Synthetic Speech: Does it increase social interaction?

1. Synthetic Speech:Does it increase social interaction? Melissa Bairos, Emily Emanuel, Aviva Krauthammer, Jen Perkins, Holly Reis, and Beth Zaglin

2. Description of AAC User • Elizabeth: 7;6 year old girl • Spastic Cerebral Palsy • Mild-Moderate Cognitive Delay • Impaired vision

3. Description of Elizabeth • Attends a self-contained first grade classroom • Has a one-on-one aid at all times • Uses wheelchair for mobility • Not motorized due to vision impairment • Dependent for all activities of daily living

4. Description of Elizabeth • No functional verbal output • Uses BIGmack switches to say “hello/goodbye” • Turns head to side for “No” • Knocks for “Yes” • Range of motion with arms: good • Able to make fist and point • Unable to isolate finger to point • Able to hold pointer in fist and purposefully point

5. Description of Elizabeth • Parents, IEP team want Elizabeth to use a speech generating device (SGD) • Social interaction • Express wants and needs • Recommendation: 7-Level Communication Builder

6. Well-built question Will the use of a speech generating device increase social interaction for a child with AAC needs?

7. Search Strategies • Data Base ResearchEBSCOTerms usedSynthetic speech and requestYield4 references, one of which included information pertaining to topic (Affect of Speech output on maintenance of requesting and frequency of vocalization in 3 children with developmental disabilities ~ Sigafoos et al) • Hand SearchReview of Affect of Speech output on maintenance of requesting and frequency of vocalization in 3 children with developmental disabilities ~ Sigafoos et alAcquisition and functional use of voice output communication of persons with profound multiple disabilities ~ Behavior Modification Journal Vol 20, pgs. 451-468, 1996 • Data Base ResearchPsycInfoTerms usedAugmenatative and Alternative Communication and palsy and socialYieldOne article included information related to the topics (Functional Communication training with assistive devices: Effects on challenging behaviors and affect) • Data Base ResearchCINAHLTerms usedOutput and communication and peerYield20 references, 2 included sections pertaining to topics1- Influence of communicative competence in AAC technique on children’s towards a peer who uses AAC.2- Attitudes of school aged kids toward peers who use AAC • Data Base ResearchPsycInfoTerms usedPalsy and children and language and requestingYield1 reference, (Developing functional requesting: Acquisition, durability, and generalization of effects.) • Data Base ResearchPsycInfoTerms usedRequesting and cerebral palsyYield1 reference, (Extending the application of constant time delay: Teaching a requesting skill to students with severe multiple disabilities) • Data Base ResearchPsycInfoTerms usedRequest and language and cerebral palsyYield1 references, (Functional Communication training using assistive devices: Effects on challenging behavior and affect)

8. Evidence Sources • Attitudes of children towards an unfamiliar peer using an AAC device with and without a voice output (Lilienfeld and Allant, 2002) • An overview • The study found that children’s attitudes towards peers who use AAC devices are more positive when the AAC device has voice output • The more positive the attitude of the peers the more likely that social interaction will increase

9. Validity • Internal: high • Difference in attitudes toward AAC user can be attributed to speech output device vs. non-speech output device • Instrumentation used has been proven to have good construct validity (Lilienfeld and Allant, 2002) • External: medium • Study can be replicated. • Not in the US, used peers and AAC user of average intelligence, and videotape as opposed to real interaction • Social: low • Results were not discussed with relevant stakeholders and consumer • No social comparison

10. Evidence Sources • The effects of information and Augmentative Communication Technique on attitudes toward non-speaking individuals (Gorenflo and Gorenflo1991) • An overview • Less favorable attitudes towards user of low tech (alphabet board) than user of a high tech (voice output) device • This study also demonstrated that the more positive the attitude of the peers the more likely that social interaction will increase

11. Validity • Internal: high • The difference in attitudes toward the AAC user can be attributed to the different AAC devices used (alphabet board vs. VOCA) • The instrumentation used has been proven to be internally consistent and valid (Gorenflo & Gorenflo) • External: medium • Study can be replicated • AAC user was adult male of average intelligence and within a controlled setting • Social: low • Results were not discussed with relevant stakeholders and consumer • No social comparison

12. Communication of Findings • Overall conclusion: even though we cannot directly answer our question based on the available research, we can draw indirect conclusions that an SGD would promote social interaction. • Attitudes were more positive when an SGD was used compared to a non-SGD. • There is no evidence stating that non-SGD increases social interaction.

13. Question for You • Have you worked in a setting with a child who used an AAC speech generating device? • How did the peers respond to the AAC user?

14. Questions for us?