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Simultaneously Training Two AAC Systems: Evaluation on Acquisition and Preference

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Title: Simultaneously Training Two AAC Systems: Evaluation on Acquisition and Preference
Language: English
Authors: Emily N. White, Sara K. Snyder (ORCID 0000-0001-7455-7037), Rachel R. Cagliani, Kevin M. Ayres
Source: Education and Training in Autism and Developmental Disabilities. 2025 60(3):266-289.
Availability: Division on Autism and Developmental Disabilities, Council for Exceptional Children. DDD, P.O. Box 3512, Fayetteville, AR 72702. Tel: 479-575-3326; Fax: 479-575-6676; Web site: http://www.daddcec.com/
Peer Reviewed: Y
Page Count: 24
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Augmentative and Alternative Communication, Preferences, Training, Pictorial Stimuli, Assistive Technology, Speech Communication, Preschool Children, Autism Spectrum Disorders, Language Acquisition
DOI: 10.1177/21541647251387001
ISSN: 2154-1647
Abstract: Augmentative and alternative communication (AAC) systems provide individuals without speech, or with limited speech, a way to functionally communicate. Current practitioner recommendations emphasize the value of multimodal communication, yet limited research exists on teaching two AAC systems simultaneously. The purpose of the current study was to evaluate the effects of simultaneously teaching two AAC systems, picture exchange (PE) and the activation of a speech generating device (SGD), to preschoolers with autism. Using a concurrent multiple probe across participants design with embedded adapted alternating treatment designs, we evaluated the Picture Exchange Communication System (PECS) instructional protocol for teaching each modality and assessed: (a) participants' rate of acquisition, (b) preference of modality, (c) occurrence or emergence of vocalizations, and (d) maintenance of each modality. Researchers found that three of the four participants reached mastery criteria for PE and SGD during simultaneous training at similar rates of acquisition and preference varied across participants and across PECS phases.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1496324
Database: ERIC
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  Value: <anid>AN0189687644;[b6wv]01sep.25;2025Dec02.06:01;v2.2.500</anid> <title id="AN0189687644-1">Simultaneously Training Two AAC Systems: Evaluation on Acquisition and Preference </title> <p>Augmentative and alternative communication (AAC) systems provide individuals without speech, or with limited speech, a way to functionally communicate. Current practitioner recommendations emphasize the value of multimodal communication, yet limited research exists on teaching two AAC systems simultaneously. The purpose of the current study was to evaluate the effects of simultaneously teaching two AAC systems, picture exchange (PE) and the activation of a speech generating device (SGD), to preschoolers with autism. Using a concurrent multiple probe across participants design with embedded adapted alternating treatment designs, we evaluated the Picture Exchange Communication System (PECS) instructional protocol for teaching each modality and assessed: (a) participants' rate of acquisition, (b) preference of modality, (c) occurrence or emergence of vocalizations, and (d) maintenance of each modality. Researchers found that three of the four participants reached mastery criteria for PE and SGD during simultaneous training at similar rates of acquisition and preference varied across participants and across PECS phases.</p> <p>Keywords: augmentative and alternative communication; picture exchange communication systems; speech-generating device; multimodal communication; preference</p> <p>For children with intellectual and developmental disabilities (IDD), including autism spectrum disorder (ASD), who do not develop functional speech, augmentative and alternative communication (AAC) systems provide a means to communicate ([<reflink idref="bib9" id="ref1">9</reflink>]). Systematic instruction is essential for individuals with complex communication needs to use AAC functionally ([<reflink idref="bib3" id="ref2">3</reflink>]). Commonly implemented interventions used by practitioners to teach AAC include the Picture Exchange Communication System (PECS; [<reflink idref="bib15" id="ref3">15</reflink>]), naturalistic strategies, time delay, prompt fading strategies, and reinforcement ([<reflink idref="bib21" id="ref4">21</reflink>]). In a meta-analysis, [<reflink idref="bib17" id="ref5">17</reflink>] found interventions incorporating physical prompting for individuals with ASD and IDD were more effective than those that included verbal prompts. Studies that included modeling were not as effective as those that did not.</p> <p>The American Speech-Language Hearing Association ([<reflink idref="bib3" id="ref6">3</reflink>]) advises practitioners to view communication as multimodal and allow for AAC system users to communicate with various modalities (e.g., speech generating device, picture exchange, spoken words). Multimodal communication is sometimes referred to as "simultaneous communication" ([<reflink idref="bib27" id="ref7">27</reflink>]) or "total communication" ([<reflink idref="bib6" id="ref8">6</reflink>]). According to the ASHA (n.d.), multimodal communication allows for flexibility across context and communication partners. For example, a child may be in the bathroom and needs help pushing their sleeves up while washing their hands. Rather than exchanging a picture, they choose to use a manual sign for "help." Furthermore, children may experience communication challenges when they can only communicate with one modality and that modality becomes unavailable either for a brief (e.g., left at school for the weekend) or extended (e.g., high-tech AAC system broken and sent for repair) period of time. In either instance, the child without a communication system loses access to their means of communication. By training multiple modalities, for example, picture exchange (PE) and a speech-generating device (SGD), a backup plan exists to hopefully prevent a scenario without a functional means of communication ([<reflink idref="bib1" id="ref9">1</reflink>]; [<reflink idref="bib23" id="ref10">23</reflink>]; [<reflink idref="bib24" id="ref11">24</reflink>]).</p> <p>Despite the prevalence of multimodal communication across society and the potential for multimodal instruction to reduce the likelihood of breakdowns in communication ([<reflink idref="bib1" id="ref12">1</reflink>]; [<reflink idref="bib23" id="ref13">23</reflink>]; [<reflink idref="bib24" id="ref14">24</reflink>]), research of AAC instruction primarily consists of teaching one mode of communication at a time ([<reflink idref="bib12" id="ref15">12</reflink>]). Research including simultaneous instruction for more than one modality has primarily focused on comparing rates of acquisition across modalities, discontinuing instruction once one modality reaches a superior level of proficiency, and inconsistently evaluating preference (e.g., [<reflink idref="bib26" id="ref16">26</reflink>]).</p> <p>[<reflink idref="bib10" id="ref17">10</reflink>], [<reflink idref="bib8" id="ref18">8</reflink>], and [<reflink idref="bib22" id="ref19">22</reflink>] compared the acquisition of two communication modalities. [<reflink idref="bib10" id="ref20">10</reflink>] and [<reflink idref="bib8" id="ref21">8</reflink>] compared PE and a mid-tech SGD and taught both modalities using PECS Phases I–III. At the end of both studies and following the acquisition of both modalities at the Phase III level, researchers conducted preference assessments by presenting both modalities and a preferred item. Preferences varied across modalities for each participant, and speed of acquisition was not indicative of preference. Bock et al. and Beck et al. conducted a generalization probe 1 week following the completion of instruction, but long-term maintenance for both modalities was unknown. They found acquisition of either modality was not hindered by teaching two modalities simultaneously.</p> <p>[<reflink idref="bib22" id="ref22">22</reflink>] also compared the acquisition of two modalities—PE and SGD, with both modalities taught using constant time delay and full-physical prompts. Only one picture that corresponded to the available preferred item was presented on both modalities across all sessions. Participants were only taught to exchange one picture and were not taught any of the skills associated with later phases of PECS (e.g., moving to a communication book and communication partner, discrimination). After the acquisition of this skill, Lorah et al. evaluated preference and found that acquisition and modality preference varied across participants. Lorah et al. also evaluated maintenance once participants met mastery criteria, but the timing of the maintenance probes in relation to the intervention ending is unclear. The findings from these studies provide preliminary evidence to support simultaneously teaching two modalities with similar procedures ([<reflink idref="bib8" id="ref23">8</reflink>]; [<reflink idref="bib10" id="ref24">10</reflink>]; [<reflink idref="bib22" id="ref25">22</reflink>]). Additional research may reveal how a user's preference around communication modalities might fluctuate when they have the advantage of learning multiple modalities.</p> <p>While researchers and practitioners may assume an individual prefers the modality they acquired faster, variability across this research may suggest otherwise. When researchers evaluated preference, they only did so after participants reached mastery criteria for each modality at the terminal phase of instruction ([<reflink idref="bib8" id="ref26">8</reflink>]; [<reflink idref="bib10" id="ref27">10</reflink>]; [<reflink idref="bib22" id="ref28">22</reflink>]). Additional research may reveal whether preference varies as learners progress through phases of learning (e.g., PECS phases). Giving the student a choice between modalities during communication training in a concurrent operant arrangement provides one means to evaluate preference ([<reflink idref="bib11" id="ref29">11</reflink>]; [<reflink idref="bib19" id="ref30">19</reflink>]). Incorporating preference into programming for students may increase the social validity of the intervention tailored to their specific needs. The current study evaluates the effects of simultaneously training two communication modalities to preschoolers with ASD and examines the rate of modality acquisition, preference, and maintenance variables. The research questions included: (a) What are the effects of simultaneously teaching two communication modalities on the rate of acquisition of preschoolers with ASD? (b) Do participants show differential rates of acquisition across modalities? (c) When learning multiple modalities, do learners demonstrate a preference for one over the other? (d) If learners display a preference for one modality over the other, does this remain static or change over the course of acquisition? and (e) If learners meet mastery criteria for two modalities, do both modalities maintain over time?</p> <hd id="AN0189687644-2">Method</hd> <p></p> <hd id="AN0189687644-3">Participants</hd> <p>The study included four preschool-aged (3–5 years) students with an educational eligibility of ASD and speech language impairment: Antonio, Declan, Addie, and Fred. We recruited participants from a self-contained special education classroom that incorporated naturalistic developmental behavioral interventions specially designed for young children with Level 3 ASD. The class roster included eight students who met criteria for the specialized ABA program due to significant deficits in language, pre-linguistic skills, toileting, and a history of severe or dangerous behavior (e.g., self-injury, aggression, elopement). Researchers obtained Institutional Review Board (IRB) approval through the affiliated university, and the primary researcher obtained informed consent from participants' parents/guardians.</p> <p>Each participant demonstrated a need for interventions focused on building communication skills based on assessment results from the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP; [<reflink idref="bib25" id="ref31">25</reflink>]), the Developmental Profile 3 (DP-3; [<reflink idref="bib2" id="ref32">2</reflink>]), and the Preschool Language Scale, 5th Edition (PLS-5; [<reflink idref="bib28" id="ref33">28</reflink>]). All participants scored as a Level 1 learner on the VB-MAPP, meaning the focus of their intervention should be on mands, echoics, motor imitation, listener discrimination, tacts, play, spontaneous vocalizations, visual perception, and matching skills. Additionally, on the Early Echoic Skills Assessment (EESA) portion of the VB-MAPP all participants scored zero indicating no echoic or vocal imitation repertoire at the time of the assessment. On the DP-3, all participants scored in the "delayed" range in both the cognitive and adaptive domains, and on the PLS-5 all participants scored in the "severely delayed" range (see Table 1). Participants primarily communicated using gestures (e.g., pointing, grabbing, or reaching).</p> <p>Table 1. Participant Descriptions.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="left" /><col align="left" /><col align="left" /><col align="left" /><col align="left" /></colgroup><thead><tr><th align="left" colspan="2">Participants</th><th align="left">Antonio</th><th align="left">Declan</th><th align="left">Addie</th><th align="left">Fred</th></tr></thead><tbody><tr><td colspan="2">Age</td><td>3 yrs 6 months</td><td>3 yrs, 7 months</td><td>3 yrs, 8 months</td><td>4 yrs, 1 month</td></tr><tr><td colspan="2">Gender</td><td>Male</td><td>Male</td><td>Female</td><td>Male</td></tr><tr><td colspan="2">Race/ethnicity</td><td>Latino</td><td>Black</td><td>Black</td><td>Black</td></tr><tr><td colspan="6"><italic>Assessment scores</italic></td></tr><tr><td rowspan="2">DP-3</td><td>Cognitive</td><td /><td><50 (<3.33 SD)</td><td><50 (<3.33 SD)</td><td>54 (−3.07 SD)</td></tr><tr><td>Adaptive</td><td>56 (−2.93 SD)</td><td>93 (−.47 SD)</td><td>56 (−2.93 SD)</td><td>93 (−.47 SD)</td></tr><tr><td colspan="2">PLS-5</td><td>50</td><td>58</td><td>50</td><td>50</td></tr><tr><td rowspan="3">VB-MAPP</td><td>Milestones</td><td>23</td><td>23.5</td><td>23</td><td>21.5</td></tr><tr><td>Barriers</td><td>57</td><td>72</td><td>81</td><td>80</td></tr><tr><td>EESA</td><td>0</td><td>0</td><td>0</td><td>0</td></tr><tr><td colspan="2" rowspan="4">SGD vocabulary (# of button presses required)</td><td>Fruit snack (1)</td><td>Popcorn (3)</td><td>Oreos (1)</td><td>Starburst (3)</td></tr><tr><td rowspan="3">Oreos (1)</td><td>Oreos (3)</td><td>Starburst (1)</td><td>M&M (3)</td></tr><tr><td>Fruit snacks (3)</td><td>Goldfish (1)</td><td rowspan="2">Legos (3)</td></tr><tr><td>Legos (3)</td><td>Crackers (1)</td></tr><tr><td colspan="2">Primary communication observed</td><td>Gestures, pointing</td><td>Moving in direction of preferred items, grabbing, pointing</td><td>Pointing, grabbing</td><td>Yelling, pointing, and pushing things away</td></tr><tr><td colspan="2">Interests demonstrated</td><td>Musical toys, blocks, adult attention (chases, singing)</td><td>Colored toys, cars, train set</td><td>Legos, magnets, bouncing balls</td><td>Sorting toys into bins, blocks, magnets, books</td></tr><tr><td colspan="2">Behaviors interfering with learning</td><td>Aggression and self-injurious</td><td>Elopement, aggression, pica, dropping to floor, disruption</td><td>Elopement, aggression, pica, disruption</td><td /></tr></tbody></table> </ephtml> </p> <p>1 Note: DP-4 = Developmental Profile 3rd edition; PLS-5 = Preschool Language Scales 5th edition; VB-MAPP = Verbal Behavior Milestones and Placement Program; EESA = Early Echoic Skills Assessment; SD = standard deviations; PECS = Picture Exchange Communication System.</p> <hd id="AN0189687644-4">Setting and Materials</hd> <p>The study occurred in the participants' preschool special education classroom in a Title 1 public school in the Southeastern United States. The setting was unique in that certified special education teachers and Board Certified Behavior Analysts (BCBA) employed by the university and graduate students pursuing degrees in special education and applied behavior analysis (ABA) conducted the daily operations of the classroom with oversight from university faculty specializing in special education and ABA. Sessions occurred at a table in the classroom and included the participant, primary researcher/communication partner, and a secondary data collector/prompter. The two researchers who conducted all sessions included two White, non-disabled Ph.D. students with master's degrees in special education and applied behavior analysis. The first author supervised classroom staff pursuing board certification in behavior analysis and was the lead teacher in the classroom for the 2 years prior. The second author, who primarily served as a secondary data collector, was a lead teacher in a similar classroom for third through fifth grade students but was familiar with the students and the classroom staff. The first author had previously completed PECS Level 1 training, and all four authors had at least 5 years of teaching AAC in school settings.</p> <p>Materials included data collection sheets, preferred edible, and tangible reinforcers specific to each participant's interests and based on the results of the preference assessment, laminated picture cards corresponding to each preferred item with Velcro<sups>TM</sups> attached to the back, a communication book and carrying strap, and an iPad with the Proloquo2Go app and carrying strap. For Daniel and Fred, the SGD was presented with the 32-icon home screen (4 × 8 grid display) including both core and fringe vocabulary. For Antonio and Addie, the SGD was changed from the 32-icon home screen to 1 icon beginning with Phase II; the single icon was identical in size to the icons on the 4 × 8 grid display.</p> <hd id="AN0189687644-5">Response Definitions and Measurement</hd> <p>Researchers measured PE and SGD activation as primary dependent variables and independent target word vocalizations as a secondary dependent variable. Throughout the manuscript, we used PE when referring to the act of exchanging a picture, whereas we used the abbreviation PECS when referencing the instructional method, we used to teach both PE and SGD, along with the associated phase. An independent PE response was defined based on the steps required to complete a PE as indicated by the associated PECS phase (Table 2). SGD response definitions were consistent except that the exchange was replaced with independently navigating to and selecting the corresponding icon and orienting to the primary researcher by turning their body towards them, touching their arm, or making eye contact (see Table 2). Any instance where the prompter used hand-over-hand guidance to help the participant complete the communicative response was considered a full-physical prompt, and any instance where the prompter guided the participant from the forearm to the shoulder to complete the communicative response was considered a partial physical prompt.</p> <p>Table 2. Required Steps and Mastery Criteria for Each Phase of Instruction for PE and SGD.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="left" /><col align="left" /><col align="left" /><col align="left" /></colgroup><thead><tr><th align="left" /><th align="left" colspan="2">Picture Exchange (PE)</th><th align="left" colspan="2">Speech-Generating Device (SGD) Activation</th></tr><tr><th align="left" /><th align="left">Required Steps</th><th align="left">Mastery Criteria</th><th align="left">Required Steps</th><th align="left">Mastery Criteria</th></tr></thead><tbody><tr><td>Phase I</td><td>Grab picture, reach picture, release picture</td><td>≥80% independence, 3 consecutive sessions</td><td>Activate button, orient to communication partner</td><td>≥80% independence, 3 consecutive sessions</td></tr><tr><td>Phase II</td><td>Grab picture, reach picture, release picture, walk to communication partner (up to 5 ft), and walk to book (up to 5 ft)</td><td>≥80% independence, 3 consecutive sessions traveling 5 ft to the communication partner and 5 ft to book</td><td>Activate button, walk to communication partner (up to 5 ft), and walk to SGD (up to 5 ft)</td><td>≥80% independence, 3 consecutive sessions traveling 5 ft to the communication partner and 5 ft to SGD</td></tr><tr><td>Phase IIIA</td><td>Grab picture, reach picture, release picture</td><td>≥80% independence, 3 consecutive sessions</td><td>Activate button, orient to communication partner</td><td>≥80% independence, 3 consecutive sessions</td></tr><tr><td>Phase IIIB</td><td>Grab picture, reach picture, release picture, take requested item (up to 5 item array)</td><td>≥80% independence, 3 consecutive sessions for 2, 3, 4, and 5 items</td><td>Activate button, orient to communication partner, take requested item (up to 5 item array)</td><td>≥80% independence, 3 consecutive sessions for 2, 3, 4, and 5 items</td></tr></tbody></table> </ephtml> </p> <p>An independent target word vocalization occurred if the participant emitted a full spoken word or spoken vocal approximation that included recognizable sounds matching the target item and occurred before the primary researcher named the item. For example, if the participant said, "Cookie," or "Cook," when requesting a cookie and before the communication partner said cookie, data collectors scored an independent target word vocalization. If the participant said, "Buh," when requesting a cookie, this vocalization was not recorded.</p> <p>For baseline and intervention conditions, researchers recorded the frequency of each occurrence for each dependent variable and then calculated the percentage of trials for which each behavior occurred. Baseline sessions consisted of 10 trials. Intervention sessions consisted of five trials for PE and five trials for SGD for a total of 10 trials. Independent target word vocalizations were scored out of 10 trials. Across phases, the frequency of independent responses was reported as a percentage of trials. The primary researcher/communication partner and a trained secondary data collector/prompter collected data in person on paper data sheets created by the first author and recorded the occurrence or nonoccurrence of each variable. For the concurrent operant condition, researchers collected frequency data on the communication modality selected by the participant and converted to a percentage of selection out of five trials.</p> <hd id="AN0189687644-6">Experimental Design</hd> <p>We evaluated our research questions using adapted alternating treatment designs (AATD) embedded in four separate concurrent multiple probe across participants designs. Each multiple probe design corresponded to each phase of the PECS protocol including Phase IIIA and Phase IIIB separately. A multiple probe design assessed the same baseline and intervention conditions across participants and utilized a time-lagged introduction to intervention conditions. Both modalities were available in baseline conditions, and modalities were presented sequentially in a random order during all intervention conditions. Rate of acquisition was evaluated through visual analysis of the AATD embedded within the multiple probe design across participants for each PECS Phase by observing the change in level and trend and how that varied across modalities. Preference was evaluated through visual analysis by observing the level of responding across each modality.</p> <hd id="AN0189687644-7">Interobserver Agreement and Procedural Fidelity</hd> <p>We calculated interobserver agreement (IOA) using point-by-point agreement and reported as a percentage (the number of agreements divided by the number of agreements plus disagreements multiplied by 100; [<reflink idref="bib20" id="ref34">20</reflink>]) for at least 20% of sessions across baseline and intervention conditions for each participant and included all communicative responses including spoken word vocalizations. IOA data across all phases and conditions ranged from 90% to 100% for Antonio, Declan, and Addie and 80%–100% for Fred. The secondary data collector/prompter also collected procedural fidelity data during all experimental conditions for the primary researcher/communication partner ([<reflink idref="bib7" id="ref35">7</reflink>]). The secondary data collector used procedural fidelity checklists specific to baseline and intervention phases. Procedural fidelity was 100% across all participants and phases, exclusive of Fred's sessions during Phase 1. For these sessions, fidelity was 97.5% (range 90%–100%).</p> <hd id="AN0189687644-8">Pre-Study Procedures</hd> <p></p> <hd id="AN0189687644-9">Vocal Screening</hd> <p>Using the Voice Memos app ([<reflink idref="bib5" id="ref36">5</reflink>]) on an iPhone, the primary researcher conducted a vocal screening to determine a reference point of target word vocalizations and to phonetically define the idiosyncratic target word vocalizations/approximations for each participant; however, no participant vocally responded during the screening. The primary researcher began the voice recording and asked each participant to say the name of the specific preferred items identified from the multiple stimulus without replacement preference assessment (e.g., "Say car") in the absence of the item. After 3 s, if the participant did not vocalize, the primary researcher repeated the statement, "Say car," and waited an additional 3 s before moving on to the next target. After each target was probed, the researcher stopped the voice recording. None of the participants vocalized during the vocal screening.</p> <hd id="AN0189687644-10">Presession Abbreviated Preference Assessment</hd> <p>Before all sessions, the communication partner conducted an abbreviated preference assessment. The items used were top-ranked edible and leisure items from a multiple stimulus without replacement preference assessment ([<reflink idref="bib13" id="ref37">13</reflink>]). The communication partner placed two to three preferred items in front of the participant and told the participant to "pick one". If the participant selected a food item, they received one bite. If the participant selected a toy, they received access to the item for 30 s. If at any point in the session, the participant demonstrated a lack of interest in the item (e.g., the participant no longer attempted to get access to the item, tried to leave the table), the communication partner represented two to three items to see if the participant demonstrated an interest in the other available items. Antonio most often selected fruit snacks, Oreos™, and a rain stick. Declan most often selected popcorn, fruit snacks, Oreos™, and Legos™. Addie most often selected Oreos™, Starbursts™, Goldfish™, and crackers. Fred most often selected Starbursts™, M&Ms™, and Legos™.</p> <hd id="AN0189687644-11">Baseline</hd> <p>For each PECS phase, baseline contingencies mirrored the sequence of steps corresponding to that specific phase of PECS (Table 2). Participants did not receive prompting to communicate with either communication system. The communication partner provided access to the preferred item if the participant grabbed for the item, activated the corresponding button on their SGD, vocalized the name or an approximation of the name of the item, or completed the sequence of steps corresponding with the PECS phase for PE and SGD activation.</p> <hd id="AN0189687644-12">General Intervention Procedures</hd> <p>The communication partner and prompter implemented the PECS protocol as outlined by [<reflink idref="bib15" id="ref38">15</reflink>] to teach both modalities. Across all sessions, the communication partner restricted and silently enticed the participant to reach for the item(s) by keeping the items in sight and out of reach of the participant. Researchers followed the PECS protocol when providing partial and full physical prompts by only providing as needed. Once the participant completed the required steps for the associated phase, the communication partner named the item, and the participant received access to the requested item (small bite or 30 s of a preferred toy).</p> <p>Across all intervention sessions, the communication partner presented one communication modality at a time, alternating between PE and SGD, until the participant reached mastery criterion for that modality (specific steps required for each phase are listed below and in Table 2). The researcher flipped a coin before each new phase to determine which modality was presented first and then alternated the presentation for 10 total trials across all intervention sessions. Participants met mastery criteria for a specific phase when they independently completed each required step of the AAC communicative response (PE or SGD activation) for 80% of trials in a session across three consecutive sessions. When a participant achieved mastery criteria for one modality, either PE or SGD, training continued for the other modality for twice the number of trials required to reach mastery with the first. If the participant did not achieve mastery criteria for the other modality, the communication partner conducted five additional trials (without alternating communication modality presentation). If the participant still did not achieve mastery criteria, training of this second modality ceased for the current PECS phase.</p> <p> <bold>Phase I.</bold> For Phase I, the necessary steps for PE included the following: (a) picking up the picture, (b) reaching their arm to present the picture to the communication partner, and (c) exchanging the picture. For SGD, the sequence included navigating to the correct page with the corresponding item button and activating the correct button (e.g., select food > then snack > then popcorn). If the participant navigated to the incorrect page, the prompter helped them navigate to the correct page. A response was only scored as independent if the participant navigated to the correct icon without any level of prompting.</p> <p> <bold>Phase II.</bold> For Phase II, the participant had to walk to the communication partner to exchange the picture. The communication partner placed the predetermined communication modality in front of the participant and moved 1 ft away while restricting item access. After three consecutive trials at mastery criteria, the communication partner moved back 1 ft from the participant to start the following trial. The communication partner continued moving back after each time the participant communicated independently for three consecutive trials until they were 5 ft away. Once the participant successfully moved to the communication partner 5 ft away, the prompter started moving the communication book away from the participant in a similar fashion. At the start of Phase II, Antonio and Addie's SGD grid displays were modified to include a single button. The grid display was modified because neither participant was progressing toward the acquisition criteria for SGD.</p> <p> <bold>Phase IIIA.</bold> For Phase IIIA, the same steps were required as Phase I; no traveling was required in this phase. If the participant exchanged or activated the button of the preferred item picture, the communication partner said, "Ooh," to reinforce the choice, then labeled and delivered the preferred item after the AAC communicative sequence. If the participant requested the non-preferred item, the communication partner labeled and gave the non-preferred item. If the participant accepted the non-preferred item, the session ended, and the researcher selected a new non-preferred item for the next session.</p> <p> <bold>Phase IIIB.</bold> Once the participant followed the steps required in previous PECS phases to request an item, the communication partner presented the tray with items and said, "Take it," "Here," or, "Go ahead." If the participant reached for the item that corresponded with the item requested, the communication partner named the item and provided access. If the participant reached for a different item than requested, the communication partner blocked access to all items, used the "teach to the reach" rationale, and implemented the four-step error correction procedure ([<reflink idref="bib15" id="ref39">15</reflink>]). Initially, in Phase IIIB, we presented two items on the tray, then after two consecutive sessions of success (80% independence or higher), an additional item was added. This process continued until the participant discriminated between five items on the tray. The number of items available on the tray corresponded to the number of pictures presented on the PE book.</p> <hd id="AN0189687644-13">Concurrent Operant</hd> <p>Once the participant met mastery criteria for at least one modality within a phase, the researcher evaluated modality preference by conducting a concurrent operant preference assessment ([<reflink idref="bib11" id="ref40">11</reflink>]; [<reflink idref="bib19" id="ref41">19</reflink>]). If the participant did not meet mastery criteria for both modalities, the concurrent operant was only conducted after Phase 1 instruction. To assess preference of modality, the communication partner sat across the table with the PE and SGD modalities next to each other within arm's reach of the participant. The left/right presentation of modalities was alternated for each presentation. The communication partner restricted access to the item(s) and waited for the participant to initiate. If the participant reached for the item(s) instead of using a communication modality to request, the communication partner tapped the table in front of both modalities and continued restricting access to the item(s). If the participant made a request using a communication modality, the communication partner stated the name of the item and delivered it to the participant. Five sessions, including five trials each, were conducted per participant with no set mastery criterion.</p> <hd id="AN0189687644-14">Maintenance</hd> <p>Once participants met mastery criteria for one or both communication modalities in Phase IIIB, and following the concurrent operant preference assessment, researchers conducted maintenance sessions. Maintenance sessions occurred once a week for 4 weeks. Each session consisted of five trials and took place at the same location as the baseline and intervention conditions. Two to three items were placed in front of the participant with each communication modality within arm's reach. If the participant attempted to access the item by reaching for it, the researcher delivered a prompt by tapping the table near the communication modalities and waited for a communicative response before delivering the item. The primary researcher collected data on the modality selected (i.e., PE, SGD, target word vocalizations) and whether prompting was needed.</p> <hd id="AN0189687644-15">Results</hd> <p>During baseline, none of the participants communicated with SGD, PE, or speech. Following simultaneous teaching of two communication modalities, all four participants reached the Phase IIIB mastery criteria for PE as specified in Table 2. Three of the four participants reached Phase IIIB mastery criteria with SGD as specified in Table 2. Participants varied in the number of sessions required to reach the mastery criteria for PE and SGD in each PECS protocol phase (Figure 1). Figures 2 to 5 depict participant responding (independent correct PE, SGD activation, and spoken word vocalizations) relative to each PECS phase. The impacts of simultaneous AAC instruction on the rate of acquisition and maintenance and the results from the concurrent operant assessments are included below for each participant across by phase. Because the design was across participants, and each phase served as its own experiment, we report the data by phase for each participant.</p> <p>Graph: Figure 1. Trials to Mastery for Picture Exchange and the Speech Generating Device Across Phases and Participants.</p> <p>Graph: Figure 2. Phase I Acquisition of Picture Exchange and Speech Generating Device.</p> <p>Graph: Figure 3. Phase II Acquisition of Picture Exchange and Speech Generating Device.</p> <p>Graph: Figure 4. Phase IIIA Acquisition of Picture Exchange and Speech Generating Device.</p> <p>Graph: Figure 5. Phase IIIB Acquisition of Picture Exchange and Speech Generating Device.</p> <hd id="AN0189687644-16">Phase I</hd> <p>All four participants reached the Phase I mastery criteria for PE in fewer than or the same number of sessions as SGD. As depicted in Figure 2, the data indicated an accelerating trend with almost immediate changes in level for PE across all participants. The level of SGD activation increased for Declan, Addie, and Fred. We observed differences in level across modalities for all four participants. Antonio reached Phase I mastery criteria for PE in five sessions, and he did not reach mastery criteria for SGD activation. Antonio did not independently vocalize during any session. In the concurrent operant condition, Antonio allocated responding to PE 100% of trials in all five sessions<bold><emph>.</emph></bold> Declan reached mastery criteria for both PE and SGD in six sessions. During sessions 17 and 19, target word vocalizations increased above baseline levels. In the concurrent operant condition, Declan allocated responding to both SGD activation and PE but allocated more to SGD. Addie reached mastery for PE in five sessions. For SGD, she responded independently, slightly above baseline levels, after four sessions, but never exceeded 40% independence and did not meet mastery criteria after 10 sessions. Addie did not independently vocalize. In the concurrent operant condition, she allocated responding to PE 100% of trials in all five sessions. Fred reached the Phase I mastery criteria for PE in four sessions. He reached mastery criteria for SGD in eight sessions. He did not independently vocalize in any session. In the concurrent operant condition, Fred allocated more responding to the SGD across all sessions but still used PE in some sessions.</p> <hd id="AN0189687644-17">Phase II</hd> <p>As was observed in Phase I, immediate changes in level were observed across all participants for PE and across Declan, Addie, and Fred for SGD activation (see Figure 3). A slight change in level for SGD activation was observed for Antonio, but responding was variable. For Declan, Addie, and Fred, only one data point overlapped during the concurrent operant. For all other sessions, a clear separation in data paths was observed. In baseline, Antonio did not activate the SGD, engage in PE, or use speech to request. Antonio reached Phase II mastery criteria for PE in seven sessions. After the modification of his SGD at the start of Phase II, Antonio demonstrated some independent responding (20%–40%) with the SGD across five sessions but never reached the Phase II mastery criterion. He did not independently vocalize in any session. In the concurrent operant, he allocated responding to PE for 100% of trials in four of the five sessions. In the second session, he selected PE for 80% of trials and the SGD for 20% of trials. Declan used PE and the SGD to request in some trials in baseline but did not exceed 20% independent responding, and target word vocalizations remained at 0%. Declan reached the Phase II mastery criteria for PE in 10 sessions and SGD in 12 sessions. Declan's target word vocalizations increased above baseline levels in session 25 (10%), 27 (30%), 28 (30%), and 29 (10%). In the concurrent operant condition, he allocated responding to the SGD 100% of trials in three of the five sessions. Addie requested with PE for 20% of trials during baseline but did not use SGD activation or target word vocalizations. Addie reached mastery criteria for Phase II in 11 sessions for PE and SGD in 13 sessions. Across all sessions, Addie did not independently vocalize. In the concurrent operant condition, Addie allocated responding to PE for 100% trials in four of the five sessions. In the third session, she allocated responding to PE for 40% of trials and to SGD for 60% of trials. Fred's independent responding with PE and SGD ranged from 10% to 30% in baseline. Fred reached Phase II mastery criteria in 10 sessions for PE and 11 sessions for SGD. Fred did not independently vocalize during Phase II. In the concurrent operant condition, he allocated responding to PE in 100% of trials for four out of five sessions.</p> <hd id="AN0189687644-18">Phase IIIA</hd> <p>We discontinued instruction for SGD activation and the concurrent operant due to a lack of progress with SGD in Phases I and II for Antonio. For Declan, Addie, and Fred, responding during the baseline condition was variable, but there was an immediate change in level for both PE and SGD activation (see Figure 4). There was a clear separation in data paths during the concurrent operant for Addie, but Declan and Fred's data overlapped for at least two sessions. Antonio did not engage in PE or target word vocalizations during baseline. Antonio reached the Phase IIIA mastery criteria for PE in seven sessions. He engaged in target word vocalizations in session 9 for 20% of trials. In baseline, Declan's responding remained stable between 10% and 30% independence for PE and SGD. He reached the mastery criteria for Phase IIIA in three sessions for PE and SGD. Declan did not independently vocalize. In the first, second, and last sessions of the concurrent operant, he allocated responding to SGD for 100% of trials. In sessions 3 and 4, he allocated to PE and SGD between 40% and 60% of trials. Addie communicated infrequently with PE and SGD in baseline. Addie reached the Phase IIIA mastery criteria for PE and SGD in three sessions. She did not independently vocalize in any sessions. In the second, third, and fifth sessions of the concurrent operant, Addie allocated responding to PE for 100% of trials. In session 1, she selected PE for 40% of trials and SGD for 60% of trials, and in session 4, she selected PE for 80% of trials and SGD for 20%. For Fred, baseline data for PE were variable, ranging from 0% to 70% independent responding. He demonstrated low but stable responding for SGD that did not exceed 20% of trials. Fred reached Phase IIIA mastery criteria in three sessions for PE and SGD. He did not independently vocalize in any session. Fred allocated responding to both SGD activation and PE across all five concurrent operant sessions. In the first three sessions, he engaged in PE more often than SGD. In sessions 4 and 5, he alternated between PE and SGD, ranging from 40% to 60% of trials for both modalities.</p> <hd id="AN0189687644-19">Phase IIIB</hd> <p>An immediate change in level for PE and SGD activation was observed for Declan, Addie, and Antonio (see Figure 5). For Declan, a change in level was observed for spoken word vocalizations, as well. There was consistent separation in data paths during the concurrent operant assessment for Declan, Addie, and Fred. Antonio demonstrated variable patterns of responding in baseline. In four non-consecutive sessions, he independently responded at 80% or higher. For all other sessions, responding was between 0% and 40% and did not exceed 60%. Antonio completed 10 baseline sessions and never reached mastery criteria (three consecutive sessions at 80% or higher) for Phase IIIB. Antonio mastered Phase IIIB for PE in eight sessions. He did not engage in target word vocalizations. Declan independently engaged in PE or SGD activation across all baseline sessions. PE never exceeded 10% of trials, and SGD activation ranged from 0% to 60% of trials. Also in baseline, Declan's vocalized target words during sessions 3 and 16. Declan met mastery criteria for Phase IIIB in eight sessions for PE and SGD. Declan engaged in target word vocalizations in all sessions except session 22, ranging between 10% and 40% of trials. In the first session of the concurrent operant condition, Declan allocated responding to the SGD for 80% of trials and PE for 20% of trials. In the remaining four sessions, he activated the SGD 100% of trials. Addie demonstrated minimal independent responding in baseline that did not exceed 20% of trials for PE and SGD, with most sessions at zero percent. Addie reached Phase IIIB mastery criteria in 15 sessions for both SGD activation and PE. Addie did not independently vocalize in any session. During the first two concurrent operant sessions, Addie allocated responding to SGD 20%–40% of trials and PE for 60%–80% of trials. In the last three sessions, she engaged in PE 100% of trials. Fred did not engage in PE, activate the SGD, or vocalize in baseline. Fred reached the mastery criteria for Phase IIIB in eight sessions for both PE and SGD activation. He did not engage in target word vocalizations during intervention. In sessions 1 and 3 of the concurrent operant, he allocated responding to both SGD and PE activation. In sessions 2, 4, and 5, he selected PE for 100% of trials.</p> <hd id="AN0189687644-20">Maintenance</hd> <p>Antonio's PE and target word vocalization responding in maintenance demonstrated similar levels to his performance at the conclusion of Phase IIIB intervention. Declan, Addie, and Fred maintained a similar level of responding to their Phase IIIB intervention for PE and SGD. During Declan's first two maintenance sessions, his target word vocalizations increased to a higher level than baseline and intervention (occurred at 50% of trials) but then decreased in the next two sessions to 40% and 20% of trials. Target word vocalizations for Addie and Fred remained at zero.</p> <hd id="AN0189687644-21">Discussion</hd> <p>The purpose of this study was to evaluate the effects of teaching two communication modalities (SGD activation and PE) simultaneously on acquisition, preference, and maintenance for various communication modalities. Researchers also monitored target word vocalizations across PECS phases and conditions. The current study replicated and extended the findings from [<reflink idref="bib10" id="ref42">10</reflink>], [<reflink idref="bib8" id="ref43">8</reflink>], and [<reflink idref="bib22" id="ref44">22</reflink>] by evaluating the effectiveness of teaching PE and SGD with the PECS protocol and then evaluating preference and maintenance of both modalities. The current study findings for acquisition were similar to [<reflink idref="bib10" id="ref45">10</reflink>] as three of the four participants reached mastery criteria for both modalities in a similar number of sessions. In the current study, participants reached mastery criteria for PE in fewer or the same number of sessions as SGD across all PECS phases (see Figure 1). Unlike [<reflink idref="bib8" id="ref46">8</reflink>], all four participants in this study reached mastery criteria for PE across all PECS phases and three of four reached mastery criteria for SGD.</p> <p>Previous researchers have not included maintenance data when more than one modality was initially trained. This study demonstrated multiple modalities maintained at near intervention levels for participants who reached mastery criteria for more than one modality 4 weeks post-intervention. Teaching more than one modality provides an individual with multiple options to communicate when they are faced with communication breakdowns ([<reflink idref="bib1" id="ref47">1</reflink>]; [<reflink idref="bib23" id="ref48">23</reflink>]; [<reflink idref="bib24" id="ref49">24</reflink>]). Adding the maintenance measure to this study confirmed that after initial instruction, learners could maintain proficiency with multiple modalities despite not having access to the SGD outside of the training context. With several communicative options, individuals have broader flexibility toward communication and can transfer between modalities if needed.</p> <p>Additionally, our findings replicated and extended the findings of [<reflink idref="bib22" id="ref50">22</reflink>]'s evaluation of modality preference following PECS Phase I training. Lorah et al. evaluated preference at the conclusion of Phase I and found preference aligned with the modality in which the participant met mastery criteria fastest and only one participant demonstrated preference for PE. Therefore, we expected participants to select the modality they were most proficient with during the concurrent operant arrangement; however, this was not always the case and modality preference shifted across PECS instructional phases. In Phase I, Declan acquired PE in fewer sessions and with more accuracy but allocated responding primarily to SGD activation during the concurrent operant arrangement. In the Phase II concurrent operant arrangement, Declan primarily chose PE despite consistently responding correctly with SGD activation and variable responding with PE during Phase II instruction. He continued to allocate to PE during the Phase III concurrent operant arrangement despite responding at 100% independence for both modalities during Phase IIIA instruction. Declan's allocation shifted back to SGD activation during the Phase IIIB concurrent operant arrangement.</p> <p>Addie and Fred's responses during the concurrent operant arrangement were also notable in several instances. During Phase I, Fred reached mastery criteria faster for PE. His allocation was variable across PE and SGD activation, but he was primarily allocated to SGD activation during the concurrent operant arrangement. However, following Phase II instruction, Fred allocated responding to PE during the concurrent operant arrangement despite rarely needing prompting for either modality during Phase II intervention. This was the same pattern of responding for Addie. Both Addie and Fred required only three sessions of instruction during Phase IIIA for both modalities. However, Addie continued to allocate responding to PE during the concurrent operant, and Fred's responding shifted across both modalities during all five sessions. In the final concurrent operant arrangement, both Addie and Fred allocated responding primarily to PE despite reaching mastery criteria for both modalities during Phase IIIB instruction. Based on these findings, ease of use and expediency of acquiring the desired reinforcer did not consistently impact responding during the concurrent operant. Additional trials to criterion or stability of responding with a modality also did not predict modality allocation during the concurrent operant.</p> <p>We recognize preference is not static and may evolve from day to day or as reinforcement history changes across modalities. Furthermore, this inclusion of preference assessments throughout early AAC instruction is paramount from a behavior analytic commitment to social validity and honoring individual preference and agency in treatment development. As demonstrated through these findings, preference is not necessarily causally related to efficacy.</p> <hd id="AN0189687644-22">Implications for Practice</hd> <p>When teaching young children with very minimal vocal repertoires to communicate with AAC systems, practitioners should intentionally teach multiple modalities in consideration of individual child strengths, preferences, and specific nuances of each modality ([<reflink idref="bib3" id="ref51">3</reflink>]). Instruction and the opportunity to use multiple communication modalities should continue to be incorporated into the child's everyday routines, regardless of rate of acquisition or initial preference. PE and SGD are the two most researched AAC systems for young children with ASD ([<reflink idref="bib16" id="ref52">16</reflink>]), and both modalities require systematic instruction. PECS provides a systematized approach to AAC instruction that can be adapted for SGD instruction ([<reflink idref="bib14" id="ref53">14</reflink>]). The circumstances of this study were unlike most classrooms in that all staff were highly trained and supervised frequently by PhDs with backgrounds in special education and behavior analysis, and the ratio of students to teachers was unlike most special education classrooms. Additionally, the researchers conducting sessions had an extensive background in teaching students with IDD and conducted sessions under contrived circumstances unlikely to be feasible in classroom settings. With that being said, the findings do suggest that early AAC users can learn multiple AACs simultaneously.</p> <p>Simultaneous AAC instruction in most special education classrooms would likely look different from the sessions described within this study, but we suggest the following based on these findings when teaching AAC. The findings of our study highlight how critical it is to provide instruction on multiple modalities across time and across phases of mastery. First, we recommend incorporating various AACs throughout the school day when feasible. For example, learners may receive PECS instruction during snack time when motivation is high. During activities when having aided AAC in reach is difficult (such as on the swing or in the restroom), instructors may teach related signs or gestures. Another way a classroom teacher could incorporate multiple modalities would be in a group activity where students each complete a response with one of three communication modalities (SGD, PE, or speech; they can include more). Incorporating opportunities to communicate with various modalities of AAC in the context of existing classroom activities can promote generalized outcomes and allow for more seamless practice opportunities throughout the school day. Inclusive classrooms can similarly support and model multimodal communication by alternating modalities by activity. For example, children could be encouraged to only use pictures or writing during clean-up time and use SGDs during a circle time.</p> <hd id="AN0189687644-23">Limitations</hd> <p>Following guidance from the creators of AssitiveWare Proloquo2Go (Hartmann, 2024), we presented participants with a 4 × 8 icon SGD grid display beginning in Phase I. Equating the response effort for SGD activation and PE would have been ideal from a research design standpoint, however according to AssitiveWare, there is no existing research to support beginning Proloquo2Go instruction with a limited number of symbols as is done in PE instruction with PECS. Furthermore, according to AssistiveWare, providers can make instruction more efficient by not limiting the grid size initially and stress that limiting the grid size can lead to user disinterest (i.e., lack of preference for system; Hartmann, n.d.). Due to lack of progress with the 32-icon system, we modified two users' SGDs to simplify selection by having fewer options when selecting a specific picture from an array. Because Antonio and Addie still chose SGD in the concurrent operant sessions, our findings demonstrate that some users may benefit from a limited number of symbols presented initially.</p> <p>Equating response difficulty and effort across SGDs may have influenced participant preference in our AAC assessment. It is unclear whether preference was influenced by response effort, proficiency with the modality, efficiency of modality, or other variables. Response effort of the two modalities was difficult to equate, and less response effort may not necessarily be preferred if other variables make the greater response effort "worth it". With that being said, these findings do suggest that early AAC users can learn multiple AAC modalities simultaneously and should be given the opportunity to do so. Researchers conducted a concurrent operant assessment regardless of whether participants met mastery criteria for both modalities following Phase I and II. Following Phase II, Antonio did not participate in a concurrent operant assessment due to the lack of progress with SGD activation.</p> <hd id="AN0189687644-24">Future Research</hd> <p>The unique partnership between the school system and the university in this study helped to erode barriers often present for individuals from traditionally underrepresented groups participating in scientific research. As a result, this allowed data gathered from more diverse communities to enter the scientific record. However, the arrangement made including caregivers and settings outside of school (e.g., home, community) difficult. Diversifying the research settings and incorporating caregivers as collaborators (particularly those from traditionally marginalized groups) will extend this work. Future researchers could evaluate communication partner AAC modality preference and determine if communication partner preference impacts the AAC users' response allocation across modalities.</p> <p>The [<reflink idref="bib4" id="ref54">4</reflink>] recommends considering user preference during comprehensive AAC assessment. We attempted an ongoing evaluation of preference as users made progress with learning each system. We experienced difficulties assessing preference when users were unable to use the modality effectively. 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Preschool Language Scales (5th ed). Pearson.</bibtext> </blist> </ref> <ref id="AN0189687644-26"> <title> Footnotes </title> <blist> <bibtext> This study was completed as part of the first author's dissertation. The researchers complied with the University of Georgia Institutional Review Board process and received parental permission for each child participant.</bibtext> </blist> <blist> <bibtext> Sara K. Snyder https://orcid.org/0000-0001-7455-7037</bibtext> </blist> <blist> <bibtext> The authors received no financial support for the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> Data available upon request of the second author.</bibtext> </blist> </ref> <aug> <p>By Emily N. White; Sara K. Snyder; Rachel R. Cagliani and Kevin M. Ayres</p> <p>Reported by Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib15" firstref="ref3"></nolink> <nolink nlid="nl2" bibid="bib21" firstref="ref4"></nolink> <nolink nlid="nl3" bibid="bib17" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib27" firstref="ref7"></nolink> <nolink nlid="nl5" bibid="bib23" firstref="ref10"></nolink> <nolink nlid="nl6" bibid="bib24" firstref="ref11"></nolink> <nolink nlid="nl7" bibid="bib12" firstref="ref15"></nolink> <nolink nlid="nl8" bibid="bib26" firstref="ref16"></nolink> <nolink nlid="nl9" bibid="bib10" firstref="ref17"></nolink> <nolink nlid="nl10" bibid="bib22" firstref="ref19"></nolink> <nolink nlid="nl11" bibid="bib11" firstref="ref29"></nolink> <nolink nlid="nl12" bibid="bib19" firstref="ref30"></nolink> <nolink nlid="nl13" bibid="bib25" firstref="ref31"></nolink> <nolink nlid="nl14" bibid="bib28" firstref="ref33"></nolink> <nolink nlid="nl15" bibid="bib20" firstref="ref34"></nolink> <nolink nlid="nl16" bibid="bib13" firstref="ref37"></nolink> <nolink nlid="nl17" bibid="bib16" firstref="ref52"></nolink> <nolink nlid="nl18" bibid="bib14" firstref="ref53"></nolink>
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  Group: Ti
  Data: Simultaneously Training Two AAC Systems: Evaluation on Acquisition and Preference
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Emily+N%2E+White%22">Emily N. White</searchLink><br /><searchLink fieldCode="AR" term="%22Sara+K%2E+Snyder%22">Sara K. Snyder</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7455-7037">0000-0001-7455-7037</externalLink>)<br /><searchLink fieldCode="AR" term="%22Rachel+R%2E+Cagliani%22">Rachel R. Cagliani</searchLink><br /><searchLink fieldCode="AR" term="%22Kevin+M%2E+Ayres%22">Kevin M. Ayres</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Education+and+Training+in+Autism+and+Developmental+Disabilities%22"><i>Education and Training in Autism and Developmental Disabilities</i></searchLink>. 2025 60(3):266-289.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Division on Autism and Developmental Disabilities, Council for Exceptional Children. DDD, P.O. Box 3512, Fayetteville, AR 72702. Tel: 479-575-3326; Fax: 479-575-6676; Web site: http://www.daddcec.com/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 24
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Augmentative+and+Alternative+Communication%22">Augmentative and Alternative Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Preferences%22">Preferences</searchLink><br /><searchLink fieldCode="DE" term="%22Training%22">Training</searchLink><br /><searchLink fieldCode="DE" term="%22Pictorial+Stimuli%22">Pictorial Stimuli</searchLink><br /><searchLink fieldCode="DE" term="%22Assistive+Technology%22">Assistive Technology</searchLink><br /><searchLink fieldCode="DE" term="%22Speech+Communication%22">Speech Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Children%22">Preschool Children</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Acquisition%22">Language Acquisition</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/21541647251387001
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 2154-1647
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Augmentative and alternative communication (AAC) systems provide individuals without speech, or with limited speech, a way to functionally communicate. Current practitioner recommendations emphasize the value of multimodal communication, yet limited research exists on teaching two AAC systems simultaneously. The purpose of the current study was to evaluate the effects of simultaneously teaching two AAC systems, picture exchange (PE) and the activation of a speech generating device (SGD), to preschoolers with autism. Using a concurrent multiple probe across participants design with embedded adapted alternating treatment designs, we evaluated the Picture Exchange Communication System (PECS) instructional protocol for teaching each modality and assessed: (a) participants' rate of acquisition, (b) preference of modality, (c) occurrence or emergence of vocalizations, and (d) maintenance of each modality. Researchers found that three of the four participants reached mastery criteria for PE and SGD during simultaneous training at similar rates of acquisition and preference varied across participants and across PECS phases.
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  Data: As Provided
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  Label: Entry Date
  Group: Date
  Data: 2026
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  Data: EJ1496324
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        Value: 10.1177/21541647251387001
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 24
        StartPage: 266
    Subjects:
      – SubjectFull: Augmentative and Alternative Communication
        Type: general
      – SubjectFull: Preferences
        Type: general
      – SubjectFull: Training
        Type: general
      – SubjectFull: Pictorial Stimuli
        Type: general
      – SubjectFull: Assistive Technology
        Type: general
      – SubjectFull: Speech Communication
        Type: general
      – SubjectFull: Preschool Children
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Language Acquisition
        Type: general
    Titles:
      – TitleFull: Simultaneously Training Two AAC Systems: Evaluation on Acquisition and Preference
        Type: main
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          Name:
            NameFull: Emily N. White
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            NameFull: Sara K. Snyder
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            NameFull: Rachel R. Cagliani
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            NameFull: Kevin M. Ayres
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              M: 09
              Type: published
              Y: 2025
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              Value: 2154-1647
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              Value: 60
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              Value: 3
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            – TitleFull: Education and Training in Autism and Developmental Disabilities
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