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?