Copyright © 2002 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Only a few studies have evaluated the efficacy of interventions to build social interaction skills with individuals who use AAC. Light and colleagues implemented the intervention program described by Light and Binger (1998) to teach two different skills that were designed to enhance social closeness interactions for individuals who use AAC: 1) the use of nonobligatory turns to increase participation in social interactions (Light et al., 1997) and 2) the use of partner-focused questions to demonstrate an interest in others during social interactions (Light, Binger, Agate, & Ramsay, 1999).

Light and colleagues (1997) targeted the use of nonobligatory turns as a strategy to increase participation in social closeness interactions by beginning communicators. This particular skill was targeted on the basis of the argument that participants should be responsive to partners, actively engaged, and able to sustain interactions over repeated turn exchanges to interact effectively in social closeness interactions (Light, 1988, 1997). The literature suggests that many individuals who require AAC participate infrequently in social interactions, typically forfeiting their nonobligatory turns (Light, Collier, & Parnes, 1985a). This limited participation may be problematic in social closeness interactions. Light and colleagues (1997) found that professionals with previous experience in AAC and adults and adolescents without experience in AAC felt that the use of nonobligatory turns enhanced the perceived communicative competence of individuals who used AAC, provided the AAC users were able to produce the turns relatively efficiently. In general, however, interactions involving individuals who use AAC often lack the reciprocity that is critical to social closeness interactions (Light et al., 1985a). Increasing the use of nonobligatory turns (e.g., the social interjections "cool," "no way," "yeah," and "gross") by beginning communicators may be one way to enhance engagement in social closeness interactions without imposing complex linguistic demands.

To test this hypothesis, Light and colleagues (1997) targeted the use of nonobligatory turns with beginning communicators as a strategy to increase their participation in social closeness interactions. Six individuals participated in the study: 1) a 4-year-old girl with cerebral palsy, 2) a 9-year-old girl with a moderate developmental delay, 3) a 12-year-old girl with a moderate developmental delay, 4) a 14-year-old boy with autism, 5) a 21-year-old woman with severe mental retardation and cerebral palsy, and 6) a 5-year-old boy with cerebral palsy. The participants used a variety of means to communicate, including some speech approximations, gestures, signs, communication boards with line drawings, and simple voice output communication aids (VOCAs). All of the participants were symbolic. With the exception of Participant 3, they had expressive vocabularies of between 50 and 200 items. The third participant had a larger expressive vocabulary of several hundred spoken words, signs, and graphic symbols. All of the participants understood familiar one-step commands. All were able to respond appropriately to simple "wh-" questions related to the here and now (e.g., "What’s that?" "What’s the boy doing?" "Who’s that?"). The participants performed best when language input was concrete and related to the immediate context. All of the participants except the third participant had difficulty with displaced talk. The third participant was able to engage in conversations that involved displaced talk about events outside the immediate context.

Prior to intervention, the participants fulfilled fewer than 30% of their nonobligatory turns in social interactions. Contexts to promote social closeness interactions were selected for each of these individuals on the basis of their interests and daily routines. These contexts typically involved familiar, motivating shared activities that could be sustained over numerous turns and that allowed the partner and the AAC user to be in close proximity (e.g., play activities, looking at photo albums and magazines). The interventions for the individuals who required AAC involved the use of a least to most prompting hierarchy to provide guided practice for the individual in using nonobligatory turns within these social contexts. The prompting hierarchy included 1) the occurrence of a natural cue (i.e., something that happens within the natural environment that signals the opportunity for a nonobligatory turn, in this case a pause in the interaction or a comment by the partner followed by a pause), 2) the use of an expectant delay (i.e., an extended pause during which the communication partner maintains eye contact and an expectant body posture and facial expression, 3) the use of a pointing prompt (i.e., pointing to the individual or the individual’s aided communication system), and 4) modeling the target communication behavior by producing an appropriate nonobligatory turn using a mode within the individual’s repertoire (Light & Binger, 1998).

Results of the study indicated that five of the six participants learned to fulfill nonobligatory turns and significantly increased the frequency of their participation in social interactions. The sixth participant did not complete the instructional program. He made good progress during the first eight sessions; then, his speech-language pathologist made significant changes to his AAC system (i.e., made the transition from one-symbol selection for access to vocabulary to two-symbol sequences for access to vocabulary). His use of nonobligatory turns decreased dramatically with the increased operational demands of the AAC system. His speech-language pathologist felt that the participant needed to focus on developing operational competence with the new system setup; as a result, he did not complete the instruction. This case clearly illustrates the importance of setting priorities in interventions with beginning communicators so that interventions to meet target goals do not impose competing demands.

The other five participants required approximately 4 - 6 hours of instruction to demonstrate significant gains in social participation (i.e., increasing their use of nonobligatory turns from less than 30% at baseline to greater than 80% after intervention). Four of the five participants generalized the use of nonobligatory turns to new partners and social contexts. Participant 4 successfully generalized to new social situations but had difficulty generalizing to new partners. In this case, additional instruction was required to facilitate generalization to new partners. Probes conducted up to 2 months after instruction showed that all of the participants maintained their use of nonobligatory turns in social interactions. Adults with no prior experience in AAC, who were not aware of the goals of the study or the experimental conditions, rated four of the five participants as being "more competent" communicators after intervention. They perceived no significant difference in the communication skills of the third participant when comparing pre- and post-intervention videotapes. Social validation interviews with facilitators indicated that the beginning communicators participated more frequently in social interactions post-intervention and that the quality of the interactions improved as a result.

In a second study, Light, Binger, and colleagues (1999) targeted the use of partner-focused questions to enhance social closeness interactions. Light (1988, 1997) argued that a key component of social closeness interactions is the participants’ ability to demonstrate interest in each other. Yet, many individuals who use AAC may have difficulties with sociorelational skills such as "other-orientation" (Warrick, 1988). Light and colleagues (1999) adapted the intervention designed by Light and Binger (1998) to teach individuals who use AAC to ask partner-focused questions (i.e., questions directed to the partner about the partner and / or his or her interests, experiences, or feelings) as a strategy to demonstrate other-orientation. Six participants were involved in the study: 1) a 44-year-old woman who had severe spastic cerebral palsy, 2) a 25-year-old man with severe cerebral palsy, 3) a 33-year-old man with moderate mental retardation, 4) a 35-year-old man who had sustained severe brain injury in a motor vehicle accident 15 years earlier, 5) a 13-year-old boy with a developmental disability that included moderate cognitive impairment, and 6) a 10-year-old girl who had cerebral palsy. The participants represented a range of skill levels. They all understood basic social conversation and were able to respond appropriately to simple "wh-" questions. They were able to engage in displaced talk about people, objects, and events outside of the immediate context. The second and fourth participants were able to generate novel partner-focused questions, although they also made use of preprogrammed questions to enhance their rate of communication. The other participants relied on a limited range of partner-focused questions, which were preprogrammed into their VOCAs. At baseline, the second participant asked partner-focused questions in fewer than 10% of the opportunities he had, the fourth participant did so in fewer than 30% of his opportunities, and the remaining participants never asked partner-focused questions. All of the participants learned to ask partner-focused questions successfully as a result of the intervention. They required approximately 3 - 11 hours of instruction. The sixth participant required some additional instruction 4 weeks after intervention to ensure long-term maintenance of the skill. All of the participants generalized use of partner-focused questions to new partners and new situations. Social validation interviews with the participants and facilitators indicated that the use of partner-focused questions significantly enhanced the participants’ social interactions. The participants interacted with others more frequently after intervention and sustained these interactions longer. Partners reported that the interactions were much more enjoyable when the participants asked partner-focused questions.

Taking nonobligatory turns and asking partner-focused questions are just two of the skills that may further social closeness interactions for individuals who require AAC. Future research is necessary to identify other skills and strategies that will allow beginning communicators to successfully meet the demands of social closeness interactions. Of particular interest are skills and strategies that allow beginning communicators to initiate social interactions effectively, participate actively in these interactions, sustain the interactions over multiple turn exchanges, demonstrate an interest in their partner, be responsive to their partner, and put their partner at ease.