions in a message-passing test. Conclusions: The safeguarding of human rights of people who are minimally or nonspeaking is of the utmost importance. Considering the harms of facilitator control over messages produced using FC or its variants and associated human rights violations, access to authorship testing should be considered a human right and, as such, provided to every person subjected to these techniques.

As artificial intelligence (AI) makes significant headway in various arenas, the field of speech–language pathology is at the precipice of experiencing a transformative shift towards automation. This study introduces QuickPic AAC, an AI-driven application designed to generate topic-specific displays from photographs in a “just-in-time” manner. Using QuickPic AAC, this study aimed to (a) determine which of two AI algorithms (NLG-AAC and GPT-3.5) results in greater specificity of vocabulary (i.e., percentage of vocabulary kept/deleted by clinician relative to vocabulary generated by QuickPic AAC; percentage of vocabulary modified); and to (b) evaluate perceived usability of QuickPic AAC among practicing speech–language pathologists. Results revealed that the GPT-3.5 algorithm consistently resulted in greater specificity of vocabulary and that speech–language pathologists expressed high user satisfaction for the QuickPic AAC application. These results support continued study of the implementation of QuickPic AAC in clinical practice and demonstrate the possibility of utilizing topic-specific displays as just-in-time supports.

As artificial intelligence (AI) makes significant headway in various arenas, the field of Speech-Language Pathology is at the precipice of experiencing a transformative shift towards automation. This study introduces QuickPic AAC, an AI-driven application designed to generate topic-specific displays from photographs in a "just-in-time" manner. Using QuickPic AAC, this study aimed to (a) determine which of two AI algorithms (NLG-AAC and GPT-3.5) results in greater specificity of vocabulary (i.e., percentage of vocabulary kept/deleted by clinician relative to vocabulary generated by QuickPic AAC; percentage of vocabulary modified); and to (b) evaluate perceived usability of QuickPic AAC among practicing speech-language pathologists. Results revealed that the GPT-3.5 algorithm consistently resulted in greater specificity of vocabulary and that speech-language pathologists expressed high user satisfaction for the QuickPic AAC application. These results support continued study of the implementation of QuickPic AAC in clinical practice and demonstrate the possibility of utilizing topic-specific displays as just-in-time supports.

Traditional topic-specific communication boards for Augmentative and Alternative Communication (AAC) require manual programming of relevant symbolic vocabulary, which is time-consuming and often impractical even for experienced Speech-Language Pathologists (SLPs). While recent research has demonstrated the potential to automatically generate these boards from photographs using artificial intelligence, there has been no exploration on how to design such tools to support the specific needs of AAC-based language instruction. This paper introduces QuickPic, a mobile AAC application co-designed with SLPs and special educators, aimed at enhancing language learning for non-speaking individuals, such as autistic children. Through a 17-month design process, we uncover the unique design features required to provide timely language support in therapy and special education contexts. We present emerging evidence on the overall satisfaction of SLPs using QuickPic, and on the advantages of large language model-based generation compared to the existing technique for automated vocabulary from photographs for AAC.

Facilitated communication (FC) has been a heavily debated and documented topic across multiple disciplines, including sociology, education, psychology, pediatrics, speech-language pathology, and disability studies. Although many professionals from various disciplines and advocates have offered opinions, suggestions, and research on the topic, there has been minimal input from the occupational therapy (OT) profession. The lack of OT input is noteworthy as OTs are experts in enabling upper extremity performance and independence through a variety of training, adaptation and modification strategies, and use of external supports. Because of their professional code of ethics and a specific knowledge base, OTs are uniquely positioned to provide a host of ethical and evidence-based strategies that enable independent access to communication technology. The consideration of multiple access options is contrary to the typical facilitated encounter where facilitators exclusively choose to manipulate an upper extremity in order for letters to be selected on a display or keyboard. The purpose of this paper is threefold: (a) To offer insight into the standard of care by OTs including their ethical standards; (b) to identify varied accommodations that enable access using a feature-matching standard of care that eliminates the need for a facilitator; and (c) to highlight how to increase independent assistive technology/augmentative and alternative communication access, thus dissuading the need or use of facilitated access to letters.

Purpose: Miniature linguistic systems (also known as matrix training) is a method of organizing learning targets to achieve generative learning or recombinative generalization. This systematic review is aimed at determining whether matrix training is effective for individuals with autism spectrum disorder (ASD) in terms of improving recombinative generalization for instruction-following, expressive language, play skills, and literacy skills.Method: A systematic review methodology was employed to limit bias in the various review stages. A multifaceted search was conducted. Potential primary studies were imported into Covidence, a systematic review software, and inclusion criteria were applied. Data were extracted regarding (a) participant characteristics, (b) matrix designs, (c) intervention methods, and (d) dependent variable. A quality appraisal using the What Works Clearinghouse (WWC) Single-Case Design Standards (Version 1.0, Pilot) was carried out. In addition to the visual analysis of the data, an effect size estimate, non-overlap of all pairs (NAP), was generated for each participant. Independentttests and between-subjects analyses of variance were conducted to identify moderators of effectiveness.Results: Twenty-six studies including 65 participants met criteria for inclusion. All included studies were single-case experimental designs. Eighteen studies received a rating ofMeets Standards Without ReservationsorMeets Standards With Reservations. The aggregated combined NAP scores for acquisition, recombinative generalization, and maintenance of a range of outcomes were in the high range.Conclusions: Findings suggested that matrix training is an effective teaching method for individuals with ASD for acquisition, recombinative generalization, and maintenance of a range of outcomes. Statistical analyses to identify moderators of effectiveness were insignificant. Based on the WWC Single-Case Design Standards matrix training meets criteria to be considered an evidence-based practice for individuals with ASD.

The objective of this case report is to demonstrate how a dynamic assessment approach may be utilized to identify appropriate augmentative and alternative communication (AAC) tools to support the expressive and receptive language skills among individuals with autism spectrum disorder (ASD) who are minimally verbal. This case report details an AAC assessment for Jack, a four-year-old boy diagnosed with ASD and a mixed receptive-expressive language disorder. Specific strategies from the Visual Immersion System™ (VIS™), which is a treatment approach that utilizes the visual strengths of individuals with ASD, were identified and incorporated into Jack’s treatment. Jack’s case highlights the need to use a thorough, individualized assessment approach that includes identifying the level of symbolic representation prior to selecting appropriate AAC supports to facilitate continued development of receptive and expressive language for individuals with ASD.

A substantial portion of individuals with autism spectrum disorder (ASD) are nonspeaking, requiring alternative and augmentative communication (AAC) to convey wants and needs with others. With many options available to consumers, AAC systems are often selected without carefully matching the needs of the communicator with the appropriate AAC features. This chapter details the use of the feature-matching process to obtain a high-tech AAC device for a young child with ASD who was using his previous AAC system solely to request. The feature-matching process entailed a multidisciplinary evaluation to select an AAC system that best fit his current and future communication needs, and completion of an evidence-based trial to ensure appropriateness of the device. As a result of this process, the child became a more effective communicator by replacing maladaptive behaviors with functional communication, broadening the purposes for which he communicated, and expanding his circle of communication partners.