Application of Augmentative and Alternative Communication to stimulate communicative intention and cognition in patients with Autism Spectrum Disorder

Mendonça, Renata da Costa Rebello de; Marques, Glória; Lione, Viviane de Oliveira Freitas; Grokoski, Kamila Castro

doi:10.1590/1982-0216/20232556823

Renata da Costa Rebello de Mendonça

Conceptualization

Data curation

Formal analysis

Investigation

Methodology

Project administration

Writing - original draft

Writing - review & editing

Instituto Priorit, Departamento de Fonoaudiologia, Rio de Janeiro, Rio de Janeiro, Brasil.

Universidade Federal Fluminense - UFF, Curso de Mestrado Profissional em Diversidade e Inclusão, Niterói, Rio de Janeiro, Brasil.

https://orcid.org/0000-0003-0940-1831

Glória Marques

Conceptualization

Data curation

Formal analysis

Investigation

Methodology

Project administration

Writing - original draft

Writing - review & editing

Instituto Priorit, Departamento de Fonoaudiologia, Rio de Janeiro, Rio de Janeiro, Brasil.

https://orcid.org/0000-0002-2206-2179

Viviane de Oliveira Freitas Lione

Conceptualization

Data curation

Investigation

Methodology

Project administration

Writing - original draft

Writing - review & editing

Universidade Federal Fluminense - UFF, Curso de Mestrado Profissional em Diversidade e Inclusão, Niterói, Rio de Janeiro, Brasil.

Universidade Federal do Rio de Janeiro - UFRJ, Faculdade de Farmácia, Departamento de Fármacos e Medicamentos, Rio de Janeiro, Rio de Janeiro, Brasil.

https://orcid.org/0000-0003-4225-698X

Kamila Castro Grokoski

Conceptualization

Data curation

Formal analysis

Investigation

Methodology

Project administration

Writing - original draft

Writing - review & editing

Universidade Federal Fluminense - UFF, Curso de Mestrado Profissional em Diversidade e Inclusão, Niterói, Rio de Janeiro, Brasil.

Instituto Priorit, Departamento de Pesquisa, Desenvolvimento e Inovação, Rio de Janeiro, Rio de Janeiro, Brasil.

https://orcid.org/0000-0003-0100-1788

Corresponding author: Kamila Castro Grokoski, PhD, Avenidas das Américas 3301, BL 1, lojas 105,108 e 109 - Barra da Tijuca, CEP: 22631-003 - Rio de Janeiro, Rio de Janeiro, Brasil, E-mail: pesquisa@institutopriorit.com.br

Conflict of interests: Nonexistent.

This questionnaire had 19 questions, organized into comprehensive (1 - 8) and expressive aspects (9 - 17) and both (18 and 19). The score ranges from 19 to 84 - higher scores indicate greater communicative intention difficulties.

(1) Initial perception of the environment and engagement: (1) Notices the presence of the parent/guardian; (2) Does not notice the presence of the parent/guardian.
(2) Eye contact: (1) Makes eye contact; (2) Makes occasional eye contact; (3) Does not make eye contact.
(3) Gesture imitation: (1) Imitates gesture models; (2) Does not imitate.
(4) Comprehensive language: (1) Responds when called by name; (2) Responds to requests; (3) Partially responds to requests; (4) Reacts to sound stimuli; (5) Does not respond to requests; (6) Does not respond to sound stimuli.
(5) Comprehension of intonation changes: (1) Understands prosody changes; (2) Partially understands prosody changes; (3) Does not understand prosody changes.
(6) Social Language: 1) Uses social language; (2) Partially uses social language; (3) Does not use social language.
(7) Reading: (1) Reads; (2) Partially reads; (3) Does not read.
(8) Verbal Comprehension: (1) Understands orders with three or more actions, requests, or comments; (2) Understands two unrelated orders; (3) Understands situational orders with one action, not accompanied by gestures; (4) Understands situational orders with one action, accompanied by gestures; (5) Responds when called by name; (6) Responds not systematically to a request, accompanied by gestures; (7) Does not respond to language.
(9) Expressive language: (1) Verbal; (2) Communicative skill; (3) Partially uses expressive language; (4) Uses expressive language; (5) Uses unintelligible sounds; (6) Does not use expressive language.
(10) Communicative intention: (1) Begins communication; (2) Responds to the interlocutor; (3) Has low communicative intention; (4) Has communicative intention with inadequate resources; (5) Does not have any communicative intention.
(11) Gestural language: (1) Uses gestural language; (2) Partially uses gestural language; (3) Does not use gestural language.
(12) Communicative functions: (1) Interactive; (2) Informative; (3) Naming; (4) Narrative; (5) Protest; (6) Instrumental.
(13) Means of Communication: (1) Words; (2) Gestures; (3) Vocalizations.
(14) Echolalia: (1) Does not use echolalia; (2) Partially uses echolalia; (3) Uses echolalia.
(15) Written language: (1) Uses written language; (2) Partially uses written language; (3) Does not use written language.
(16) Language contextualization: (1) The language goes beyond the immediate situation, referring to more distant events; (2) The language describes the action that is taking place and does not go beyond the immediate context; (3) The language refers only to the immediate concrete situation.
(17) Imitation/symbolic play: (1) Uses verbal language to report what is happening in the play situation; (2) Develops symbolic play; (3) Organizes symbolic sequences; (4) Uses dolls or action figures; (5) Does not use symbolic behavior.
(18) Level of toy organization: (1) Sorts toys according to their differences, following criteria; (2) Sorts objects by trial and error; (3) Groups toys in categories; (4) Puts objects in a row; (5) Makes little groups; (6) Handles toys in a disorganized way.
(19) Cognitive aspects: (1) Explores objects one by one in a diversified way; (2) Handles two or more objects repetitively and simultaneously, relating them; (3) Persists in the activity when obstacles appear, trying to overcome them; (4) Explores objects one by one, repetitively; (5) Gives up when an obstacle appears; (6) Is not interested in objects.

Phase	Description	PAC notebook	Session record
1	A single figure is shown. The therapist stimulates the patient to remove the image from the notebook sheet, assisting them at the same time if necessary for the action to be complete. The therapist must support the patient in this phase so they can understand what they need to do; the support is gradually removed. The patient only advances to the next phase when they manage to hand the card to the therapist autonomously.	Only one communication card is included in the notebook. The communication cards measure 4.0 x 4.0 cm.	The patient must be able to remove the figure from the communication notebook sheet and hand it to the therapist. (1) The patient was able to remove the figure from the notebook sheet and hand it to the therapist with their support. (2) The patient was able to remove the figure from the notebook sheet and hand it to the therapist independently. (3) The patient was unable to remove the figure.
2	Two cards are included in the notebook. The therapist chooses the figures on the cards (based on the patient’s interest). At this moment, the patient is free to choose which card will be used. The number of cards in this phase may progress to six.	2 to 6 cards are used. The communication cards measure 4.0 x 4.0 cm.	The patient must be able to choose the figure form among six options on the notebook sheet. (1) The patient was able to choose a figure among two options on the notebook sheet and hand it to the therapist with their support. (2) The patient was able to choose a figure among three options on the notebook sheet and hand it to the therapist, independently. (3) The patient was able to choose a figure among six options on the notebook sheet and hand it to the therapist with their support.
3	In this phase, the patient is encouraged to be independent in constructing simple sentences, such as “I want x”. Support is still provided when necessary. Records were based on the items used in the previous phase; hence, in this phase, the patient must be able to select the card among six options in the notebook sheet and hand it to the therapist in order, independently.		Introducing the communication notebook and forming sentences. The patient must be able to use the communication notebook and build sentences. (1) The patient was able to choose one figure among six options on the notebook sheet and hand it to the therapist autonomously. (2) The patient was able to choose the “I want” figure (to begin forming sentences) and then the preferred figure, with support. (3) The patient was able to choose the “I want” figure (to begin forming sentences) and then the preferred figure, independently.
4	The patient can fully autonomously remove cards from the notebook and build complete sentences of what they want on the sentence strip. Moreover, multiple commands such as “I want x and y” must be encouraged beginning in this phase.	The strip measures 15 x 5 cm, is made in card stock, laminated, and with Velcro tape (13 x 1.5 cm).	The patient must be able to use the communication notebook, build sentences, and hand the sentence strip, requesting multiple items (“I want paper, scissors, and glue”.) (1) The patient was able to use the communication notebook, forming sentences with multiple items, with support. (2) The patient was able to use the communication notebook, forming sentences with multiple items, autonomously.

Case	Age	Toys	Objects	People	Places	Sensory Resources	Social Plays
1	12.5	Owl game, frog memory game, puzzle (specific figures)	-	Mother, father	House, school, Instituto Priorit	Little ball, pop-it	Dancing, tickling
2	13.4	Super-hero games and activities	-	Mother, father, brother	House, Instituto Priorit	Ball	Yes, tickling
3	3.4	Rings, hammer game, tower cups	-	Mother, father, aunt	House, school, Instituto Priorit	Teething toy, ball	Somersault, tickling
4	5.1	Games with letters and books	Cup	Mothers, brother	House, school	Lycra, swing	-
5	3.9	Games (specific figures)	-	Mother, father	House, Instituto Priorit	Purse	-
6	7.6	Castle, dragon, game (specific), plant, princess	-	Mother, father, grandmother	House, school, Instituto Priorit	Bond paper (to wave)	Yes
7	3.6	Ball and books	Pens and crayons	Mother, father	House	Lycra, hammock	Tickling, massage
8	2.4	Ball, shape sorters	Sticks, pots	Mother, father, sister	House	Cream, massage	-
9	3.8	-	Pens, colored pencils	-	-	Sensory rug	Yes
10	3.8	Shape sorters	Pens, colored pencils, paper	Mother, father, brother	House	Ball	Tickling, somersault

Assessment	Total	Comprehensive	Expressive	Comprehensive/Expressive
Initial	67.5 ± 6.53	24.7 ± 3.26	30.4 ± 2.75	12.4 ± 0.84
Final	48.0 ± 10.19	17.6 ± 3.27	23.2 ± 4.91	7.2 ± 2.52
Δ	19.5	7.1	7.2	5.2

Case	Age (years)	Communicative Intention*								Vineland-3 - Communication Subdomain
Case	Age (years)	Total		Comprehensive		Expressive		Comprehensive/Expressive		Receptive/ Equivalent Age		Expressive/ Equivalent Age		Writing/ Equivalent Age
1	12.5	60	45	21	18	27	19	12	8	2.3	2.3	1.4	1.4	5.1	5.1
2	13.4	72	56	28	20	32	28	12	8	1.4	1.4	0.10	0.10	4.2	4.2
3	3.4	71	56	27	19	32	27	12	10	1.0	1.1	0.9	0.10	3.0	3.0
4	5.1	63	36	22	12	29	19	12	5	1.2	1.3	1.6	1.7	4.8	5.1
5	3.9	74	58	27	20	33	28	14	10	1.4	1.7	1.5	1.7	4.2	4.2
6	7.6	56	36	20	14	25	17	11	5	1.8	1.9	1.9	1.10	3.8	3.10
7	3.6	72	61	27	22	32	29	13	10	1.2	1.2	1.1	1.2	<3.0	<3.0
8	2.4	73	55	28	20	32	27	13	8	0.9	1.0	0.8	1.1	-	-
9	3.8	62	36	21	14	29	19	12	3	1.5	1.7	1.4	1.5	3.2	3.7
10	3.8	72	41	26	17	33	19	13	5	1.7	1.7	1.7	1.10	0.4	2.3

[1] Corresponding author: Kamila Castro Grokoski, PhD, Avenidas das Américas 3301, BL 1, lojas 105,108 e 109 - Barra da Tijuca, CEP: 22631-003 - Rio de Janeiro, Rio de Janeiro, Brasil, E-mail: pesquisa@institutopriorit.com.br

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Application of Augmentative and Alternative Communication to stimulate communicative intention and cognition in patients with Autism Spectrum Disorder

ABSTRACT

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