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Augmentative and Alternative Communication in Autism Education: A Systematic Review

Esther Ajayi

Abstract

Communication difficulties remain one of the most defining features of autism spectrum disorder , and a substantial proportion of children on the spectrum enter formal schooling with limited or no functional speech. Augmentative and alternative communication has, over the past three decades, matured from a last-resort intervention into a central component of educational practice for learners with complex communication needs. This systematic review synthesises the peer-reviewed classroom-based evidence published between 2009 and 2019 on three of the most widely deployed AAC modalities for children with ASD: The Picture Exchange Communication System , speech-generating devices , and low-technology communication boards. Drawing on peer-reviewed journal articles, single-case experimental studies, group comparison studies, practitioner-oriented syntheses, and prior meta-analyses, the review maps the theoretical scaffolds of each modality, interrogates the evidence for requesting, commenting, and social use, examines the role of instructional assistants and paraprofessionals in mediating AAC use, and reflects on the methodological limitations of the existing corpus. The review argues that no single AAC modality is empirically superior across all learners, developmental profiles, and classroom ecologies, and that practitioner decision-making should be guided by a learner-first, modality-flexible framework that privileges communicative function, naturalistic opportunity, and stakeholder buy-in. Implications are drawn for teachers, paraprofessionals, speech-language therapists, and school leaders operating in inclusive and specialist settings. The review concludes with a set of propositions for future research, including the need for longer follow-up periods, greater attention to cross-cultural implementation, and stronger integration between AAC provision and the broader curriculum.

Keywords

CommunicationAutismSpectrum disorderPicture ExchangeSpeech-generating devices

References

Barnes, C. S., Dunning, J. L., & Rehfeldt, R. A. (2011). An evaluation of strategies for training staff to implement the picture exchange communication system. Research in Autism Spectrum Disorders, 5(4), 1574–1583. Beukelman, D. R., & Mirenda, P. (2013). Augmentative and alternative communication: Supporting children and adults with complex communication needs (4th ed.). Paul H. Brookes. Biggs, E. E., Carter, E. W., & Gustafson, J. (2018). Efficacy of peer support arrangements to increase peer interaction and AAC use. American Journal on Intellectual and Developmental Disabilities, 122(1), 25–48. Binger, C., & Light, J. (2007). The effect of aided AAC modeling on the expression of multi- symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication, 23(1), 30–43. Binger, C., Kent-Walsh, J., Ewing, C., & Taylor, S. (2010). Teaching educational assistants to facilitate the multisymbol message productions of young students who require augmentative and alternative communication. American Journal of Speech-Language Pathology, 19(2), 108–120. Boesch, M. C., Wendt, O., Subramanian, A., & Hsu, N. (2013). Comparative efficacy of the Picture Exchange Communication System versus a speech-generating device: Effects on requesting skills. Research in Autism Spectrum Disorders, 7(3), 480–493. Bondy, A. S., & Frost, L. A. (1994). The Picture Exchange Communication System. Focus on Autistic Behavior, 9(3), 1–19. Bondy, A. S., & Frost, L. A. (2001). The Picture Exchange Communication System. Behavior Modification, 25(5), 725–744. Brady, N. C., Bruce, S., Goldman, A., Erickson, K., Mineo, B., Ogletree, B. T., ... & Wilkinson, K. (2016). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. American Journal on Intellectual and Developmental Disabilities, 121(2), 121–138. Calculator, S. N. (1988). Promoting the acquisition and generalization of conversational skills by individuals with severe disabilities. Augmentative and Alternative Communication, 4(2), 94–103. Cannella-Malone, H. I., DeBar, R. M., & Sigafoos, J. (2010). An examination of preference for augmentative and alternative communication devices with two boys with significant intellectual disabilities. Augmentative and Alternative Communication, 26(4), 262–273. Carr, D., & Felce, J. (2007). The effects of PECS teaching to Phase III on the communicative interactions between children with autism and their teachers. Journal of Autism and Developmental Disorders, 37(4), 724–737. Carter, E. W., O'Rourke, L., Sisco, L. G., & Pelsue, D. (2009). Knowledge, responsibilities, and training needs of paraprofessionals in elementary and secondary schools. Remedial and Special Education, 30(6), 344–359. Carter, M., & Maxwell, K. (1998). Promoting interaction with children using augmentative communication through a peer-directed intervention. International Journal of Disability, Development and Education, 45(1), 75–96. Charlop-Christy, M. H., Carpenter, M., Le, L., LeBlanc, L. A., & Kellet, K. (2002). Using the picture exchange communication system with children with autism. Journal of Applied Behavior Analysis, 35(3), 213–231. www.ijee.io Cress, C. J., & Marvin, C. A. (2003). Common questions about AAC services in early intervention. Augmentative and Alternative Communication, 19(4), 254–272. Crowe, B., Machalicek, W., Wei, Q., Drew, C., & Ganz, J. (2022). Augmentative and alternative communication for children with intellectual and developmental disability: A mega-review of the literature. Journal of Developmental and Physical Disabilities, 34(1), 1-42. Donaldson, A. L., & Stahmer, A. C. (2014). Team collaboration: The use of behavior principles for serving students with ASD. Language, Speech, and Hearing Services in Schools, 45(4), 261–276. Douglas, S. N., Light, J. C., & McNaughton, D. B. (2013). Teaching paraeducators to support the communication of young children with complex communication needs. Topics in Early Childhood Special Education, 33(2), 91–101. Drager, K., Light, J., & McNaughton, D. (2010). Effects of AAC interventions on communication and language for young children with complex communication needs. Journal of Pediatric Rehabilitation Medicine, 3(4), 303–310. Erickson, K. A., Hatch, P., & Clendon, S. (2010). Literacy, assistive technology, and students with significant disabilities. Focus on Exceptional Children, 42(5), 1–16. Flippin, M., Reszka, S., & Watson, L. R. (2010). Effectiveness of the Picture Exchange Communication System on communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal of Speech-Language Pathology, 19(2), 178–195. Flores, M., Musgrove, K., Renner, S., Hinton, V., Strozier, S., Franklin, S., & Hil, D. (2012). A comparison of communication using the Apple iPad and a picture-based system. Augmentative and Alternative Communication, 28(2), 74–84. Frea, W. D., Arnold, C. L., & Vittimberga, G. L. (2001). A demonstration of the effects of augmentative communication on the extreme aggressive behavior of a child with autism. Journal of Positive Behavior Interventions, 3(4), 194–198. Frost, L., & Bondy, A. (2002). The Picture Exchange Communication System training manual (2nd ed.). Pyramid Educational Products. Fuller, D. R., & Lloyd, L. L. (1991). Toward a common usage of iconicity terminology. Augmentative and Alternative Communication, 7(3), 215–220. Ganz, J. B. (2015). AAC interventions for individuals with autism spectrum disorders: State of the science and future research directions. Augmentative and Alternative Communication, 31(3), 203–214. Ganz, J. B., Davis, J. L., Lund, E. M., Goodwyn, F. D., & Simpson, R. L. (2012). Meta-analysis of PECS with individuals with ASD: Investigation of targeted versus non-targeted outcomes. Research in Developmental Disabilities, 33(2), 406–418. Ganz, J. B., Mason, R. A., Goodwyn, F. D., Boles, M. B., Heath, A. K., & Davis, J. L. (2014). Interaction of participant characteristics and type of AAC with individuals with ASD: A meta-analysis. American Journal on Intellectual and Developmental Disabilities, 119(6), 516–535. Ganz, J. B., Morin, K. L., Foster, M. J., Vannest, K. J., Genc Tosun, D., Gregori, E. V., & Gerow, S. L. (2017). High-technology augmentative and alternative communication for individuals with intellectual and developmental disabilities and complex communication needs: A meta-analysis. Augmentative and Alternative Communication, 33(4), 224-238. Ganz, J. B., Rispoli, M. J., Mason, R. A., & Hong, E. R. (2013). Moderation of effects of AAC based on setting and types of aided AAC on outcome variables: An aggregate study of www.ijee.io single-case research with individuals with ASD. Developmental Neurorehabilitation, 17(3), 184–192. Gevarter, C., O'Reilly, M. F., Rojeski, L., Sammarco, N., Lang, R., Lancioni, G. E., & Sigafoos, J. (2013). Comparing communication systems for individuals with developmental disabilities: A review of single-case research studies. Research in Developmental Disabilities, 34(12), 4415–4432. Giangreco, M. F., Suter, J. C., & Doyle, M. B. (2010). Paraprofessionals in inclusive schools: A review of recent research. Journal of Educational and Psychological Consultation, 20(1), 41–57. Goldbart, J., & Marshall, J. (2004). 'Pushes and pulls' on the parents of children who use AAC. Augmentative and Alternative Communication, 20(4), 194–208. Halliday, M. A. K. (1975). Learning how to mean: Explorations in the development of language. Edward Arnold. Harris, M. D., & Reichle, J. (2004). The impact of aided language stimulation on symbol comprehension and production in children with moderate cognitive disabilities. American Journal of Speech-Language Pathology, 13(2), 155–167. Holyfield, C., Drager, K. D. R., Kremkow, J. M. D., & Light, J. (2017). Systematic review of AAC intervention research for adolescents and adults with autism spectrum disorder. Augmentative and Alternative Communication, 33(4), 201-212. Howlin, P., Gordon, R. K., Pasco, G., Wade, A., & Charman, T. (2007). The effectiveness of Picture Exchange Communication System training for teachers of children with autism: A pragmatic, group randomised controlled trial. Journal of Child Psychology and Psychiatry, 48(5), 473–481. Iacono, T., Trembath, D., & Erickson, S. (2016). The role of augmentative and alternative communication for children with autism: Current status and future trends. Neuropsychiatric Disease and Treatment, 12, 2349–2361. Kagohara, D. M., van der Meer, L., Ramdoss, S., O'Reilly, M. F., Lancioni, G. E., Davis, T. N., ... & Sigafoos, J. (2013). Using iPods and iPads in teaching programs for individuals with developmental disabilities: A systematic review. Research in Developmental Disabilities, 34(1), 147–156. Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R., ... & Almirall, D. (2014). Communication interventions for minimally verbal children with autism: A sequential multiple assignment randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 53(6), 635–646. Kent-Walsh, J., & Binger, C. (2018). Methodological advances, opportunities, and challenges in AAC research. Augmentative and Alternative Communication, 34(2), 93-103. Kent-Walsh, J., & McNaughton, D. (2005). Communication partner instruction in AAC: Present practices and future directions. Augmentative and Alternative Communication, 21(3), 195– 204. Kent-Walsh, J., Murza, K. A., Malani, M. D., & Binger, C. (2015). Effects of communication partner instruction on the communication of individuals using AAC: A meta-analysis. Augmentative and Alternative Communication, 31(4), 271–284. Koegel, L. K., & Koegel, R. L. (2012). The PRT pocket guide: Pivotal Response Treatment for autism spectrum disorders. Paul H. Brookes. Koegel, L. K., Singh, A. K., & Koegel, R. L. (2012). Improving motivation for academics in children with autism. Journal of Autism and Developmental Disorders, 42(6), 1057–1066. www.ijee.io Kummerer, S. E. (2010). Language intervention for Hispanic children with language-learning disabilities: Evidence-based practice. Intervention in School and Clinic, 46(2), 84–94. Light, J. (1988). Interaction involving individuals using augmentative and alternative communication systems: State of the art and future directions. Augmentative and Alternative Communication, 4(2), 66–82. Light, J., & Drager, K. (2007). AAC technologies for young children with complex communication needs: State of the science and future research directions. Augmentative and Alternative Communication, 23(3), 204–216. Light, J., & McNaughton, D. (2012). The changing face of augmentative and alternative communication: Past, present, and future challenges. Augmentative and Alternative Communication, 28(4), 197–204. Light, J., & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication? Augmentative and Alternative Communication, 30(1), 1–18. Light, J., McNaughton, D., & Caron, J. (2014). New and emerging AAC technology supports for children with complex communication needs and their communication partners: State of the science and future research directions. Augmentative and Alternative Communication, 35(1), 26–41. Light, J., McNaughton, D., Beukelman, D., Fager, S. K., Fried-Oken, M., Jakobs, T., & Jakobs, E. (2019). Challenges and opportunities in augmentative and alternative communication: Research and technology development to enhance communication and participation for individuals with complex communication needs. Augmentative and Alternative Communication, 35(1), 1-12. Logan, K., Iacono, T., & Trembath, D. (2017). A systematic review of research into aided AAC to increase social-communication functions in children with autism spectrum disorder. Augmentative and Alternative Communication, 33(1), 51-64. Lorah, E. R., Parnell, A., Whitby, P. S., & Hantula, D. (2015). A systematic review of tablet computers and portable media players as speech generating devices for individuals with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(12), 3792– 3804. Magiati, I., & Howlin, P. (2003). A pilot evaluation study of the Picture Exchange Communication System for children with autistic spectrum disorders. Autism, 7(3), 297–320. Mandak, K., O'Neill, T., Light, J., & Fosco, G. M. (2017). Bridging the gap from values to actions: A family systems framework for family-centered AAC services. Augmentative and Alternative Communication, 33(1), 32–41. Marshall, J., & Goldbart, J. (2008). 'Communication is everything I think.' Parenting a child who needs augmentative and alternative communication . International Journal of Language & Communication Disorders, 43(1), 77–98. McNaughton, D., & Light, J. (2013). The iPad and mobile technology revolution: Benefits and challenges for individuals who require augmentative and alternative communication. Augmentative and Alternative Communication, 29(2), 107–116. McNaughton, D., & Light, J. (2015). What we write about when we write about AAC: The past 30 years of research and future directions. Augmentative and Alternative Communication, 31(4), 261–270. 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 www.ijee.io disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49(2), 248–264. Mirenda, P. (2003). Toward functional augmentative and alternative communication for students with autism: Manual signs, graphic symbols, and voice output communication aids. Language, Speech, and Hearing Services in Schools, 34(3), 203–216. Mirenda, P., & Iacono, T. (2009). Autism spectrum disorders and AAC. Paul H. Brookes. Mizuko, M. (1987). Transparency and ease of learning of symbols represented by Blissymbolics, PCS, and Picsyms. Augmentative and Alternative Communication, 3(3), 129–136. Morin, K. L., Ganz, J. B., Gregori, E. V., Foster, M. J., Gerow, S. L., Genc-Tosun, D., & Hong, E. R. (2018). A systematic quality review of high-tech AAC interventions as an evidence- based practice. Augmentative and Alternative Communication, 34(2), 104-117. Muharib, R., & Alzrayer, N. M. (2018). The use of high-tech speech-generating devices as an evidence-based practice for children with autism spectrum disorders: A meta-review. Review Journal of Autism and Developmental Disorders, 5(1), 43-57. National Autism Center. (2015). Findings and conclusions: National Standards Project, Phase 2. National Autism Center. Prelock, P. A., & McCauley, R. J. (2012). Treatment of autism spectrum disorders: Evidence- based intervention strategies for communication and social interactions. Paul H. Brookes. Preston, D., & Carter, M. (2009). A review of the efficacy of the picture exchange communication system intervention. Journal of Autism and Developmental Disorders, 39(10), 1471–1486. Prizant, B. M., Wetherby, A. M., Rubin, E., Laurent, A. C., & Rydell, P. J. (2006). The SCERTS model: A comprehensive educational approach for children with autism spectrum disorders. Paul H. Brookes. Reichle, J., York, J., & Sigafoos, J. (1991). Implementing augmentative and alternative communication: Strategies for learners with severe disabilities. Paul H. 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., 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. Rose, V., Trembath, D., Keen, D., & Paynter, J. (2016). The proportion of minimally verbal children with autism spectrum disorder in a community-based early intervention programme. Journal of Intellectual Disability Research, 60(5), 464–477. Schepis, M. M., Reid, D. H., Behrmann, M. M., & Sutton, K. A. (1998). Increasing communicative interactions of young children with autism using a voice output communication aid and naturalistic teaching. Journal of Applied Behavior Analysis, 31(4), 561–578. Schlosser, R. W. (2003). The efficacy of augmentative and alternative communication: Toward evidence-based practice. Academic Press. 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., & Raghavendra, P. (2004). Evidence-based practice in augmentative and alternative communication. Augmentative and Alternative Communication, 20(1), 1–21. www.ijee.io 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. Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., ... & Halladay, A. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428. Sennott, S. C., & Bowker, A. (2009). Autism, AAC, and Proloquo2Go. SIG 12 Perspectives on Augmentative and Alternative Communication, 18(4), 137–145. Sennott, S. C., Light, J. C., & McNaughton, D. (2016). AAC modeling intervention research review. Research and Practice for Persons with Severe Disabilities, 41(2), 101–115. Sigafoos, J. (1999). Creating opportunities for augmentative and alternative communication: Strategies for involving people with developmental disabilities. Augmentative and Alternative Communication, 15(3), 183–190. Sigafoos, J., Lancioni, G. E., O'Reilly, M. F., Achmadi, D., Stevens, M., Roche, L., ... & Green, V. A. (2013). Teaching two boys with autism spectrum disorders to request the continuation of toy play using an iPad-based speech-generating device. Research in Autism Spectrum Disorders, 7(8), 923–930. Sigafoos, J., Schlosser, R. W., & Sutherland, D. (2014). Augmentative and alternative communication. In J. H. Stone & M. Blouin (Eds.), International encyclopedia of rehabilitation. CIRRIE. Son, S. H., Sigafoos, J., O'Reilly, M., & Lancioni, G. E. (2006). Comparing two types of augmentative and alternative communication systems for children with autism. Pediatric Rehabilitation, 9(4), 389–395. Soto, G., & Yu, B. (2014). Considerations for the provision of services to bilingual children who use augmentative and alternative communication. Augmentative and Alternative Communication, 30(1), 83–92. Soto, G., & Zangari, C. (2009). Practically speaking: Language, literacy, and academic development for students with AAC needs. Paul H. Brookes. Stephenson, J. (2009). Iconicity in the development of picture skills: Typical development and implications for individuals with severe intellectual disabilities. Augmentative and Alternative Communication, 25(3), 187–201. Tager-Flusberg, H., & Kasari, C. (2013). Minimally verbal school-aged children with autism spectrum disorder: The neglected end of the spectrum. Autism Research, 6(6), 468–478. Thistle, J. J., & Wilkinson, K. M. (2015). Building evidence-based practice in AAC display design for young children: Current practices and future directions. Augmentative and Alternative Communication, 31(2), 124–136. Tincani, M. (2004). Comparing the Picture Exchange Communication System and sign language training for children with autism. Focus on Autism and Other Developmental Disabilities, 19(3), 152–163. Tincani, M., & Devis, K. (2011). Quantitative synthesis and component analysis of single- participant studies on the picture exchange communication system. Remedial and Special Education, 32(6), 458–470. van der Meer, L., & Rispoli, M. (2010). Communication interventions involving speech-generating devices for children with autism: A review of the literature. Developmental Neurorehabilitation, 13(4), 294–306. www.ijee.io van der Meer, L., Sutherland, D., O'Reilly, M. F., Lancioni, G. E., & Sigafoos, J. (2012). A further comparison of manual signing, picture exchange, and speech-generating devices as communication modes for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 6(4), 1247–1257. Wendt, O. (2009). Research on the use of manual signs and graphic symbols in autism spectrum disorders: A systematic review. In P. Mirenda & T. Iacono (Eds.), Autism spectrum disorders and AAC (pp. 83–139). Paul H. Brookes. Wetherby, A. M., & Prizant, B. M. (2000). Autism spectrum disorders: A transactional developmental perspective. Paul H. Brookes. Wilkinson, K. M., & Hennig, S. (2007). The state of research and practice in augmentative and alternative communication for children with developmental/intellectual disabilities. Mental Retardation and Developmental Disabilities Research Reviews, 13(1), 58–69. Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., ... & Schultz, T. R. (2015). Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951–1966. Yoder, P. J., & Stone, W. L. (2006). A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. Journal of Speech, Language, and Hearing Research, 49(4), 698–711.