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PURPOSE: To review issues related to the use of augmentative systems with young children and present a case study of one child and family's experience with the System for Augmenting Language (SAL). METHOD: The case involved a preschool child with severe developmental delays who had little functional speech. Acquisition and use of graphic symbols on a speech-output communication device was studied in home and clinical settings. Language and communication behaviours of the child and his communication partners were observed and language assessment measures were collected. RESULTS: Child engagement state varied across the two settings with a stable profile seen in the therapy setting and a clear increase at home. Child communicative attempts increased following the introduction of the augmented system. Parents reported successful use of the SAL. CONCLUSION: SAL is a viable communication intervention approach for young children.

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The communication skills of 13 youth with moderate or severe mental retardation were compared while they communicated with a "standard partner" with and without access to their communication devices. When participants employed the communication device, they were able to convey more appropriate information as well as clearer and more specific information to an unfamiliar adult partner than they were able to convey without the device. These findings highlight the distinct contributions the participants' use of an augmented communication device make to the overall communicative interaction.

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This article provided an introduction to AAC systems for children and adolescents with severe spoken-language disorders. Over the last decade, significant advances have been made in assessment and intervention approaches. For children with severe spoken communication disabilities, the AAC assessment is an ongoing process that includes information about the child's communication development, the child's environments, and the child's physical abilities. Children with severe disabilities who use AAC systems can demonstrate communication achievements far beyond traditional expectations. Recommended assessment and intervention practices are continuing to develop and the future is certainly optimistic for children with severe spoken-language disorders who may use AAC to communicate.

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The word-learning ability of 12 school-age subjects with moderate or severe mental retardation was assessed. Subjects had little or no functional speech and used the System for Augmenting Language with visual-graphic symbols for communication. Their ability to fast map novel symbols revealed whether they possessed the novel name-nameless category (N3C) lexical operating principle. On first exposure, 7 subjects were able to map symbol meanings for novel objects. Follow-up assessments indicated that mappers retained comprehension of some of the novel words for up to delays of 15 days and generalized their knowledge to production. Ability to fast map reliably was related to symbol achievement status. Implications for understanding vocabulary acquisition by youth with mental retardation were discussed.

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The expressive communication of individuals with cognitive impairments may be directly influenced by a partner's input, because such individuals often have limited conversational skills. Sequential analyses of dyadic interactions examined the effects of input by 32 normally developing adolescents on responses by male subjects with mental retardation whose communication modes included augmented communication. Results suggested that (a) verbal prompts in the form of questions were significantly more likely to receive responses from subjects with mental retardation than directive prompts, (b) comments were significantly more likely to receive responses from subjects with retardation than were directive prompts, when the nondisabled peer was male, and (c) male subjects with mental retardation were more likely to respond to input from male peers than from females. These data suggest that questions facilitate naturally occurring conversations but underscore the importance of evaluating gender-related effects on interaction involving persons with severe cognitive and communication impairments.

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The primary purpose of this study was to characterize the frequency and nature of augmented input that adult partners provided to 13 youth with mental retardation as they began to use the System for Augmenting Language (SAL). Analyses of youth-partner interactions revealed differences in the frequency with which home and school partners provided augmented input and in the manner and style of home and school partners' augmented input, particularly in directiveness and position of lexigram symbols within Utterances. Overall, partners naturally provided augmented input in a manner likely to promote youth's learning of the SAL.

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Preschool children with mental retardation typically have delays in language comprehension that may result in difficulty understanding spoken messages. The effect of the systematic application of object and movement cues was investigated to determine whether either or both cues would facilitate children's comprehension of a partner's intended referent during play and snack activities. Children were presented with stimulus items that the communication partner referred to under three conditions: object cue and speech, movement cue and speech, or speech alone. All children identified the intended referents with fewer trials to criterion when object or movement cues were used with speech than when speech alone was employed.

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Research and practice on augmentative communication for persons with moderate or severe mental retardation have primarily targeted the acquisition and use of single symbols. Symbol combinations, however, provide insight into how augmented communicators use individual symbols to build more complex communications. In Study 1, untaught symbol combinations produced during natural communication interactions by 7 subjects with mental retardation were examined for their semantic, ordering, and generalization patterns. The symbol combinations largely resembled those produced by young speaking language learners, suggesting that the augmented communicators were following typical patterns of communication in generating their symbol combinations. In Study 2, we examined the symbol combinations modeled for subjects by their partners. The structure of the modeled combinations did not resemble the children's productions, indicating that the children could not have relied on simple rote imitation for their combination production. These results suggest that augmented communicators with mental retardation may use their symbols as speaking children use oral words in the development of complex communications.

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This study characterizes the success and effectiveness of adult-directed communications of youth with mental retardation and little or no functional speech who used the System for Augmenting Language (SAL), in concert with vocalizations and gestures, to communicate over a 2-year period. Subjects were introduced to the SAL, a speech-output communication device used during daily interactions, to encourage attempts at communication either at home or school. All subjects used the SAL at home and at school during the second year. Results indicate that subjects used the SAL with their extant forms of communication, particularly vocalizations. Extant communications were more successful than SAL communications, although the environment influenced the success of all the youth's communications. The SAL, however, was more effective than vocalizations or gestures in conveying information and interacting with adults in both environments. Maintenance, generalization, and implications for practice are discussed.

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Naturally occurring peer-directed communicative interactions of 13 youth with mental retardation and little or no functional speech who used the System for Augmenting Language (SAL) as their primary means of communication were described. Findings suggest that this system was an integral component of both successful and effective conversations and may be one important means of enhancing social interactions with peer communicative partners who have and do not have mental retardation.

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Fifty nonspeaking or minimally speaking subjects with moderate, severe, or profound mental retardation underwent evaluation of handedness. Results confirmed previously reported increased prevalence of non-right handedness and the occurrence of a large subtype of ambiguous handedness. Results suggest that incidence of atypical hand preference is not closely linked to level of cognitive impairment, especially as represented by significant speech-language impairment in this population, as has been previously hypothesized. Atypical handedness of persons with mental retardation probably depends on language organization, and there is little support for the view that such subtypes represent bilateral hemispheric damage.

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Communication devices designed to augment the language development of individuals with severe cognitive disabilities and little or no functional speech typically contain primarily nouns because they seem easiest to acquire and evaluate. In this study, the effect of a more diverse vocabulary was assessed. Systematic observations of the use of computerized speech-output devices by 12 youth with moderate or severe mental retardation and severe spoken language disability and by their partners were made over a 2-year period. Social-regulative symbols (e.g., "please," "I'm finished") were used as soon as they were introduced, and their availability expanded the focus of conversations both at home and at school. Implications for conceptualizing variation in early language use and for the design of language intervention programs are discussed.

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Recent studies have used auditory evoked response (AER) procedures to study word meaning in young infants. The present study represents an initial application of these procedures to nonspeaking subjects with moderate or severe mental retardation. AERs were recorded from electrodes placed on the scalp over frontal, temporal, and parietal regions of the left and right hemispheres. As six symbol-experienced subjects viewed visual-graphic symbols (lexigrams), a series of probe tones were presented to elicit the AERs. Half of the symbols were meaningful to the subjects. AER activity recorded from the left hemisphere frontal and temporal electrode sites discriminated between the meaningful and meaningless symbols. Discriminant function analyses indicated that the wave-forms could be correctly classified in terms of the evoking stimulus with greater than 80% accuracy. These findings support the usefulness of AERs for studying the neurolinguistic processes underlying behavioral measures of language performance of difficult-to-assess populations.

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This study characterizes the communicative patterns of youngsters with moderate or severe mental retardation and severe spoken language impairments who are not independent speakers with conversational partners at home and at school. Nine subjects were observed during six 1-hr mealtime sampling periods in both settings for a total of 12 hr. Live continuous observations were made, employing a coding scheme designed to record occurrences of the subjects' communicative behaviors. Findings are discussed with respect to the modes and functions of the youngsters' communications with home and school conversational partners.

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Evidence was presented that successful participation in augmentative communication intervention can foster developmental changes that extend beyond the targeted effect. Ten persons with severe mental retardation were assigned in matched pairs to a lexigram condition (graphic symbols) or a control condition (social stimulation). A coding system, developed to assess pre- versus postintervention performance in four domains, was applied to videotapes of each subject in dyadic interaction. The 3 subjects who successfully acquired lexigrams exhibited changes in attention, intentional communication, and sociability; the other subjects improved only in sociability. Supporting results were obtained using an abbreviated coding system. Application of the coding systems to additional subject populations and interventions would clarify how broadly the results generalize.

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