0743-4618/99/1501-0002 $3.
00/0; Volume 15, March 1999
AAC Augmentative and Alternative Communication
Copyright © 1999 by ISAAC
INTRODUCTION TO THE SPECIAL ISSUE
AAC Efficacy Research: Challenges for the New
Century
Jan L. Bedrosian
Department of Speech Pathology and Audiology, Western Michigan University, Kalamazoo, Michigan, USA
At the 1994 ISAAC conference in Maastricht, I
attended an interesting session concerning the lan-
guage and literacy characteristics of children with
severe speech impairments who require augmenta-
tive and alternative communication (AAC). When it
was time for questions from the audience, Pat
Mirenda, in her inimitable style, arose from her chair
and said, “Look, we know these kids have problems.
When are we going to start seeing some intervention
research?” Once I recovered from my initial shock, I
realized that her point, although bluntly stated, was
indeed valid.
As with any new field of scientific study, research in
AAC began with descriptive investigations. Initially,
these studies attempted to delineate communication
patterns of AAC system users and their partners.
Each time a new area of clinical practice was identi-
fied, descriptive studies were again implemented. It is
not surprising, then, that most of the AAC research lit-
erature, especially that pertaining to aided communi-
cation systems, consists of such studies.
Were we wrong in conducting these studies? No,
because descriptive research has been essential in
providing us with clinical tools for identifying problem
areas needing intervention. However, there comes a
time when descriptions are no longer sufficient. The
social, emotional, educational, and vocational welfare
of our clients depends on our abilities, as clinical
researchers, to design and conduct effective inter-
vention programs.
These programs must yield more than anecdotal
reports of success. With the increasing demand for
accountability, data demonstrating the efficacy of our
interventions with AAC system users are needed.
Additionally, these data must be reflective of func-
tional outcomes, that is, outcomes that are useful in
the context of everyday life. Such empirical data are
critical in supporting decisions that guide our clinical
practice and in ensuring that our intervention efforts
will have a positive impact on the quality of life of AAC
system users.
In our field, there has been only limited research to
establish the efficacy of AAC interventions. This may
be attributed in part to the unique population of com-
2
municators represented by AAC system users, result-
ing in a multitude of methodological issues that have
yet to be resolved. These issues include (1) determin-
ing subject selection criteria pertinent to the interven-
tion to be investigated and, at the same time, sensitive
to the heterogeneity characteristic of the population;
(2) selecting an experimental design, whether it be
single-subject or group experimental designs; (3)
selecting relevant and valid intervention goals; (4)
determining instructional procedures reflective of best
practices; (5) measuring behavior change, including
generalization and maintenance of targeted skills; and
(6) evaluating outcomes and collateral effects.
It was an interest in these particular methodological
issues pertaining to efficacy research that led me to
bring together a panel of international AAC
researchers at the 1997 American Speech-Language-
Hearing Association (ASHA) convention and again at
the 1998 ISAAC conference. Each member of the
panel had considerable experience in conducting effi-
cacy research within a given area of AAC. The goals
of this panel were to (1) discuss these methodologi-
cal issues using examples from several areas of the
field, (2) provide directions for future efficacy research
in AAC, (3) encourage more efforts pertaining to effi-
cacy research in AAC, and (4) promote collaborative
discourse among those interested in conducting effi-
cacy research.
Based on the positive feedback we received at the
ASHA convention, I spoke with Pat Mirenda about the
possibility of having a special journal issue focusing
on efficacy research. She responded with enthusias-
tic support. The peer-reviewed papers in this issue,
therefore, represent an elaboration of the ideas pre-
sented by panel members at each conference as well
as by other researchers who were not panel partici-
pants. The authors discuss their unique approaches
to dealing with various methodological issues in effi-
cacy research for their given area of study.
In the first paper, Stephen Calculator introduces the
concept of efficacy as it relates to AAC outcomes for
children and youth with severe disabilities. Using
examples from his past and current research inter-
ests, he explores issues pertaining to treatment effi-
 AAC Efficacy Research
ciency and interaction effects. The paper concludes
with a discussion of evaluating outcomes related to
inclusive education.
Janice Light discusses three challenges in con-
ducting efficacy research in AAC. These challenges
include a consideration of defining the research ques-
tion, identifying an appropriate research design, and
evaluating outcomes. She uses examples from three
recent research studies to illustrate the issues pre-
sented. The studies involve the design, implementa-
tion, and evaluation of intervention to build the com-
municative competence of individuals who use AAC.
Next, Mats Granlund and Cecilia Olsson discuss
several challenges associated with evaluating the effi-
cacy of communicative interventions with people who
are presymbolic communicators. These challenges
include defining the population, defining communica-
tion and intentional communication, determining the
goals of intervention, determining appropriate
research designs, evaluating effects and outcomes,
and determining the certainty of evidence. Examples
from the AAC literature pertaining to this population
are used to highlight the various issues.
In their paper, Rose Sevcik, Mary Ann Romski, and
Lauren Adamson consider a range of methodological
issues relating to interventions for children and youth
with severe developmental disabilities who acquire
language through augmented means. These issues
include participant selection, intervention approaches,
experimental design, and measurement of change.
Their longitudinal study of augmented language
development, as well as a follow-up trilogy of studies
focusing on treatment outcomes, is used to exemplify
these various issues.
In the next paper, I address several methodological
issues in efficacy research concerning interactive
storybook reading in young children with severe
speech impairments who require AAC. Three recent
studies examining the effects of intervention on facil-
itating the linguistic participation of these children dur-
ing storybook reading are discussed in order to
illustrate the following issues: subject selection,
experimental design, intervention goals and
approaches, measurement of change, and evaluation
of outcomes.
3
Ralf Schlosser presents an in-depth discussion of
comparative efficacy research in AAC (i.e., research
comparing the effectiveness and efficiency of two or
more interventions). Following a thorough review of
the AAC literature involving studies using comparative
single-subject experimental designs, several method-
ological decision points in comparative evaluations
are discussed and potential solutions offered. These
decision points include formulating the research ques-
tion, choosing the appropriate single-subject experi-
mental design, setting a learning criterion versus a
teaching criterion, choosing appropriate materials,
creating equivalent instructional sets as well as func-
tionally independent sets, minimizing carryover
effects, and interpreting data. The author draws from
his own comparative efficacy research experience in
the area of speech output.
The final paper by John Todman and Pat Dugard
departs somewhat from the others in its approach to
evaluating treatment efficacy in single-case and small-
n experimental designs. The authors demonstrate the
importance of using random assignment procedures,
either random allocation of treatments to subjects or
to available treatment times, when conducting effi-
cacy research with such designs. Randomization pro-
cedures allow for the use of randomization tests that
provide a means for drawing statistical conclusions
about the efficacy of treatment effects in these
designs. Numerous single-case and small-n designs
are presented to illustrate the application of the ran-
domization approach to various areas of study in
AAC.
It is our hope that the papers presented in this spe-
cial issue will shed light on the range and complexity
of methodological issues that must be considered
when conducting efficacy research in AAC. We
encourage collaborative discourse among colleagues
as a means for resolving these issues and promoting
more efforts pertaining to efficacy research in the next
century. While the challenges are many, so too will be
the benefits. As a profession, our efforts to enhance
the quality of life of AAC system users are well worth
the undertaking.
Address reprint requests to: Jan Bedrosian,
Department of Speech Pathology and Audiology,
Western Michigan University, Kalamazoo, MI 49008,
USA.