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Telepractice-Supported Augmentative and Alternative Communication Intervention: A Systematic Review

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Title: Telepractice-Supported Augmentative and Alternative Communication Intervention: A Systematic Review
Language: English
Authors: Jessica Simacek (ORCID 0000-0003-4147-773X), Sanikan Wattanawongwan, Joe Reichle, Betul Cakir-Dilek, J. Birdie Ganz, Marianne Elmquist (ORCID 0000-0003-4815-4626), Ee Rea Hong, Lauren Pierson
Source: Focus on Autism and Other Developmental Disabilities. 2026 41(2):102-116.
Availability: SAGE Publications and Hammill Institute on Disabilities. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 15
Publication Date: 2026
Sponsoring Agency: Institute of Education Sciences (ED)
Contract Number: R324A180110
Document Type: Journal Articles
Information Analyses
Descriptors: Literature Reviews, Autism Spectrum Disorders, Intellectual Disability, Students with Disabilities, Intervention, Augmentative and Alternative Communication, Assistive Technology, Technology Uses in Education, Videoconferencing, Access to Health Care, Telecommunications, Preschool Children, Children, Adolescents, Special Needs Students, Communication (Thought Transfer), Barriers
DOI: 10.1177/10883576251376319
ISSN: 1088-3576
1538-4829
Abstract: Children with autism spectrum disorder and/or with intellectual disabilities (IDD) who experience complex communication needs often benefit from augmentative and alternative communication (AAC) intervention. Given shortages, access to professionals with expertise in AAC instruction can prove difficult. Telepractice may help to connect more specialists to children and practitioners or families who can implement AAC interventions with guidance. As both AAC technology and telehealth rapidly advance, the evidence base has struggled to keep pace. This systematic review answers questions related to the use of telepractice in intervention for AAC. Data to be reported were gleaned from a comprehensive meta-analysis on AAC and intervention for preschool and school-age children on the autism spectrum and/or with IDD. In the current systematic review, eight studies were identified, representing 22 participants, that met inclusion criteria. Synthesized findings across telepractice methodologies, participant characteristics, intervention parameters, including intervention intensity, and methodological quality are reported.
Abstractor: As Provided
IES Funded: Yes
Entry Date: 2026
Accession Number: EJ1503863
Database: ERIC
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  Value: <anid>AN0193226598;fdd01jun.26;2026Apr27.04:52;v2.2.500</anid> <title id="AN0193226598-1">Telepractice-Supported Augmentative and Alternative Communication Intervention: A Systematic Review </title> <p>Children with autism spectrum disorder and/or with intellectual disabilities (IDD) who experience complex communication needs often benefit from augmentative and alternative communication (AAC) intervention. Given shortages, access to professionals with expertise in AAC instruction can prove difficult. Telepractice may help to connect more specialists to children and practitioners or families who can implement AAC interventions with guidance. As both AAC technology and telehealth rapidly advance, the evidence base has struggled to keep pace. This systematic review answers questions related to the use of telepractice in intervention for AAC. Data to be reported were gleaned from a comprehensive meta-analysis on AAC and intervention for preschool and school-age children on the autism spectrum and/or with IDD. In the current systematic review, eight studies were identified, representing 22 participants, that met inclusion criteria. Synthesized findings across telepractice methodologies, participant characteristics, intervention parameters, including intervention intensity, and methodological quality are reported.</p> <p>Keywords: alternative/augmentative (AAC) communication; intellectual disability; autism spectrum disorders; communicative functions</p> <p>Children with autism spectrum disorder and/or with intellectual disabilities (ASD/IDD) who experience complex communication needs (e.g., minimal verbal communication; [<reflink idref="bib7" id="ref1">7</reflink>]) often benefit from augmentative and alternative communication (AAC; [<reflink idref="bib7" id="ref2">7</reflink>]). AAC ranges from nonverbal communication that is aided by external stimuli to the body (e.g., picture cards, iPad applications with symbols) to unaided communication forms (e.g., gestures, signs). To allow for implementation throughout the child's day, AAC intervention must include both the child and their communication partners (e.g., family, educators; [<reflink idref="bib19" id="ref3">19</reflink>]). While competent interventionists play an essential role in the implementation of evidence-based intervention ([<reflink idref="bib34" id="ref4">34</reflink>]), the workforce faces extreme shortages of professions to support AAC instruction (e.g., shortages of speech-language pathologistsSpeech Language Pathologists; [<reflink idref="bib3" id="ref5">3</reflink>]). Evidence-based information on specific AAC intervention parameters (e.g., intervention targets, implementer, setting, dosage) that indicate <emph>how</emph> to implement AAC with this heterogenous and low-incidence population are needed to inform and extend the reach of professionals with competence in teaching AAC instruction.</p> <p>Telepractice warrants investigation as a means to facilitate access to AAC assessment and intervention. Telepractice may include synchronous ("live"), asynchronous ("store-and-forward"), or combined connection approaches between an AAC interventionist and an end user, such as the child and their caregivers, educators, or related direct support providers ([<reflink idref="bib37" id="ref6">37</reflink>]). Telepractice may enhance educational teams'teams ability to support a child across multiple environments (e.g., school and home).</p> <p>Given the necessity to rapidly transition in-person interventions during the height of the COVID-19 pandemic, telepractice transformed the field of care delivery. Although not always the right modality, there is now an opportunity to examine the conditions under which telepractice is helpful in improving access to or the quality of intervention, particularly considering significant provider shortages. Recent systematic reviews have synthesized information on the features, fidelity, and effectiveness of telepractice-delivered interventions for children on the autism spectrum ([<reflink idref="bib1" id="ref7">1</reflink>]; [<reflink idref="bib29" id="ref8">29</reflink>]; [<reflink idref="bib37" id="ref9">37</reflink>]; [<reflink idref="bib42" id="ref10">42</reflink>]). [<reflink idref="bib29" id="ref11">29</reflink>] investigated the fidelity features of 19 studies, which included participants on the autism spectrum, and various telepractice end users (e.g., parent, educator, therapist). Telepractice was shown to be a promising service delivery practice for training end users to acceptable implementation fidelity, particularly with caregiver coaching strategies (e.g., [<reflink idref="bib37" id="ref12">37</reflink>]). However, these findings varied as a function of the type of intervention and telepractice modality. Group training via telepractice and the use of self-paced online modules, for example, showed more-mixed results. [<reflink idref="bib42" id="ref13">42</reflink>] conducted a systematic review of 14 studies focused on telepractice assessment and intervention with people on the autism spectrum. Interventions delivered via telepractice were found to produce similar results to in-person interventions and were associated with positive parent satisfaction. While informative with respect to the overall use of telepractice in intervention for children on the autism spectrum, these reviews were not specific to AAC intervention or supporting learners with complex communication needs.</p> <p>Children who experience complex communication needs are historically underrepresented in autism research ([<reflink idref="bib17" id="ref14">17</reflink>]–2017; [<reflink idref="bib20" id="ref15">20</reflink>]), leaving little evidence on which to guide intervention decisions. The use of single-case experimental design (SCED; [<reflink idref="bib22" id="ref16">22</reflink>]) allows researchers to answer idiographic questions about the particular intervention strategies that are supportive at the individual level, making it an important methodology for heterogenous and low-incidence groups (e.g., [<reflink idref="bib5" id="ref17">5</reflink>]). [<reflink idref="bib1" id="ref18">1</reflink>] reported on a systematic review of 12 telepractice-based studies using parent-implemented language and providing a range of child communication outcomes (e.g., verbal and nonverbal communicative initiations), including children with complex communication needs. Communication interventions showed improvement in parent implementation fidelity and child communication outcomes. However, the investigators noted that child performance resulting from interventions such as Functional Communication Training, which may be used as preliminary means by which to introduce AAC, were not within the scope of their review.</p> <p>Given the promise of telepractice as a means to provide guidance to AAC intervention and to overcome barriers that prevent or delay intervention access; further synthesis of the rapidly emerging research in this area is warranted. The goal of the current systematic review was to drill down into a comprehensive meta-analysis on AAC by identifying SCED studies with telepractice in AAC intervention. Thus, the current review was designed to answer the following research questions:</p> <p></p> <ulist> <item> <bold> RQ1. </bold> To what extent and how has telepractice been used in AAC interventions for preschool- and school-age children on the autism spectrum or with IDD with complex communication needs?</item> <p></p> <item> <bold> RQ2. </bold> What was the outcome of the studies on child communication?</item> <p></p> <item> <bold> RQ3. </bold> What is the quality of the evidence in this area? At the participant level, what were the reported intervention parameters on type, modality, assessment-informed, teleproviders, and barriers to telepractice use?</item> </ulist> <hd id="AN0193226598-2">Method</hd> <p>The current review was based on the comprehensive Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) with a focus on (a) participant, instructional parameters in aided AAC intervention for children on the autism spectrum or with IDD and (b) quality of single-case experimental studies (SCED. The rationale for examining only SCED was to focus on the idiographic nature of SCED to investigate interventions at the level of the individual. Due to the heterogeneous and low-incidence nature of our target population, SCED designs were best suited to examine intervention parameters (e.g., setting, AAC modality, communication message) at the individual level. Furthermore, given the relatively nascent stage of research investigating the use of telehealth to deliver AAC intervention to children with ASD/IDD and complex communication needs, we postulated that there would be few, if any, group designs to include in the review. The detailed process for the screening and coding for the comprehensive meta-analysis is provided in [<reflink idref="bib14" id="ref19">14</reflink>], and a summary of it is described below, followed by a description of the current systematic review that was derived from the meta-analysis.</p> <hd id="AN0193226598-3">Comprehensive Meta-Analysis Search Process Summary</hd> <p>The initial search for the comprehensive meta-analysis was conducted in October and December of 2018. A second updated search was executed in April 2020. The following databases were searched: <emph>Academic Search Complete, ERIC, PsycINFO, Conference Proceedings Citation Index—Social Science & Humanities (Web of Science)</emph>, and <emph>Proquest Dissertations & Theses Global</emph>, using the following terms; [([ or alternative] within one word (w1) communicat*) or "sign language" or manual sign* or speech-generating device* or SGD (speech generating device) or "voice output communication aid" or VOCA* or PECS or "picture exchange communication system" or AAC or "visual scene display" or "functional communication training"] AND ([down* w1 syndrome] or [(develop* or intellectual] w1 [delay* or disabil* or impair*]) or autis* or retard*). Based on this initial search, a total of 7,327 documents were identified and were subsequently organized into the Rayyan web platform for screening and full-text review ([<reflink idref="bib30" id="ref20">30</reflink>]). In October 2022 and January 2023, an updated search was executed. After removing duplicates, we had a total of 1,634 studies for additional screening.</p> <p>Coders completed a title/abstract review of all documents using the following criteria: (a) the study included an AAC intervention (excluding AAC interventions that have been discredited such as facilitated communication or supported typing), (b) at least one participant was diagnosed with ASD and/or IDD and complex communication needs, (c) social-communicative or challenging behaviors served as the dependent variable, (d) the study implemented a modality of AAC intervention in any setting, (d) the study utilized SCED, and (e) interventions were disseminated in English. A total of 1,940 documents that met inclusion criteria continued to the full-text screening by coders. Participants who had a primary diagnosis of physical or sensory impairments were excluded at this stage to focus on intervention parameters for participants with ASD and/or IDD. A total of 686 documents that met criteria continued to the basic methodological quality standards screening. After screening the title, abstract and full texts of documents meeting inclusion criteria, documents were screened for basic design quality standards (described below).</p> <hd id="AN0193226598-4">Basic Methodological Quality Standards Screening of Studies</hd> <p>To determine methodological quality, we used the What Works Clearinghouse standards (WWC single-case design standards; [<reflink idref="bib44" id="ref21">44</reflink>]) for SCED, given both the rigor and the importance of these quality standards in special education ([<reflink idref="bib27" id="ref22">27</reflink>]). These criteria were used to evaluate quality standards of the included studies and included review of the study documents for the following: (a) systematic manipulation of an independent variable; (b) interrater agreement (IRA) for a minimum of 20% of data points across baseline and intervention phasesphase; (c) IRA of at least 80% or.60 kappa; (d) a study design with a minimum of three phase changes; and (e) a minimum of three data points per baseline and intervention phase, or four data points per intervention phase for alternating treatment designs. Based on these criteria, 257 AAC intervention studies met the inclusion criteria for the comprehensive meta-analysis and therefore were also screened for the current telepractice systematic review. From the updated review, 15 newly identified articles for additional screening were identified.</p> <hd id="AN0193226598-5">Telepractice Systematic Review Screening and Inclusion</hd> <p>The telepractice screening and full text review was coded by four of the study authors following two rounds of training to identify the subset of studies from the comprehensive meta-analysis focused on telepractice in AAC assessment and/or intervention as depicted in the PRISMA Flowchart in Appendix A. The authors reviewed the 257 studies/articles from the initial search and then 15 articles from the updated search on AAC intervention studies from the comprehensive meta-analysis to identify if studies had at least one participant for whom telepractice was used as (a) a component of the investigated AAC intervention or (b) part of assessment that informed the AAC intervention (or both) as defined by any of the following terms: <emph>telehealth, telepresence, telemedicine, e-coaching, remote or virtual coaching, online training</emph>. Partial or hybrid telepractice models were included. Telephone-only is often not considered a telepractice modality (e.g., for Medicaid reimbursable services) and was thus excluded from this review. One study ([<reflink idref="bib15" id="ref23">15</reflink>]) was excluded at the coding phase because it used a mobile technology app for "just in time" visual scene display programming of a high tech AAC device but the intervention was not delivered via telepractice.</p> <hd id="AN0193226598-6">Coding Methodology</hd> <p>The search process yielded eight studies (<emph>n</emph> = 22 participants) that met inclusion criteria in the current review. Demographic information for the participants and quality indicators of the studies were extracted from the comprehensive codes and are available on the Open Science Framework at OSF https://osf.io/gpdb7/. The authors simultaneously coded the studies for additional variables to answer the unique research questions of the current review related to telepractice components of assessment and intervention and treatment intensity.</p> <hd id="AN0193226598-7">Participant Characteristics</hd> <p>Information was extracted on each participant's: (a) chronological age, (b) disability status, (c) any reported standardized communication assessments and scores, (d) current communication mode(s) (i.e., how participants were communicating prior to intervention), and (e) race and ethnicity.</p> <hd id="AN0193226598-8">Intervention and Telepractice Components</hd> <p>The included participants' data and information were extracted for components of the intervention they received and the targeted communication skills. These items are briefly summarized below, and detailed descriptions are provided in Appendices the online protocol https://osf.io/2j5ay/. Intervention characteristics included items for the communication response, such as (a) the targeted AAC response(s) (i.e., natural gestures, verbalizations, low to high tech AAC), (b) communication function (i.e., behavior regulation, joint attention, social interaction), and (c(b) the intervention type (i.e., a brief description of the intervention).</p> <p>Studies were reviewed to determine if AAC assessment included telepractice components, defined as preintervention activities to ascertain information on the participant's communication and behavioral status as well as information about the intervention environment. If a study indicated the use of telepractice assessment, the modality of telepractice used was as follows: <emph>Synchronous</emph>, live connection between a telepractice end user (e.g., a participant and/or an interventionist) and a telepractice provider (e.g., researcher or interventionist providing coaching, observation, or direct instruction via telecommunications technology); <emph>Asynchronous</emph>, connection involving telecommunications between a telepractice end user and telepractice provider that was not provided at the same point in time (e.g., reviewing video or audio files that were uploaded and providing later feedback); <emph>Online modules/eLearning</emph>, an end user connecting to an online learning platform/materials in an instructed manner as part of the assessment process; and <emph>Combined modalities</emph>, a combination of any of the above modalities to support assessment activities. Studies were also coded for whether telepractice was used in AAC intervention; when this item was endorsed, the same telepractice modalities were recorded as in the assessment category.</p> <p>Across all studies, the following information was also extracted: (a) the setting in which the intervention was delivered (i.e., school, home, clinic/classroom, community/other, multiple settings); (b) if there was any provided hardware or software descriptions of the telepractice equipment (i.e., yes/no and description); (c) who served as the tele-provider (provided the assessment and/or intervention via telehealth (i.e., researcher, teacher/educator, speech-language pathologist, BCBA, other); (d) who served as the end user who received support in delivering the intervention to the child via a telepractice modality (i.e., mother, father, other family member, teacher, paraprofessional/assistant, other educator type, other clinician, other); (e) if there were any reported barriers or challenges in the use of telepractice (i.e., description); and (f) anecdotal reports and empirical-based evaluation of social validity (i.e., description).</p> <hd id="AN0193226598-9">Treatment Intensity (Dosage) Parameters</hd> <p>Treatment intensity parameters were coded based on the parameters delineated by Warrren, Fey, and Yoder (2007). These parameters have been reported in previous scoping ([<reflink idref="bib31" id="ref24">31</reflink>]) and systematic ([<reflink idref="bib38" id="ref25">38</reflink>]) reviews. The current study coded a subset of dosage parameters that included (a) session length, (b) learning opportunities per session, (c) frequency of sessions per week, and (d) total intervention duration (in weeks). After we extracted the actual descriptions of dosage parameters in each study, we categorized them into ranges of lower (e.g., 1- to 10-min sessions), medium (e.g., 11- to 20-min sessions), and higher (21-minor more sessions).</p> <hd id="AN0193226598-10">Quality Indicators</hd> <p>Full methodological quality indicators were developed from expert methodological standards (i.e., [<reflink idref="bib11" id="ref26">11</reflink>]; [<reflink idref="bib16" id="ref27">16</reflink>]; [<reflink idref="bib33" id="ref28">33</reflink>]). These quality indicators were used to review articles for descriptions of the following: (a) participants, (b) settings, (c) materials, (d) implementers, (e) procedures in baseline and intervention, (f) the dependent variable, (g) maintenance, (h) generalization, (i) procedural fidelity, and (j) social validity description. Investigators identified the standard levels of design criteria, including the following codes: (<reflink idref="bib1" id="ref29">1</reflink>) meets design standards, (<reflink idref="bib2" id="ref30">2</reflink>) meets design standards with reservations, or (<reflink idref="bib3" id="ref31">3</reflink>) does not meet standards. See the online protocol https://osf.io/x4m7a/ for a detailed description.</p> <hd id="AN0193226598-11">Interrater Reliability (IRR)</hd> <p>The IRR process and results were based on whether the included codes were completed as part of the original meta-analysis or the additional telepractice and intervention intensity codes implemented subsequent to the original data analysis. Interrater reliability for the participant characteristics, intervention parameters, and quality standards review was based on the original comprehensive meta-analysis. The IRR process for these codes was completed on 30% of included articles by four raters with doctoral degrees in special education or related fields. Randomly selected practice studies were used for coding training until 80% item by item agreement was reached. Any coding below the 80% criterion resulted in additional discussion and re-training. The authors calculated percentage agreement by dividing agreements by agreements + disagreements multiplied by 100 to calculate IRR. The IRR scores on title/abstract, full-text stage, moderator coding, and raw outcome data extraction stage were 93%, 93%, 92%, and 98%, respectively.</p> <p>Interrater reliability for the telepractice and treatment intensity codes was completed for the current review. The IRR process for these codes was completed by three study authors, two of whom held PhDs and one who was an advanced doctoral student in special education. Coding was completed in an online Qualtrics database; the raters independently coded the studies in this system. Interrater reliability was calculated for 62.5% of the included studies and 42.8% of included participant data. Interrater reliability was an average of 83%, with a range of 71% to 100%. The process used in identifying studies is depicted in the PRISMA chart presented in Appendix A.</p> <hd id="AN0193226598-12">Results</hd> <p>Eight studies yielded 22 participants who were the recipients of telepractice components in AAC assessment and/or intervention. A summary of characteristics of the study participants who met inclusion criteria is presented in the demographics table in Appendix B. Most children were in the preschool- and school-age range, with three participants in the high school/transition age range. The mean was 6 years (range = 2–20 years). Ten participants were White/Caucasian (45.4%), two were Black/African American (9%), two were Asian/Asian American (9%), one was reported as Multi Racial (4%), and for seven participants race was not reported (31.8%). Four of the studies included caregivers who spoke English ([<reflink idref="bib13" id="ref32">13</reflink>], [<reflink idref="bib12" id="ref33">12</reflink>]; [<reflink idref="bib21" id="ref34">21</reflink>]; [<reflink idref="bib36" id="ref35">36</reflink>]), one study included caregivers who spoke Turkish, Greek, Spanish, Russian, and Arabic ([<reflink idref="bib43" id="ref36">43</reflink>]), and three studies did not report inclusion criteria on caregiver language ([<reflink idref="bib6" id="ref37">6</reflink>]; [<reflink idref="bib9" id="ref38">9</reflink>]; [<reflink idref="bib10" id="ref39">10</reflink>]).</p> <p>Four of the studies (<emph>n</emph> = 11; 50% of participant sample) included standardized communication measures for participant characterization (see Appendix B). Of these, [<reflink idref="bib10" id="ref40">10</reflink>] utilized Individual Growth and Development Indicators: Early Communication Indicator ([<reflink idref="bib25" id="ref41">25</reflink>]), with two participants using primarily gestures, and one using single words. [<reflink idref="bib9" id="ref42">9</reflink>], [<reflink idref="bib21" id="ref43">21</reflink>] and [<reflink idref="bib36" id="ref44">36</reflink>] used the Vineland Adaptive Behavior Scales (VABS; [<reflink idref="bib40" id="ref45">40</reflink>]) with participants scoring in the low range. [<reflink idref="bib9" id="ref46">9</reflink>] also used the Behavioral Language Assessment Form ([<reflink idref="bib41" id="ref47">41</reflink>]) with the three participants included in this review with a range of scores across the domains, including higher scores on requests for two-thirds of participants, low-moderate scores on receptive language, and low scores on conversational skills.</p> <p>The intervention and specific telepractice components of the included studies are summarized in Table 1. Telepractice was used across both assessments and interventions. There were no studies where telepractice was used only to support assessment. A variety of AAC interventions were examined across the studies. Two studies examined AAC interventions with the POWR (Prepare, Offer, Wait, Respond) procedure, which involves instructing parents to prepare the AAC activity, offer opportunities to communicate, wait for the child's communication, and respond to the child's communication (POWR <emph>n</emph> = 7, 31.8% of sample; [<reflink idref="bib13" id="ref48">13</reflink>], [<reflink idref="bib12" id="ref49">12</reflink>]) and three studies used Functional Communication Training (<emph>n</emph> = 7; 31.8% of sample; [<reflink idref="bib6" id="ref50">6</reflink>]; [<reflink idref="bib36" id="ref51">36</reflink>]; [<reflink idref="bib43" id="ref52">43</reflink>]). Other interventions included coaching antecedent-choice-making-consequence programming for an educator in a classroom (<emph>n</emph> = 3, 13.6%; [<reflink idref="bib10" id="ref53">10</reflink>]), Naturalistic Developmental Behavioral Intervention (NDBI)/naturalistic language intervention (<emph>n</emph> = 2, 9%; [<reflink idref="bib21" id="ref54">21</reflink>]), and behavioral strategies for mand teaching in classroom (<emph>n</emph> = 3; 13.6%). A more detailed description of each of the included interventions follows.</p> <p>Table 1. Intervention Parameters and Telepractice Description for Studies.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">Citation/sample</th><th align="center" rowspan="2">AAC mode</th><th align="center" rowspan="2">Intervention/communication function</th><th align="center" colspan="2">Telepractice</th><th align="center" rowspan="2">Hardware/software description</th><th align="center" rowspan="2">Teleprovider end-user/setting</th><th align="center" rowspan="2">Barriers to use</th></tr><tr><th align="center">Assessment: modality</th><th align="center">Intervention: modality</th></tr></thead><tbody><tr><td><xref ref-type="bibr" rid="bibr6">Benson et al. (2017)</xref>(<italic>n</italic> = 1)</td><td><bold>Unaided AAC:</bold> Natural gestures, verbalization</td><td>FCT/Behavior regulation (1)</td><td>Yes: Synchronous FA</td><td>Yes: Synchronous</td><td><bold>TP:</bold> Desktop, webcam, Google Hangout<bold>EU:</bold> iPad/tablet</td><td>Researcher/Mother/Family home</td><td>None reported</td></tr><tr><td><xref ref-type="bibr" rid="bibr9">Carnett et al. (2021)</xref>(<italic>n</italic> = 3)</td><td><bold>Aided AAC:</bold> High tech, SGD</td><td>Behavioral teaching strategies/Behavior Regulation (3)</td><td>No</td><td>Yes: Synchronous, Online learning module</td><td><bold>TP:</bold> University computer, VSEE platform<bold>EU:</bold> Laptop or iPad, Bluetooth headset</td><td>Researcher/Special Education Teacher, Teaching Assistants</td><td>None reported</td></tr><tr><td><xref ref-type="bibr" rid="bibr10">Coogle et al. (2017)</xref>(<italic>n</italic> = 3)</td><td><bold>Unaided AAC:</bold> Natural gestures, verbalizations</td><td>eCoaching teacher on choice making/Joint attention/Social interaction (1)/Joint attention (2)</td><td>Yes: Synchronous</td><td>Yes: Synchronous</td><td><bold>TP:</bold> not reported<bold>EU:</bold> iPad mini, Bluetooth earpiece, Swivl webcam</td><td>Researcher/Teacher/School</td><td><bold>TP:</bold> Teacher or child out of view <bold>EU:</bold> Internet, earbud</td></tr><tr><td><xref ref-type="bibr" rid="bibr13">Douglas et al. (2017)</xref>(<italic>n</italic> = 4)</td><td><bold>Unaided AAC:</bold> Gestures, verbalization, manual sign<bold>Aided AAC:</bold> high-tech</td><td>POWR strategy/Joint attention/Behavior regulation (3)/Joint attention (1)/</td><td>No</td><td>Yes: Asynchronous, Online modules, eLearning</td><td><bold>TP:</bold> Not provided<bold>EU:</bold> Not provided</td><td>Researcher/Mother/Family home</td><td>None reported</td></tr><tr><td><xref ref-type="bibr" rid="bibr12">Douglas et al. (2018)</xref> (<italic>n</italic> = 3)</td><td><bold>Unaided AAC:</bold> Gestures, sign, verbalizations<bold>Aided AAC:</bold> Low tech</td><td>POWR strategy/Joint attention, Behavior regulation (3)</td><td>No</td><td>Yes: Asynchronous, Online modules, eLearning</td><td><bold>TP:</bold> Not provided<bold>EU:</bold> Not provided</td><td>Researcher/Mother/Family home</td><td><bold>EU</bold>: Internet speed, single parent</td></tr><tr><td><xref ref-type="bibr" rid="bibr21">Law et al. (2018)</xref>(<italic>n</italic> = 2)</td><td><bold>Unaided AAC:</bold> Natural gestures, verbalizations</td><td>NDBI/ Behavior regulation (1); Behavior regulation, joint attention, social interaction (1)</td><td>No</td><td>Yes: Synchronous, Asynchronous, Online modules, eLearning</td><td><bold>TP:</bold> Skype<bold>EU:</bold> ipad Map4speech app</td><td>Researcher/Mother/Home and Community Playground</td><td><bold>TP:</bold> Data collection on app <bold>EU:</bold> video conference</td></tr><tr><td><xref ref-type="bibr" rid="bibr36">Simacek et al. (2017)</xref>(<italic>n</italic> = 2)</td><td><bold>Unaided AAC:</bold> Gestures, verbalizations, sign<bold>Aided AAC:</bold> Pictures</td><td>FCT/Behavior regulation (2)</td><td>Yes: Synchronous SDA and FA</td><td>Yes: Synchronous</td><td><bold>TP:</bold> Desktop, webcam,Google Hangouts<bold>EU:</bold> Desktop, webcam</td><td>Researcher/Parents/Family home</td><td>None reported</td></tr><tr><td><xref ref-type="bibr" rid="bibr43">Tsami et al. (2019)</xref>(<italic>n</italic> = 4)</td><td><bold>Aided AAC:</bold> Low-tech picture card exchange</td><td>FCT/Behavior regulation (4)</td><td>Yes: Synchronous FA</td><td>Yes: Synchronous</td><td><bold>TP:</bold> Desktop, Ethernet, Vidyo<bold>EU:</bold> Computer, iPad, smartphone</td><td>Researcher/Practitioner (BCBA-D)/Home</td><td><bold>TP:</bold> Sound & video quality, Internet</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note.</emph> AAC = Augmentative and alternative communication; FA = functional analysis; FCT = Functional Communication Training; TP = teleprovider; EU = end user; SGD = speech-generating device; SDA = structured descriptive assessment; POWR = Prepare, Offer, Wait, Respond; NDBI = Naturalistic Developmental and Behavioral Intervention; SDA = structured descriptive assessment; BCBA-D = Board Certified Behavior Analyst-Doctoral.</p> <p>Collectively, studies focused on several different AAC modalities. Three studies focused on unaided AAC ([<reflink idref="bib6" id="ref55">6</reflink>]; [<reflink idref="bib10" id="ref56">10</reflink>]; [<reflink idref="bib21" id="ref57">21</reflink>]; <emph>n</emph> = 6, 27.2%), one focused on aided AAC ([<reflink idref="bib43" id="ref58">43</reflink>]; <emph>n</emph> = 4, 31.8%), and three studies focused on both unaided and aided AAC forms ([<reflink idref="bib13" id="ref59">13</reflink>], [<reflink idref="bib12" id="ref60">12</reflink>]; [<reflink idref="bib36" id="ref61">36</reflink>]; <emph>n</emph> = 9; 40.9%). In the five studies that included an unaided AAC form for participants ([<reflink idref="bib6" id="ref62">6</reflink>]; [<reflink idref="bib10" id="ref63">10</reflink>]; [<reflink idref="bib13" id="ref64">13</reflink>], [<reflink idref="bib12" id="ref65">12</reflink>]; [<reflink idref="bib36" id="ref66">36</reflink>]), gestures were the primary modality, often combined with manual sign language and/or verbalizations. In the four studies with an aided AAC form for participants ([<reflink idref="bib12" id="ref67">12</reflink>]; [<reflink idref="bib36" id="ref68">36</reflink>]; [<reflink idref="bib43" id="ref69">43</reflink>]), low-tech forms were the primary modality. [<reflink idref="bib43" id="ref70">43</reflink>] noted a focus across different communication forms that included gestures and verbalizations, but the participants who met inclusion criteria for the current review engaged in picture card exchange. [<reflink idref="bib13" id="ref71">13</reflink>] reported the use of high tech AAC, but it was unclear as to the extent to which this form was used versus the other available communication modes. Collectively across studies, implementors who provided the onsite instruction to the participants were primarily parents ([<reflink idref="bib6" id="ref72">6</reflink>]; [<reflink idref="bib13" id="ref73">13</reflink>], [<reflink idref="bib12" id="ref74">12</reflink>]; [<reflink idref="bib21" id="ref75">21</reflink>]; [<reflink idref="bib36" id="ref76">36</reflink>]; [<reflink idref="bib43" id="ref77">43</reflink>]). Two studies had special educator implementers ([<reflink idref="bib9" id="ref78">9</reflink>]; [<reflink idref="bib10" id="ref79">10</reflink>]; see Table 1).</p> <hd id="AN0193226598-13">Studies With AAC Assessment and AAC Intervention Telepractice Components</hd> <p>Four studies ([<reflink idref="bib6" id="ref80">6</reflink>]; [<reflink idref="bib10" id="ref81">10</reflink>]; [<reflink idref="bib36" id="ref82">36</reflink>]; [<reflink idref="bib43" id="ref83">43</reflink>]) reported AAC assessment with telepractice, representing a total of 10 participants (45.5% of sample). These participants ranged from 2 to 7 years old. All four studies involved synchronous telepractice coaching of interventionists. Communication functions are provided in detail in Table 1 and are summarized as follows: single functions (<emph>n</emph> = 9; 40.9% of sample), two functions (<emph>n</emph> = 6; 27.2% of sample), and three functions (<emph>n</emph> = 1; 4.5% of sample).</p> <p>Assessments conducted via telepractice included structured descriptive assessment (SDA; [<reflink idref="bib4" id="ref84">4</reflink>]; [<reflink idref="bib6" id="ref85">6</reflink>]; [<reflink idref="bib36" id="ref86">36</reflink>]), in which parents of the children were coached via synchronous telepractice to provide alternating contexts (antecedents) during brief periods of time (e.g., 3–5 minutes) while researchers measured participant communicative responding. [<reflink idref="bib6" id="ref87">6</reflink>] and [<reflink idref="bib36" id="ref88">36</reflink>] both included fully synchronous telehealth in assessment and intervention. The assessment included a structured descriptive assessment (SDA) and components of functional behavior assessment or analysis. These studies, produced from the same research lab, also included synchronous telehealth intervention through parent-coaching on Functional Communication Training ([<reflink idref="bib8" id="ref89">8</reflink>]). The purpose of these studies, however, differed. [<reflink idref="bib6" id="ref90">6</reflink>] focused on the use of Functional Communication Training to reduce self-injurious behavior by teaching functionally equivalent natural gestures and verbalizations. The participant who met inclusion for the current review increased their use of low-tech-aided AAC requests and decreased engagement in self-injury. [<reflink idref="bib36" id="ref91">36</reflink>] identified potential idiosyncratic communication responses across three routines for the children and implementing low-tech AAC. The two participants who met inclusion for this review increased their use of low-tech-aided AAC for three requests.</p> <p>[<reflink idref="bib10" id="ref92">10</reflink>] provided eCoaching to a special education teacher on the use of an antecedent-choice making-consequence strategy. First, the study team implemented the Individual Growth and Development Indicators (IGDIs; [<reflink idref="bib24" id="ref93">24</reflink>]) to measure children's communication. Second, the study team collected baseline data on educator use of embedded learning opportunities. Next, intervention was implemented with the goal of improvingimprove natural gestures and verbalizations for three students on the autism spectrum in an inclusive preschool classroom environment. The synchronous telehealth included a "bug-in-ear" via a Bluetooth earpiece and remote coaching involving an iPad Mini and a moveable (Swivl) camera. Prior to implementing intervention, the educator was provided with eCoaching. The children's responses increased when the teacher was coached to provide embedded learning opportunities. One child increased single-word use and two children increased in gesture use.</p> <p>[<reflink idref="bib43" id="ref94">43</reflink>] targeted AAC emissions focused on independent behavior regulation communicative acts (e.g., requests; protests) by teaching Functional Analysis and Functional Communication Training to mothers in their homes by researchers at a university site. To meet the needs of international families, [<reflink idref="bib43" id="ref95">43</reflink>] collaborated with language interpreters. Of the four participants in [<reflink idref="bib43" id="ref96">43</reflink>] who met inclusion for the current review, three experienced almost immediate increases in requests and subsequent decreases in challenging behavior. One participant experienced a delayed increase in requests after approximately 10, 5-minute intervention sessions and a subsequently decreasing trend in challenging behavior.</p> <hd id="AN0193226598-14">Studies with AAC Intervention-Only Telepractice</hd> <p>Four studies utilized telepractice in the delivery of AAC intervention without assessment components via telepractice reported ([<reflink idref="bib9" id="ref97">9</reflink>]; [<reflink idref="bib12" id="ref98">12</reflink>]; [<reflink idref="bib13" id="ref99">13</reflink>]; [<reflink idref="bib21" id="ref100">21</reflink>]). This accounted for 12 included participants (54.5% of the sample). The age of child participants in these studies ranged from 2 to 20 years. One study used combined synchronous and asynchronous online modules and e-learning ([<reflink idref="bib21" id="ref101">21</reflink>]), two studies used combined asynchronous and online modules ([<reflink idref="bib12" id="ref102">12</reflink>]; [<reflink idref="bib13" id="ref103">13</reflink>]), and one study used a combination of online modules and synchronous telehealth ([<reflink idref="bib9" id="ref104">9</reflink>]).</p> <p>[<reflink idref="bib21" id="ref105">21</reflink>] used a combination of synchronous and asynchronous, or "store-and-forward" telepractice methods, online modules, and e-learning to investigate the effectiveness of a Naturalistic Developmental Behavioral Intervention. Unaided AAC in the form of gestures was the targeted communication mode. Parents were provided feedback and instruction through the app on functional communication skills of children (e.g., pointing gestures). The two participants who met inclusion criteria for the current review both increased in prompted pointing during the intervention. Only one of the two participants increased substantially in spontaneous pointing to request.</p> <p>[<reflink idref="bib13" id="ref106">13</reflink>] and [<reflink idref="bib12" id="ref107">12</reflink>] used intervention approaches similar to those utilized by Law and colleagues (2018), as they were from the same investigative team. The methodology of these studies included both asynchronous/ "store-and-forward" video models of adults using the POWR strategy: <bold>p</bold>reparing an activity and the AAC to encourage communication, providing <bold>o</bold>pportunities for the child to communicate, providing sufficient time for the child to communicate (<bold>w</bold>aiting) and providing a reinforcing <bold>r</bold>esponse to the child's communication. Parents were provided with individualized feedback from the tele-providers.</p> <p>In [<reflink idref="bib13" id="ref108">13</reflink>], all four participants met the inclusion criteria. One participant experienced increases in communication posttraining that reduced to near-baseline levels during the maintenance period, two participants experienced increases posttraining and maintained those effects in the maintenance period, and one participant had minimal changes in communication in the posttraining period, but modest and gradual changes were observed in the maintenance period. In [<reflink idref="bib12" id="ref109">12</reflink>], all three of the participants met inclusion for the current review. Post online training and maintenance, one participant experienced minimal changes post treatment and gradual and modest changes during intervention, and two participants experienced increases in posttraining and sustained these increases in maintenance.</p> <p>In [<reflink idref="bib9" id="ref110">9</reflink>], three of the four participants met the inclusion criteria. The intervention was implemented by educators who first received module-based instruction and then synchronous coaching through a Behavioral Skills Training model, focused on the use of behavioral strategies to teach requesting using speech-generating devices. All three of the included participants experienced an improved percentage of independent responses. One of the three participants required procedural modifications (addition of a blank distractor symbol to the speech-generating device) to increase the participant's use of eye gaze scanning across an array of responses.</p> <hd id="AN0193226598-15">Barriers to Telepractice Use</hd> <p>Barriers to the effective use of telepractice were reported in five studies (62.5% of total; [<reflink idref="bib9" id="ref111">9</reflink>]; [<reflink idref="bib10" id="ref112">10</reflink>]; [<reflink idref="bib12" id="ref113">12</reflink>]; [<reflink idref="bib21" id="ref114">21</reflink>]; [<reflink idref="bib43" id="ref115">43</reflink>]). Of these, three studies noted at least some difficulty with internet connectivity (42% of total; [<reflink idref="bib10" id="ref116">10</reflink>]; [<reflink idref="bib12" id="ref117">12</reflink>]; [<reflink idref="bib43" id="ref118">43</reflink>]). Two studies noted difficulties with data collection (28% of total; [<reflink idref="bib21" id="ref119">21</reflink>]; [<reflink idref="bib43" id="ref120">43</reflink>]). One study noted educator feedback on the social validity questionnaires about the potential for telehealth coaching to be somewhat disruptive to the classroom ([<reflink idref="bib9" id="ref121">9</reflink>]). [<reflink idref="bib43" id="ref122">43</reflink>] had difficulty with the quality of the sound and video, which posed challenges to data coding from videos. [<reflink idref="bib21" id="ref123">21</reflink>] noted a challenge with the data collected from the mobile application due to a design error. [<reflink idref="bib10" id="ref124">10</reflink>] noted some challenges with set-up due to the child or educator moving out of view of the camera or the Bluetooth earbud slipping out of the educator's ear. In [<reflink idref="bib12" id="ref125">12</reflink>] a parent reported difficulty with caregiver-delivered implementation due to the demands of being a single parent.</p> <hd id="AN0193226598-16">Intervention Intensity Parameters</hd> <p>The length of session (dose) was clearly reported in seven studies (<emph>n</emph> = 18, 81.1% of sample). [<reflink idref="bib6" id="ref126">6</reflink>], [<reflink idref="bib10" id="ref127">10</reflink>], and [<reflink idref="bib36" id="ref128">36</reflink>] reported intervention sessions that were between 1 to 10 minutes (range = 5–6 min; see Appendix C for supplemental table on summarized intervention dosage). [<reflink idref="bib21" id="ref129">21</reflink>] reported sessions within 11 to 20 minutes (with slight variations across study phases). [<reflink idref="bib13" id="ref130">13</reflink>] and [<reflink idref="bib12" id="ref131">12</reflink>] both reported sessions lasting approximately 15 minutes, a standardized 10 min was used for data coding. The number of opportunities per session was clearly reported for four studies (<emph>n</emph> = 12, 54.5% of sample). [<reflink idref="bib36" id="ref132">36</reflink>] reported a range of 1 to 5 opportunities per session but for one participant the number of opportunities was unclear. [<reflink idref="bib43" id="ref133">43</reflink>], based opportunities for participants to request following a 30 second exposure to the reinforcement, [<reflink idref="bib13" id="ref134">13</reflink>] and [<reflink idref="bib12" id="ref135">12</reflink>] had opportunities in the "over 20 opportunities per session" category. For other participants, this information was not reported or unclear ([<reflink idref="bib6" id="ref136">6</reflink>]; [<reflink idref="bib10" id="ref137">10</reflink>]; [<reflink idref="bib21" id="ref138">21</reflink>]).</p> <p>The frequency of sessions per day or week was difficult to discern, because it was often reported as ranges. Several studies reported that multiple sessions occurred per day or per week; however, extracting the exact number of sessions per day or per week proved difficult, and these studies were then categorized as <emph>not reported or unclear</emph> ([<reflink idref="bib6" id="ref139">6</reflink>]; [<reflink idref="bib9" id="ref140">9</reflink>]; [<reflink idref="bib13" id="ref141">13</reflink>], [<reflink idref="bib12" id="ref142">12</reflink>]; [<reflink idref="bib36" id="ref143">36</reflink>]). When intervention frequency was reported, it was most often in the category of five or more sessions: [<reflink idref="bib10" id="ref144">10</reflink>]; <emph>n</emph> = 3) and [<reflink idref="bib21" id="ref145">21</reflink>]; <emph>n</emph> = 2). It was one to two sessions per week from [<reflink idref="bib43" id="ref146">43</reflink>]; <emph>n</emph> = 4).</p> <p>Total intervention duration was reported for four studies (<emph>n</emph> = 13, 59.1%) and was most often under 15 weeks. Seven of the participants received relatively short-term interventions, categorized as five weeks or less ([<reflink idref="bib13" id="ref147">13</reflink>], [<reflink idref="bib12" id="ref148">12</reflink>]). Two participants received between 6 to 10 weeks of intervention ([<reflink idref="bib43" id="ref149">43</reflink>]). Four participants received over 11 weeks of intervention ([<reflink idref="bib21" id="ref150">21</reflink>]; [<reflink idref="bib43" id="ref151">43</reflink>]). With nine participants, the total intervention duration was either not reported or was unclear given difficulty extracting from the reported ranges ([<reflink idref="bib6" id="ref152">6</reflink>]; [<reflink idref="bib9" id="ref153">9</reflink>]; [<reflink idref="bib10" id="ref154">10</reflink>]; [<reflink idref="bib36" id="ref155">36</reflink>]).</p> <hd id="AN0193226598-17">Study Quality Indicators</hd> <p>Overall study quality across 11 indicator categories depicted in Tables 2 and 3 were scrutinized, along with an overall summary of the percentage of studies within the three categories of <emph>Meets standard</emph>, <emph>Meets standard with reservation</emph>, and <emph>Does not meet standard.</emph> See the online protocol https://osf.io/x4m7a/ for the full methodological quality indicators and descriptions of each criterion to meet each standard. The studies in the current review all met the standards for sufficient descriptions of materials and of independent variables. Most of the studies (87.5%) met the standards for the description of baseline conditions and procedural integrity. Fewer than half of the studies met the standards for the remaining quality indicators. Of note, all of the studies fell into the <emph>Does not meet standard</emph> category for description of settings, and the majority of studies fell into the <emph>Does not meet standard</emph> category for the participant, maintenance, and generalization descriptions.</p> <p>Table 2. Extended Methodological Quality Standard Ratings by Experiment.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">First author/year</th><th align="center" rowspan="2">Design</th><th align="center" colspan="11">Quality criterion</th></tr><tr><th align="center">Participant desc.</th><th align="center">Setting desc.</th><th align="center">Materials desc.</th><th align="center">IM desc.</th><th align="center">DV desc.</th><th align="center">BL desc.</th><th align="center">IV desc.</th><th align="center">Main desc.</th><th align="center">Gen desc.</th><th align="center">PI desc.</th><th align="center">SV desc.</th></tr></thead><tbody><tr><td><xref ref-type="bibr" rid="bibr6">Benson et al. (2017)</xref></td><td>ABAB</td><td>0</td><td>0</td><td>2</td><td>1</td><td>1</td><td>2</td><td>2</td><td>0</td><td>0</td><td>2</td><td>0</td></tr><tr><td><xref ref-type="bibr" rid="bibr9">Carnett et al. (2021)</xref></td><td>ABAB</td><td>1</td><td>0</td><td>2</td><td>1</td><td>2</td><td>2</td><td>2</td><td>2</td><td>0</td><td>2</td><td>1</td></tr><tr><td><xref ref-type="bibr" rid="bibr10">Coogle et al. (2017)</xref></td><td>MPD</td><td>0</td><td>0</td><td>2</td><td>2</td><td>1</td><td>1</td><td>2</td><td>0</td><td>0</td><td>2</td><td>2</td></tr><tr><td><xref ref-type="bibr" rid="bibr13">Douglas et al. (2017)</xref></td><td>MPD</td><td>0</td><td>0</td><td>2</td><td>1</td><td>1</td><td>2</td><td>2</td><td>1</td><td>1</td><td>1</td><td>2</td></tr><tr><td><xref ref-type="bibr" rid="bibr12">Douglas et al. (2018)</xref></td><td>MPD</td><td>0</td><td>0</td><td>2</td><td>1</td><td>1</td><td>2</td><td>2</td><td>1</td><td>1</td><td>2</td><td>1</td></tr><tr><td><xref ref-type="bibr" rid="bibr21">Law et al. (2018)</xref></td><td>MBD</td><td>1</td><td>0</td><td>2</td><td>1</td><td>1</td><td>2</td><td>2</td><td>0</td><td>0</td><td>2</td><td>2</td></tr><tr><td><xref ref-type="bibr" rid="bibr36">Simacek et al. (2017)</xref></td><td>MPD</td><td>0</td><td>0</td><td>2</td><td>1</td><td>1</td><td>2</td><td>2</td><td>0</td><td>0</td><td>2</td><td>0</td></tr><tr><td><xref ref-type="bibr" rid="bibr43">Tsami et al. (2019)</xref></td><td>MPD</td><td>0</td><td>0</td><td>2</td><td>2</td><td>2</td><td>2</td><td>2</td><td>0</td><td>0</td><td>2</td><td>1</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note</emph>. The quality standards' full definitions and coding are described in Appendix A. 2 = met the standard (all defined criteria); 1 = met the standard with reservations (partial criteria met); 0 = did not meet the standard (did not meet criteria). IM = implementer; DV = dependent variable; BL = baseline; IV = intervention; Main = maintenance; Gen = generalization; PI = procedural integrity; SV = social validity; ABAB is a single-case experimental design in which conditions are alternated. MPD = Multiple Probe Design, a single-case experimental design in which session probes are conducted over time, with a staggering of intervention conducted across three responses, settings, or individuals; MBD = Multiple Baseline Design, a single-case experimental design in which baseline sessions are continuously conducted along with a staggering of intervention across three responses, settings, or individuals.</p> <p>Table 3. Summary of the Percentage of Studies Within the Three Standard Categories.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">Standard status</th><th align="center" colspan="11">Quality criteria</th></tr><tr><th align="center">Participant desc.</th><th align="center">Setting desc.</th><th align="center">Materials desc.</th><th align="center">IM desc.</th><th align="center">DV desc.</th><th align="center">BL desc.</th><th align="center">IV desc.</th><th align="center">Main desc.</th><th align="center">Gen desc.</th><th align="center">PI desc</th><th align="center">SV desc</th></tr></thead><tbody><tr><td>Meets standard</td><td>0 (0%)</td><td>0 (0%)</td><td>8 (100%)</td><td>2 (25%)</td><td>2 (25%)</td><td>7 (88%)</td><td>8 (100%)</td><td>1 (12%)</td><td>0 (0%)</td><td>7 (88%)</td><td>3 (38%)</td></tr><tr><td>Meets standard with reservation</td><td>2 (25%)</td><td>0 (0%)</td><td>0 (0%)</td><td>6 (75%)</td><td>6 (75%)</td><td>1 (12%)</td><td>0 (0%)</td><td>2 (25%)</td><td>2 (25%)</td><td>1 (12%)</td><td>3 (38%)</td></tr><tr><td>Does not meet standard</td><td>6 (75%)</td><td>8 (100%)</td><td>0 (0%)</td><td>0 (0%)</td><td>0 (0%)</td><td>0 (0%)</td><td>0 (0%)</td><td>5 (63%)</td><td>6 (75%)</td><td>0 (0%)</td><td>2 (24%)</td></tr></tbody></table> </ephtml> </p> <p>3 <emph>Note.</emph> The quality standards full definitions and coding are described in Appendix A. 2 = met the standard (all defined criteria); 1 = met the standard with reservations (partial criteria met); 0 = did not meet the standard (did not meet criteria). IM = implementer; DV = dependent variable; BL = baseline; IV = intervention; Main = maintenance; Gen = generalization; PI = procedural integrity; SV = social validity.</p> <hd id="AN0193226598-18">Discussion</hd> <p>We identified eight studies that included telepractice methods and outcome data for 22 participants. The literature on telepractice to deliver AAC assessment or intervention is clearly at a relatively nascent stage, as the earliest identified study in our sample was published in 2017. Although this review was derived from a meta-analysis that included preschool- through transition-age children and youth, most of the studies using telepractice included young children as participants, often to support the delivery of interventions implemented by parents. The inclusion of younger children in AAC intervention with telepractice likely highlights promising changes in the field in regards to supporting the acceptability of earlier delivery of AAC intervention to young children instead of "waiting to see" if verbal communication emerges. Furthermore, these findings suggest that a benefit of using telepractice is the opportunity it offers to provide home- and routines-based intervention.</p> <p>A high proportion of studies targeted unaided AAC (most frequently, gestures). This finding may also be reflective of the young age range of the participants. Gestures are an important component to communication intervention with young children. Gestures allow for communication skills at a distance. Additionally, they have the advantage of portability. Aided AAC was reported in a little over half of the studies, often in the form of low-tech picture cards. Two studies noted a high-tech AAC application. [<reflink idref="bib9" id="ref156">9</reflink>] introduced speech-generating devices to the participants through coaching their educators in (a) how to prepare the device and (b) the instructional strategies to teach initial requests. [<reflink idref="bib13" id="ref157">13</reflink>] indicated that one participant had access to an AAC application on an iPad, but it was unclear whether that was used during the study sessions or only at the child's school ([<reflink idref="bib13" id="ref158">13</reflink>]). Like gestures, low-tech AAC may provide an immediate option for initial AAC instruction for young children, prior to or during the process of obtaining a mid- to high-tech device. However, it is important to consider the inclusion of high-tech AAC in future telepractice-delivered research. Families need support to use high-tech AAC for both intervention instruction and device programming.</p> <p>Previous reviews of telepractice interventions for children with ASD have reported that requests have represented the predominant communicative function taught ([<reflink idref="bib1" id="ref159">1</reflink>]; [<reflink idref="bib29" id="ref160">29</reflink>]; [<reflink idref="bib42" id="ref161">42</reflink>]). Although our study was more focused on children with ASD and/or IDD and complex communication needs, we found consistent results, with a large proportion of studies focused on "behavior regulation" (often through requests for objects or for a break from a task).</p> <p>None of the studies met the standards with or without reservations across all domains of the extended methodological quality standard ratings. At most, three studies met the standards with or without reservations for nine domains ([<reflink idref="bib9" id="ref162">9</reflink>]; [<reflink idref="bib13" id="ref163">13</reflink>], [<reflink idref="bib12" id="ref164">12</reflink>]). This collective mid- to lower-range of study quality limits the level of certainty with which the results can be interpreted. Areas identified for improvement in future research include descriptions of (a) participants, (b) intervention settings, (c) maintenance and generalization, and (d) social validity.</p> <p>The studies included in this review included interventions that were relatively short-term: Most participants received interventions that lasted under five weeks. Intervention intensity—<emph>how much and in what ways an intervention is applied</emph>—is an important aspect of treatment integrity that remains under-reported in the AAC literature ([<reflink idref="bib23" id="ref165">23</reflink>]; [<reflink idref="bib32" id="ref166">32</reflink>]; [<reflink idref="bib38" id="ref167">38</reflink>]). Although some preliminary correlations have been made between higher communication treatment intensity and treatment effects ([<reflink idref="bib23" id="ref168">23</reflink>]), the continued lack of reporting of these parameters makes it difficult to draw firm conclusions that translate to clinical application. Intensity information helps to inform fidelity of implementation. When an intervention is not leading to improved skills, evaluation of whether the child was receiving the intended level of intensity is an important consideration, prior to abandoning the intervention ([<reflink idref="bib26" id="ref169">26</reflink>]) or the use of AAC altogether. We recommend that future studies report across the multiple parameters of intervention intensity, such as those proposed by [<reflink idref="bib45" id="ref170">45</reflink>]. When reporting intensity information, it is important to accompany ranges with means or total counts to allow for better extraction of these data. Attendance logs, video recordings, and related meta-data collection strategies can assist researchers and practitioners alike in gathering with intervention intensity information ([<reflink idref="bib26" id="ref171">26</reflink>]).</p> <p>There are several limitations to the current literature. First, there was a strong focus on assessment and treatment related to functional behavior intervention (e.g., Functional Analysis) to inform Functional Communication Training and not assessments of AAC system selection. Although most investigations focused on teaching behavior regulation communicative functions; there were also several examples of studies that focused on a joint attention function ([<reflink idref="bib10" id="ref172">10</reflink>]; [<reflink idref="bib13" id="ref173">13</reflink>], [<reflink idref="bib12" id="ref174">12</reflink>]). For example, [<reflink idref="bib13" id="ref175">13</reflink>] instructed parents to provide opportunities for comments, questions, and choices. Second, AAC terminology convention involves a range of disciplines that study and implement it (e.g., speech-language pathology, special education, occupational therapy, behavior analysis). Speech Language Pathology, Special Education, Occupational Therapy, Behavior Analysis). Although the review attempted to have an exhaustive list of search terms, terms such as <emph>prelinguistic communication</emph> may have identified more documents.</p> <p>Our review identified the most SCED evidence to date that is supportive of the use of telepractice for coaching caregivers of young children on AAC intervention strategies. It also identified gaps, such as few interventions focused on older children, other contexts, or high-tech AAC modalities. As our review focused on SCED and individual-level evidence, the extent to which there is strong external validity of these results remains unknown. Future research needs to confirm these findings on a broader level, with experimental designs that better lend themselves to nomothetic approaches. Given the heterogeneous and low-incidence nature of this population, large-scale designs can be logistically challenging. However, with emergence of adaptive treatment designs, such as the Sequential Multiple Assignment Randomized Trial ([<reflink idref="bib2" id="ref176">2</reflink>]) designs that allow for randomization to test intervention tailoring, future research may be better equipped to address these needs at a broader level ([<reflink idref="bib18" id="ref177">18</reflink>]). Furthermore, the rapidly expanding methodology to combine SCED and group designs in meta-analytic reviews will also allow for these eventual designs to be analyzed together (e.g., [<reflink idref="bib35" id="ref178">35</reflink>]).</p> <p>As telepractice AAC emerges further in research and practice, we are tasked with evaluating how well it works—and when it does not—in different intervention situations. It is an opportune time to examine these questions, as telepractice can be viewed as a modality to improve access to care when helpful as opposed to a necessity resultant from an event such as the COVID-19 pandemic. It is not likely that telepractice makes a sufficient substitute for all in-person AAC intervention delivery; at present, it may be best considered as a tool to improve access to coaching of interventionists or communication partners.</p> <p>Graph: Appendix A. PRISMA Flowchart.Note. Flowchart based on [<reflink idref="bib28" id="ref179">28</reflink>].</p> <p>Appendix B. Summary of Characteristics of Participant Demographics.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="center">Citation; included participants (n)</th><th align="center">Child participant age, and disability category</th><th align="center">Measurement/scores</th><th align="center">Child's communication mode prior to intervention (n)</th><th align="center">Child race: child ethnicity (n)</th></tr></thead><tbody><tr><td><p><xref ref-type="bibr" rid="bibr6">Benson et al. (2017)</xref> (<italic>n</italic> = 1)</p></td><td><p>#1 w/ ASD (1),<break /> Age: 5 (1)</p></td><td><p>N/A</p></td><td><p>Natural gestures (1)</p></td><td><p>White/Caucasian (1)</p></td></tr><tr><td><p><xref ref-type="bibr" rid="bibr9">Carnett et al. (2021)</xref> (<italic>n</italic> = 3)</p></td><td><p>#1 w/ ASD, #2 Down's syndrome; Age: 20 (1), 15 (1), 18 (1)</p></td><td><p>Vineland Adaptive Behavior Scales (<xref ref-type="bibr" rid="bibr40">Sparrow et al., 2016</xref>) low adaptive level (communication subscale, <italic>n</italic> = 3), Behavioral Language Assessment Form (<xref ref-type="bibr" rid="bibr41">Sundberg & Partington, 1998</xref>) Requests 2, 4, 3; vocal imitation 1, 2, 1, receptive 2, 3, 3, conversation skills 1, 1, 1</p></td><td><p>Natural gestures (3)</p></td><td><p>White/Caucasian (3)</p></td></tr><tr><td><p><xref ref-type="bibr" rid="bibr10">Coogle et al. (2017)</xref> (<italic>n</italic> =3)</p></td><td><p>#3 w/ ASD<break />Age: 4 (2), 5 (1)</p></td><td><p>Individual Growth and Development Indicators: Early Communication Indicator (Luze et al., 2001); Participants used the following communication modalities most frequently: Gestures (<italic>n</italic> = 1, M = 20% of intervals), multiple words (<italic>n</italic> = 1, M = 23% of intervals), single word (<italic>n</italic> = 1; M = 19% of intervals).</p></td><td><p>Natural gestures (1)<break />Verbalization (2)</p></td><td><p>White/Caucasian (3)</p></td></tr><tr><td><p><xref ref-type="bibr" rid="bibr13">Douglas et al. (2017)</xref> (<italic>n</italic> = 4)</p></td><td><p>#4 w/ IDD (3),<break /> Age: 4 (3); 3 (1)</p></td><td><p>N/A</p></td><td><p>Natural gestures and verbalization (2)<break />Natural gestures, manual sign language, mid-to-high-tech aided AAC, verbalization (1)<break />Natural gestures (1)</p></td><td><p>White/Caucasian (2);<break />Not specified (1);<break />Multi-racial (1)</p></td></tr><tr><td><p><xref ref-type="bibr" rid="bibr12">Douglas et al. (2018)</xref> (<italic>n</italic> = 3)</p></td><td><p>#3 w/ ASD<break />Age: 4 (2), 5 (1)</p></td><td><p>N/A</p></td><td><p>Natural gestures, low-tech aided AAC, and verbalization (1)<break />Natural gestures, manual sign language, and verbalization (1)<break />Natural gestures and verbalization (1)</p></td><td><p>White/Caucasian (1);<break />African American/Black (2)</p></td></tr><tr><td><p><xref ref-type="bibr" rid="bibr21">Law et al. (2018)</xref> (<italic>n</italic> = 2)</p></td><td><p>#3 w/ ASD Age: 2 (1), 3 (1)</p></td><td><p>Vineland Adaptive Behavior<break />66 (low), 63 (low), 70 (low)</p></td><td><p>Natural gestures (<italic>n</italic>=2)/ Natural gestures and verbalization (1)</p></td><td><p>Asian/Asian American (2);</p></td></tr><tr><td><p><xref ref-type="bibr" rid="bibr36">Simacek et al. (2017)</xref> (<italic>n</italic> = 2)</p></td><td><p>#2 w/ ASD (2),<break /> Age: 3 (1), 4 (1)</p></td><td><p>Vineland Adaptive Behavior Scales, parental interview (<xref ref-type="bibr" rid="bibr39">Sparrow et al., 2005</xref>; <xref ref-type="bibr" rid="bibr40">Sparrow et al., 2016</xref>), low adaptive range (defined as between 20 and 70)</p></td><td><p>Natural gestures and verbalization (1)<break />Manual sign language, low-tech aided AAC, and verbalization (1)</p></td><td><p>Not specified (2)</p></td></tr><tr><td><p><xref ref-type="bibr" rid="bibr43">Tsami et al. (2019)</xref><break />(<italic>n</italic> = 4)</p></td><td><p>#4 w/ ASD (4)<break />Age: 3 (3), 7 (1)</p></td><td><p>N/A</p></td><td><p>Verbalization (1)<break />Did not communicate using vocal speech (3)</p></td><td><p>Not specified (4)</p></td></tr></tbody></table> </ephtml> </p> <p>Appendix C. Pooled Treatment Intensity Parameters.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="center">Dosage code</th><th align="center">n</th><th align="center">Percent of pooled sample</th></tr></thead><tbody><tr><td><p>Dose session length</p></td><td /><td /></tr><tr><td><p> 1-10 min</p></td><td><p>13</p></td><td><p>59.00</p></td></tr><tr><td><p> 11- 20 min</p></td><td><p>5</p></td><td><p>22.72</p></td></tr><tr><td><p> 21 min or longer</p></td><td><p>0</p></td><td><p>0</p></td></tr><tr><td><p> Not reported or unclear</p></td><td><p>4</p></td><td><p>18.18</p></td></tr><tr><td><p>Dose opportunities per session</p></td><td /><td /></tr><tr><td><p> 1-5</p></td><td><p>5</p></td><td><p>22.72</p></td></tr><tr><td><p> 6-10</p></td><td><p>0</p></td><td><p>0</p></td></tr><tr><td><p> 11-15</p></td><td><p>0</p></td><td><p>0</p></td></tr><tr><td><p> 16-20</p></td><td><p>0</p></td><td><p>0</p></td></tr><tr><td><p> 20 or over</p></td><td><p>7</p></td><td><p>31.81</p></td></tr><tr><td><p> Not reported or unclear</p></td><td><p>10</p></td><td><p>45.45</p></td></tr><tr><td><p>Dose frequency of sessions per week</p></td><td /><td /></tr><tr><td><p> 1-2 sessions per week</p></td><td><p>4</p></td><td><p>18.18</p></td></tr><tr><td><p> 3-4 sessions per week</p></td><td><p>0</p></td><td><p>0</p></td></tr><tr><td><p> 5 or greater sessions per week</p></td><td><p>5</p></td><td><p>22.72</p></td></tr><tr><td><p> A combination of these</p></td><td><p>3</p></td><td><p>13.63</p></td></tr><tr><td><p> Not reported or unclear</p></td><td><p>10</p></td><td><p>45.45</p></td></tr><tr><td><p>Total duration</p></td><td /><td /></tr><tr><td><p> 5 weeks or less</p></td><td><p>7</p></td><td><p>31.81</p></td></tr><tr><td><p> 6-10 weeks</p></td><td><p>2</p></td><td><p>9.09</p></td></tr><tr><td><p> 11-15 weeks</p></td><td><p>4</p></td><td><p>18.18</p></td></tr><tr><td><p> 16+ weeks</p></td><td><p>0</p></td><td><p>0</p></td></tr><tr><td><p> Not reported or unclear</p></td><td><p>9</p></td><td><p>40.90</p></td></tr></tbody></table> </ephtml> </p> <p>4 <emph>Note.</emph> Appendix 3 contains dosage parameters ([<reflink idref="bib45" id="ref180">45</reflink>]), operational definitions from coding schema, and methods adapted from [<reflink idref="bib31" id="ref181">31</reflink>] and [<reflink idref="bib38" id="ref182">38</reflink>].</p> <ref id="AN0193226598-19"> <title> References </title> <blist> <bibl id="bib1" idref="ref7" type="bt">1</bibl> <bibtext> Akemoglu Y., Muharib R., Meadan H. 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What Works Clearinghouse Standards handbook version 4.1. https://ies.ed.gov/ncee/WWC/Docs/referenceresources/Final_WWC-HandbookVer5_0-0-508.pdf</bibtext> </blist> <blist> <bibtext> Warren S. F., Fey M. E., Yoder P. J. (2007). Differential treatment intensity research: A missing link to creating optimally effective communication interventions. Mental Retardation and Developmental Disabilities Research Reviews, 13(1), 70–77. https://doi.org/10.1002/mrdd.20139</bibtext> </blist> </ref> <ref id="AN0193226598-20"> <title> Footnotes </title> <blist> <bibtext> The opinions expressed are those of the authors and do not represent views of the Institute or the U.S. Department of Education.</bibtext> </blist> <blist> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The research described here is supported by the Institute of Education Sciences, U.S. Department of Education, through Grant R324A180110 to Texas A&M University.</bibtext> </blist> <blist> <bibtext> Jessica Simacek</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0000-0003-4147-773X Marianne Elmquist</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0003-4815-4626</bibtext> </blist> </ref> <aug> <p>By Jessica Simacek; Sanikan Wattanawongwan; Joe Reichle; Betul Cakir-Dilek; J. Birdie Ganz; Marianne Elmquist; Ee Rea Hong and Lauren Pierson</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib19" firstref="ref3"></nolink> <nolink nlid="nl2" bibid="bib34" firstref="ref4"></nolink> <nolink nlid="nl3" bibid="bib37" firstref="ref6"></nolink> <nolink nlid="nl4" bibid="bib29" firstref="ref8"></nolink> <nolink nlid="nl5" bibid="bib42" firstref="ref10"></nolink> <nolink nlid="nl6" bibid="bib17" firstref="ref14"></nolink> <nolink nlid="nl7" bibid="bib20" firstref="ref15"></nolink> <nolink nlid="nl8" bibid="bib22" firstref="ref16"></nolink> <nolink nlid="nl9" bibid="bib14" firstref="ref19"></nolink> <nolink nlid="nl10" bibid="bib30" firstref="ref20"></nolink> <nolink nlid="nl11" bibid="bib44" firstref="ref21"></nolink> <nolink nlid="nl12" bibid="bib27" firstref="ref22"></nolink> <nolink nlid="nl13" bibid="bib15" firstref="ref23"></nolink> <nolink nlid="nl14" bibid="bib31" firstref="ref24"></nolink> <nolink nlid="nl15" bibid="bib38" firstref="ref25"></nolink> <nolink nlid="nl16" bibid="bib11" firstref="ref26"></nolink> <nolink nlid="nl17" bibid="bib16" firstref="ref27"></nolink> <nolink nlid="nl18" bibid="bib33" firstref="ref28"></nolink> <nolink nlid="nl19" bibid="bib13" firstref="ref32"></nolink> <nolink nlid="nl20" bibid="bib12" firstref="ref33"></nolink> <nolink nlid="nl21" bibid="bib21" firstref="ref34"></nolink> <nolink nlid="nl22" bibid="bib36" firstref="ref35"></nolink> <nolink nlid="nl23" bibid="bib43" firstref="ref36"></nolink> <nolink nlid="nl24" bibid="bib10" firstref="ref39"></nolink> <nolink nlid="nl25" bibid="bib25" firstref="ref41"></nolink> <nolink nlid="nl26" bibid="bib40" firstref="ref45"></nolink> <nolink nlid="nl27" bibid="bib41" firstref="ref47"></nolink> <nolink nlid="nl28" bibid="bib24" firstref="ref93"></nolink> <nolink nlid="nl29" bibid="bib23" firstref="ref165"></nolink> <nolink nlid="nl30" bibid="bib32" firstref="ref166"></nolink> <nolink nlid="nl31" bibid="bib26" firstref="ref169"></nolink> <nolink nlid="nl32" bibid="bib45" firstref="ref170"></nolink> <nolink nlid="nl33" bibid="bib18" firstref="ref177"></nolink> <nolink nlid="nl34" bibid="bib35" firstref="ref178"></nolink> <nolink nlid="nl35" bibid="bib28" firstref="ref179"></nolink>
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  Data: Telepractice-Supported Augmentative and Alternative Communication Intervention: A Systematic Review
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  Data: <searchLink fieldCode="AR" term="%22Jessica+Simacek%22">Jessica Simacek</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4147-773X">0000-0003-4147-773X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sanikan+Wattanawongwan%22">Sanikan Wattanawongwan</searchLink><br /><searchLink fieldCode="AR" term="%22Joe+Reichle%22">Joe Reichle</searchLink><br /><searchLink fieldCode="AR" term="%22Betul+Cakir-Dilek%22">Betul Cakir-Dilek</searchLink><br /><searchLink fieldCode="AR" term="%22J%2E+Birdie+Ganz%22">J. Birdie Ganz</searchLink><br /><searchLink fieldCode="AR" term="%22Marianne+Elmquist%22">Marianne Elmquist</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4815-4626">0000-0003-4815-4626</externalLink>)<br /><searchLink fieldCode="AR" term="%22Ee+Rea+Hong%22">Ee Rea Hong</searchLink><br /><searchLink fieldCode="AR" term="%22Lauren+Pierson%22">Lauren Pierson</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Focus+on+Autism+and+Other+Developmental+Disabilities%22"><i>Focus on Autism and Other Developmental Disabilities</i></searchLink>. 2026 41(2):102-116.
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  Data: SAGE Publications and Hammill Institute on Disabilities. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
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  Data: Y
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  Data: 15
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  Data: 2026
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  Data: Institute of Education Sciences (ED)
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  Data: R324A180110
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  Data: Journal Articles<br />Information Analyses
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  Data: <searchLink fieldCode="DE" term="%22Literature+Reviews%22">Literature Reviews</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Augmentative+and+Alternative+Communication%22">Augmentative and Alternative Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Assistive+Technology%22">Assistive Technology</searchLink><br /><searchLink fieldCode="DE" term="%22Technology+Uses+in+Education%22">Technology Uses in Education</searchLink><br /><searchLink fieldCode="DE" term="%22Videoconferencing%22">Videoconferencing</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Health+Care%22">Access to Health Care</searchLink><br /><searchLink fieldCode="DE" term="%22Telecommunications%22">Telecommunications</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Children%22">Preschool Children</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Special+Needs+Students%22">Special Needs Students</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+%28Thought+Transfer%29%22">Communication (Thought Transfer)</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink>
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  Data: 10.1177/10883576251376319
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  Data: 1088-3576<br />1538-4829
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Children with autism spectrum disorder and/or with intellectual disabilities (IDD) who experience complex communication needs often benefit from augmentative and alternative communication (AAC) intervention. Given shortages, access to professionals with expertise in AAC instruction can prove difficult. Telepractice may help to connect more specialists to children and practitioners or families who can implement AAC interventions with guidance. As both AAC technology and telehealth rapidly advance, the evidence base has struggled to keep pace. This systematic review answers questions related to the use of telepractice in intervention for AAC. Data to be reported were gleaned from a comprehensive meta-analysis on AAC and intervention for preschool and school-age children on the autism spectrum and/or with IDD. In the current systematic review, eight studies were identified, representing 22 participants, that met inclusion criteria. Synthesized findings across telepractice methodologies, participant characteristics, intervention parameters, including intervention intensity, and methodological quality are reported.
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  Data: 2026
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  Data: EJ1503863
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        Value: 10.1177/10883576251376319
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      – Text: English
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        PageCount: 15
        StartPage: 102
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        Type: general
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