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Article |
Andy Omar Villón Montero[*]
Oswaldo Enrique Zavala Cabrera*
Bertha Alice Naranjo Sanchez*
Abstract
An exhaustive research was conducted on
the communication systems used by people diagnosed with autism spectrum
disorder (ASD). The objective of this article is to identify the systems that
allow the development of communication boards in order to identify the one that
provides the best environment for the development of communicative language in
children with Autism Spectrum Disorder (ASD). A literature review was used to
analyze information from the most relevant articles related to communication
systems and a matrix was elaborated to evaluate related characteristics. As a
result, a list of dimensions and metrics of the communicational systems was
obtained and a comparative table with indicators and a measurement scale was
established. A through a technical evaluation of 3 types of users, it was
identified that the optimal communicational system for the creation of a
dashboard is the TEACCH System with a considerable satisfaction index in
design, content, pedagogy and characteristics.
Key words: Communicative Systems, ASD, ICT, Communicative
Dashboard, SAAC.
Resumen
Se realizó una investigación
exhaustiva sobre los sistemas de comunicación que utilizan las personas
diagnosticadas con el trastorno del espectro autista. El objetivo del presente
artículo implica identificar los sistemas que permiten desarrollar tableros
comunicacionales para lograr identificar el que provee un mejor entorno para el
desarrollo del lenguaje comunicativo en niños con el Trastorno del Espectro
Autista (TEA). Se utilizó la revisión de la literatura para analizar la
información de los artículos más relevantes, relacionados a los sistemas
comunicacionales y se elaboró una matriz para evaluar características afines.
Como resultado se pudo obtener un listado de dimensiones y métricas de los
sistemas comunicacionales, con ello se procedió a establecer un cuadro
comparativo con indicadores y una escala de medición. A través de una
evaluación técnica de 3 tipos de usuarios, se identificó que el sistema
comunicacional óptimo para la creación de un tablero es el Sistema TEACCH con
un índice de satisfacción considerable en diseño, contenido, pedagogía y
características.
Palabras clave: Sistemas Comunicacionales, TEA, TIC, Tablero Comunicacional, SAAC.
Introduction
Individuals with ASD (Autism Spectrum Disorder) may
experience or present difficulties in social interaction, frustration and/or
anxiety when using functional language and nonverbal communication.
People with ASD have two relationship patterns: a
more inhibited one, who has difficulties in initiating social interaction and
remains more isolated with their interests; and another profile, who seeks
contact and relationship with others, but often does not use appropriate
strategies and also has complications in the social environment. Therefore, it
is advisable to develop social skills from daily life situations, for example,
through Role Playing methods, both individually and in groups.
It is extremely necessary to deal with social rules
with children with ASD, which are difficult for them to understand. Somehow,
they need to be given the facility to memorize and interact, even if they do
not fully understand the why of some things, so that they can incorporate those
contents in daily life.
One of the complications faced by some people on the
spectrum is social interaction and communication. They are often unaware that
they are engaging in inappropriate behavior and the impact their actions have
on others.
The person with autism must understand that there
are turns of words in a dialogue between two people in order to maintain an
interpersonal distance both in games and in conversation. The communication
boards can help us understand the importance of controlling the impulse of
wanting to explain everything continuously without realizing that the other
person also needs his or her space.
It is complex to communicate with people diagnosed
with autism spectrum disorder; however, it could be considered a process to get
to have that connection with the child who has this profile and behavior, which
is why the use of tools such as communication boards is established, which
allow greater development in adopting assertive skills for an appropriate
communicative language according to their age.
Autism Spectrum Disorder
ASD is four times more common in boys than in girls
and occurs in every racial, ethnic and socioeconomic group. About 1 in 66
children are diagnosed with this disorder. According to Fonseca et al, (2020) a
diagnosis of autism at 2 or 3 years of age is stable and reliable. More and
more children receive an early diagnosis of this condition. ASD children
require clinical support, and although in some countries there are no fixed
data on the causes of its onset, this is one of the main reasons for consultation
to neuropediatrics and child psychiatrist (Fonseca et al., 2020).
Autism is a neurodevelopmental disorder that appears
and develops in childhood. Complications with social interaction, communication
problems, limiting and repetitive interests and behaviors identify it.
Currently, therapeutic approaches approach communication difficulties from a
conceptual axis, defining two different approaches depending on the educational
and therapeutic objectives. According to the theoretical framework that
supports them, related to cognitive behavioral theory and psychoanalytic-based theories,
the importance of disciplinary and social connections is introduced
(Maddalleno, 2023).
The communication skills of children with this
disorder depend on their level of intellectual and social development. Some of
them show a restricted use of language, which includes aspects such as
gestures, intonation and emphasis when speaking. These difficulties complicate
their ability to relate, particularly with other children of the same age
(Carvajal & Naranjo, 2024).
Complexity in social relationships and
communication, as well as flexibility in behavior and thinking, are
characteristics of ASD. Diagnosis is based on the clinical aspect, as there are
no biological markers. Symptoms and signs appear in different ways; they begin
at 18 months and develop at 36 months, it may be related to a history of
epilepsy and perinatal neurological risk, as well as to family histories of
developmental disorders; the cause is uncertain and multifactorial.
Infants with ASD develop several clinical variants
that cause communication problems and complications in various social
relationships, as well as repetitive behavior patterns. This disorder does not
allow the individual to fully communicate with the environment and the people
around them, so people with this disorder need constant psychoeducational
intervention to learn to understand and act in various areas of life. This is
achieved through the use of photographs, pictograms, real objects and other materials
understandable to children (Paredes and Ponguillo, 2022). They possess a
notable limitation in the ability to process new or complex information, as
well as to acquire and use new skills, which implies intellectual impairment.
This affects autonomy in daily life and social functioning, manifesting before
adulthood and with permanent developmental consequences (Jimpikit et al.,
2023).
Hyperactivity, pervasive developmental delay,
oppositional and challenging behavior, anxiety and behavioral changes and mood
processes are behavioral factors that affect the quality of family life. It has
been identified that tools such as communication boards associated with their
comprehension skills can be significantly supportive for the development of
greater understanding in children with ASD (Garrido et al., 2020).
A more detailed understanding of changes related to
ASD developmental trajectories as well as practitioner approaches is needed.
These deviations affect diagnostic practice. On the other hand, it is estimated
that more than 70% of people with ASD have other disorders, the most common
being: attention deficit hyperactivity disorder and anxiety disorder with or
without hyperactivity disorder (ADHD), with prevalence rates of 28% and 20%,
respectively (Zeidan et al., 2022).
The prevalence of ASD increases more in boys than,
in girls, with a ratio of 15-20/10,000. Autism begins to be evident at 18
months, with the following characteristics:
When social interactions experience difficulties,
which implies that they do not share attention, do not imitate or repeat
gestures, do not bring objects to show them, among other characteristics. In
social interaction, non-verbal behaviors are used such as: unusual and limited
facial expressions, non-verbal responses to physical contact, cannot hold gaze
or gaze is not related to other perspectives to communicate social concern
(they do not look at adults or eyes).
Failure to establish age-appropriate peer
relationships, putting oneself in another person's perspective is difficult,
due to complex understanding of what they are going to do, no understanding of
why people do things.
They interact with other infants, but insufficiently
(they seek developmental activities such as physical contact such as wrestling
or tickling).
They limit social relationships to things they need,
such as food, and adopt inappropriate social behaviors, such as hugging a child
too much, among others, this means that they do not comply with social norms
(García et al., 2016).
Not only the mental foundation can explain ASD,
there are other models or theories, such as, for example:
Hobson's social theory of emotions: Proposes that
autistic children from birth are unable to control their emotions in their
immediate environment and mood. In addition, it mentions that the deficits of
autistic children are related to their emotional nature. He also explains the
natural ability of children to express and perceive these feelings that adults
transmit to them, but for a child with autism these abilities do not exist and
symbolic play is difficult for him/her (Rodriguez, 2021).
Intersubjectivity theory: Colwyin Trevarthen refers
to the lack of intersubjectivity or social expression of feelings: from the
primary stage (2-9 months) to the secondary stage, there is lack of interest,
no interaction (pointing, approaching to give or accept something,
manipulation). In this case, children with ASD have problems in the second
stage, which prevents them from learning or understanding meaning, making
communication difficult (Rodriguez, 2021).
The "central coherence" theory: Uta Frith
drew on several real-life examples and evidence to develop his explanation: the
central coherence theory. In it, Frith presented her first version and
supported the tendency of children to process meaning and the big picture of
information. People with ASD have impaired central coherence, meaning that they
have difficulty integrating sensory information to make sense of social
situations and gain the perspective of others (Rodriguez, 2021).
James Russell proposed the theory of executive
action deficits in people with ASD; it is one of the most studied theories
because it seeks to explain the main deficits in people with disorders such as
ASD, Tourette syndrome, obsessive-compulsive disorder and schizophrenia. They
have difficulties with skills, impulsivity, flexibility, initiative,
self-regulation and maintenance of an independent life, decision making,
problem solving, emotion regulation, generalization of learning and adaptation
to different situations (Rodriguez, 2021).
ASD has two variations: pervasive developmental
disorder and Asperger syndrome. When we speak of autism, we refer to a similar
set of transformations; however, the manifestations vary in degree and form
depending on the person. Recognizing that we use common terms to talk about
very different people helps us to understand that autism is neither a continuum
nor a single category.
It is possible that the differences in autism are
even greater, as there are currently enormous differences between patients with
other disorders. Therefore, it can be stated that "autism" exists
because each individual is different. However, in summary, a group of disorders
that are characterized by severe developmental disorders are autistic
disorders. They sometimes cause pathological or repetitive behaviors and affect
planning, emotional reciprocity and social interaction.
Autism does not have specific characteristics, so
each child or young person with this condition will develop differently,
depending on where they grew up and their life experiences, especially the
educational system in which they were prepared. Currently, without a doubt, the
educational system has proposed several reforms that will benefit not only
students with autism, but also those without autism, and will create an
inclusive environment with the ultimate goal of building and developing a
respectful society (Morán, 2021).
Any intervention to be applied to a child with ASD
should be tailored to the particular characteristics of each individual. In
order to prioritize goals during the intervention, it is necessary to assess
their abilities and question the parents. Students with autism pay excessive
attention to small details and show great resistance to change, so it is
necessary to use different situations or environments and use different options
to increase their flexibility to change. Automated tools can awaken their
attention and motivation.
The purpose of speech and language rehabilitation
for individuals with ASD is to improve understanding, speech and use of speech.
Some individuals with ASD can communicate verbally; others, through video or
electronic communication, can use gestures, gestures, pictures and images. With
respect to occupational-level scenarios, this includes skills that will enable
them to live as autonomously as possible, such as interacting with others,
eating, bathing and dressing. Sensory integration therapy may also be included
as it helps to improve response to soothing or limiting sensory stimulation.
Being able to read and write gives people on the
autism spectrum a great deal of independence and autonomy. In addition to being
a means of communication, reading and writing are also considered fundamental
elements of the learning process and socio-cognitive development. Today's
society is deeply linked to writing, so enhancing writing skills in children,
regardless of their level, is essential for their personal development.
Although some students require alternative supports, such as images or pictograms,
it is equally important to strengthen their skills. The teaching of literacy
should be guided by respecting individual differences, avoiding the
standardization of methods that may be detrimental to academic performance. In
particular, for children with ASD, teachers face the challenge of adapting
literacy strategies, as a one-size-fits-all approach does not always respond to
their specific needs. Therefore, teachers need to be trained in different
methods and specific educational needs, and they need the support of
professionals (e.g., occupational therapists, speech therapists, etc.) to guide
their educational work (Gonzalez, 2023).
To decrease stereotyped behaviors in students with
autism, it is necessary to implement physical education programs, particularly
those based on psychomotor activities and team games, reinforced by adequate
verbal interaction from teachers and focused on positive reinforcement and
reflection (Hortal-Quesada & Sanchis-Sanchis,
2022).
It has been found that the development of this work
has a remarkable relevance both for the theoretical understanding and for the
practical application of methodologies specifically oriented to people with
cognitive limitations, particularly those diagnosed with Autism. This approach
enables the expansion of fundamental knowledge and the promotion of skills
adjusted to the particular needs of this population, contributing significantly
to the field of research on the implementation of Augmentative and Alternative
Communication (AAC), Augmentative and Alternative Communication Systems (AACS)
and Information and Communication Technologies (ICT) in subjects with
difficulties in verbal expression. Likewise, it allows assessing the impact and
advances derived from the application of specialized techniques, aimed at
enhancing the communicative and linguistic abilities of these individuals,
favoring a more effective and emotionally meaningful interaction with their
immediate social environment (Zapata & Gómez, 2021).
Studies on the sports performance of children with
ASD denote a functional impairment in aspects such as control, balance and
manual dexterity. Regarding gait pattern, problems including "shorter
strides, postural asymmetry and difficulty performing a heel-to-toe
pattern" have been reported. These deficits lead to limited participation
in physical activity (PA), which is related to a higher prevalence of obesity
in children with ASD. However, to achieve a healthy and active lifestyle,
participation in PA is essential. Reduction and loss of personal autonomy
(Mariño et al., 2021).
The need to find solutions to the reality
experienced in our environment arises after discovering and noticing the lack
of training and interest in presenting children (ASD). Therefore, it is
necessary to motivate teachers, who, together with parents, are the pillars of
this path. Be prepared and feel competent in any educational situation, because
the teacher's performance and the implementation of a set of actions and
strategies will be aimed at achieving the goals set with these students
(Vazquez-Vazquez et al., 2020).
A previous study systematically analyzed the results
obtained in studies that employed behavioral strategies as intervention methods
for individuals with ASD over a 10-year period. Multiple studies coincide in
suggesting behavioral interventions as those with the greatest results of
effectiveness in children with ASD, as they show significant improvements in
the different areas of intervention (Trejos et al., 2023).
Educational inclusion of students with ASD
The educational inclusion of students with ASD is
usually limited to their presence in educational centers intended for their
care. However, due to their difficulties in social and communication skills,
many must adapt to environments that are not very inclusive, closer to a model
of integration than true inclusion. Among the current measures proposed by the
educational system to attend to students with ASD according to their level of
impairment, there are, from lower to higher level of inclusion, the following
schooling modalities: specific center for autism, specific center, special
education classrooms located in regular centers, combined schooling, regular
center (López et al., 2022). The
evaluation of students with intellectual disabilities can be carried out
through teamwork projects, written exams using clear and accessible language,
and avoiding forcing the student to participate in oral evaluations if he/she
does not feel comfortable. In addition, it is important to provide the academic
material in video format, allowing the student to listen to it as many times as
needed to reinforce their learning, since in certain cases repetition is
essential to consolidate knowledge (Naranjo, 2022).
Two important factors have contributed to the global
awareness of ASD. The first is related to the positive results of educational
and behavioral interventions, whose impact is notable in the first years of
life, with historically notable improvements in adaptive, cognitive and
language skills. The second factor is the remarkable increase in the number of
people diagnosed with autism worldwide. Currently, the estimate has increased
from 0.04% in the 1970s to 1-2% (Buffle and Naranjo,
2021).
Among the factors contributing to the explanation
for this increase in prevalence would be improved diagnostic practices, the
increase in the number of trained professionals, the inclusion in studies of
individuals without intellectual disabilities, and the changes in diagnostic
criteria in the fourth edition of the revised Diagnostic and Statistical Manual
of Mental Disorders. (Buffle and Naranjo, 2021, p.
21).
It is determined that the psycho-pedagogical
proposals based on the PECS system are effective because they help children
with ASD to develop communication skills and social interaction, which improves
their interpersonal relationships and fosters their greater independence,
especially in the educational setting. As a general objective, implementing the
PECS picture exchange communication system served to improve communication and
social interaction skills in a student with ASD (Espinosa et al., 2023).
A nonverbal child is an individual who does not
correlate speech. The term "nonverbal" is often used, but in our opinion it is incorrect, as it does not refer to
"nonverbal" children, but to individuals who do not speak and who are
sometimes dependent on their environment and caregivers due to certain
cognitive deficits. Medicine considers all children with this syndrome as part
of "ASD", an "umbrella" idea that covers all grades without
taking into account individual differences. Traditionally, pictures or images
have served as a link between what the child with autism wishes to connote and
the outside world for communication in nonverbal people. According to more
traditional linguistics, certain social conventions mediate the handling of
symbols; these types of conventions, in addition to being functional in
allowing us to act in the world, allow us to express and realize desires,
ideas, feelings, and beliefs (Villarroel, 2019).
Aids are required for the first uses of SAACs;
figures, such as drawings, graphs, pictograms, words, or letters; gestural,
such as mime, gestures, or hand signs; and a variety of figure matrix. These
resources include technology, such as artificial speech communicators or
personal computers or tablets with specific programs, which allow different
forms of access adapted for people with reduced mobility, and facilitate the
incorporation of the different pictographic and orthographic sign systems, as
well as different forms of output including voice output (Luz, 2023).
To better understand the psychological and
neuropsychological functioning of autistic children, the varied theories on
autism and current knowledge allow us to understand what are the relationships
between the brain and cognitive and executive functions; with a particular
focus on memory, attention, planning ability and action vigilance, these
functions are more affected. The areas
of the brain devoted to visual processing are often used to solve any type of
need, even those without a visual component. It is important to always keep in
mind that people with ASD achieve greater autonomy goals if they have a clear
and stable visual structure that allows them to understand from their
perspective at all times (Solis and Barcia, 2021).
A four-phase protocol is proposed for the creation
and implementation of psychosocial interventions for people with ASD. First, it is necessary to consider initial
research on the effectiveness of a specific technique or intervention. To
determine the feasibility of a particular intervention, intervention manuals
must be created and pilot tested. Subsequently, they analyze the importance of
implementing the intervention on a large scale, monitoring the circumstances
surrounding the study and evaluating the results obtained to assess
effectiveness. Finally, despite the difficulties involved in this type of
study, since the conditions of the researchers and the context can be very
diverse, it is possible to evaluate the effectiveness of the intervention in community
contexts (Bru et al., 2020).
It is necessary to engage with educators who are
trained in the use of ICT as an educational tool to improve the
socio-communicative skills of students. The family should be part of this
action, since it is the environment in which the child grows and develops, and
where he/she begins to develop his/her first skills. Therefore, it can be an
ally to collaborate with educators in this field (Marzal et al., 2023).
Interventions should be tailored to the needs of the
individual, including age, ability, and other factors, because each case of ASD
is different due to the broad combination of abilities and severity.
Intelligence and certain areas are affected. The child's autonomy and ability
to adapt to the environment will improve with early intervention (between 2 and
3 years of age). In order for infants to achieve their potential and succeed,
early intervention fosters plasticity in their brain. However, long waiting
times and high medical costs make early evaluation difficult. Inconveniences
often delay interventions, negatively affecting effective techniques to improve
children's quality of life and opportunities for progress. Conventional
intervention plans also depend on therapist expertise (Alcañiz
et al., 2022).
To increase the participation of students with ASD,
it is also advisable to organize activities and present messages verbally with
visual support; visual timelines can be used physically, as proposed in picture
books, as they support the social stories being told; and new technologies,
such as iPads, can be used, as they address topics of common interest to
students with ASD. Activities that foster inclusion and avoid boredom (Guasch
and Gavaldà, 2020).
Technology for Autism Spectrum Disorder
Technology currently represents an alternative to
support and strengthen interaction with ASD children, some emerging
technologies such as virtual reality (VR) are attracting increasing attention
for applications in research and intervention fields. Through the use of
software, VR allows individuals to join a virtual world and interact with
electronic devices in an environment that represents an imaginary or real experience . These applications give access to each virtual
or imaginary reality taking into account the requirements of each person, so
there are two fundamental concepts to keep in mind when talking about these
virtual spaces. One is interaction, which reflects the active role of the
subject in the visualization of virtual reality graphics projection, the other
is immersion, that is, the feeling that the body exists in the virtual world,
which results as a "real" experience (Delgado et al., 2020), so each
time the technology continues to raise alternatives for teachers and thus
facilitate the inclusion of each of the students in the course.
In recent years, several initiatives linked to ICT
have provided support to people with ASD. Educational research has demonstrated
the benefits of these tools in the management of the teaching-learning process
for these students. ICTs are distinguished by their adaptability, flexibility
and versatility. They adjust to the characteristics of students with autism
spectrum disorder, encouraging more individualized learning and varied learning
rhythms. As a result, they are a part of learning that includes significant
motivations and reinforcements in the learning development process. ICTs
provide students with multiple opportunities to teach in the classroom. They
are very useful and motivating tools for children to acquire new knowledge,
coordination and stroke skills, and also serve to reinforce previously acquired
knowledge (Durán, 2021), contribute to semantic association and visual
processing skills (Fernández and Onandia, 2022).
Material more adapted to the needs of children with
ASD and more versatile is provided through ICTs. Advancement and highlighting
social skills are some of the benefits of using ICTs with individuals on the
autism spectrum. However, they not only improve emotional and social aspects,
but also increase motivation to perform those tasks. The use of technology to
improve and stimulate communication in children with ASD has grown
exponentially in recent years and provides opportunities to develop other deficit
skills such as attention, anticipation, executive functions and work capacity
(Gallardo-Montes et al., 2021).
According to experts, the use of materials or
technological options with a perspective of inclusive academic practices can
generate important contributions in the field of education and psychopedagogy. Preliminary findings on the educational
situation of children with autism spectrum disorder under conditions of
inclusion, as well as technological innovations that have helped their
education, are adequate (Solórzano et al., 2022).
Alternative Communication Systems
Alternative communication systems comprise a set of
tools and devices designed to transmit, receive and emit different types of
signals, whether voice, data, audio, video, in digital or analog format. In the
case of children with autism, the use of visual aids such as images, pictograms
and other graphic resources is essential to favor language comprehension and
expression. Likewise, the implementation of visual routines contributes to
provide structure and predictability, key aspects for their well-being and
adaptation.
PECS System
The PECS system (Picture Exchange Communication
System) was created in 1985 as a unique, complementary and alternative learning
experience to help anyone with autism and other communication disorders to
participate in communication. The exchange of symbols occurs between a
non-speaking person and his or her interlocutor. Symbols are a way of
initiating a process, making a decision, providing data or clarifying. This
method has five progressive stages. The images used can be objects, textures,
pictures, drawings and printed words. In general, all tools to promote
linguistic harmonization should, in the first place, be used in the clearest
and most transparent way, taking into account the child's abilities. It is
worth emphasizing that this process does not make a difference in the way the
infant perceives, but rather changes the child's perception so that he/she
understands how to translate what he/she receives according to the structure of
everyday language (Espinosa et al., 2023).
SAAC
The SAACs (Augmentative and Alternative
Communication Systems) integrate all forms of communication (other than speech)
designed to determine thoughts, needs, desires and ideas. When we express
through gestures, facial expressions, symbols, illustrations and/or writing, we
use all these forms of communication. To combine residual speech or as an
alternative to non-functional speech, people with severe speech limitations or
of expression require augmentative communication. The goal of communicating
with others and expressing their ideas can be achieved with other communication
tools, such as message boards with pictures and symbols, this can improve
social interactions, academic performance and feelings of self-worth.
TEACCH
TEACCH whose meaning in Spanish refers to "The
treatment and education of children with autism and related communication
problems (TEACCH)" (Panerai et al., 2002, p. 1) is based on a methodology
that prioritizes structured experience through visual stimulation. This method
was designed in the 1970's by Dr. Eric Sholper for the state government of
Northern California, USA, with the main purpose of avoiding the inadequate
institutionalization that was practiced in that period in school environments
for people with ASD and "maximizing the adaptation of materials and
structuring the environment to improve the functional skills and abilities of
the students who use it" (Guzmán, 2023, p. 37).
The TEACCH approach is one of the most effective
ways of working with people with ASD, the system recommends structured
training, focusing on social and cognitive skills, communication and language
needs and, always, on their performance. Thanks to its policies and working
methods, TEACCH has achieved satisfactory results in its applications. It is
based on simple, ordered and structured tasks and is designed to promote
autonomy and independence (Once and Pando, 2022).
SPC
Pictographic communication system (SPC). It is one
of "the most widely used systems for the social integration of people with
communication difficulties" (Benito, 2018, para. 3). It is quickly
understood what one wants to communicate thanks to the icons, so it is very
easy to decipher. In 1981, Roxana Mayer Johnson created 300 drawings
representing concepts that were used in everyday life and were part of a
fundamental communicative repertoire that offered a useful and practical
response to communication. Currently, there are more than 3,000 symbols
available for free in image banks such as Board Maker, Plaphoons and Arasaac,
all in digital pictogram format. According to the sensory integration model,
the central nervous system organizes and interprets the sensations it receives
to generate adaptive responses.
Communication Boards
The communication board can often be based or used
with elements such as images, drawings, pictograms, words, letters or gestures.
Technologies such as electronic communication boards, systems or applications
that read the words that are written and programs with pictograms are
frequently used to communicate. An exchange can provide these communication
systems through the exchange of pictures; in this case, giving and receiving
pictograms to another person as needed is a form of alternative and augmentative
or aided communication.
One form of communication is through words that go
together with gestures according to the scenario or what you want to express,
the communicational board is widely used by children with autism, intellectual
and cognitive disabilities, it is determined as a bimodal communication, since
it involves a board with images of gestures which you want to express along
with hand gestures through signs.
A communication system with figures that tend to
resemble words, as the basis of a communication board is very useful for people
who have complications in expressing their needs when communicating. In
addition, a board where several pictograms can be combined is the initial part
to connect much bigger ideas, in this way it is an alternative and augmentative
system; since the final idea that one wants to express will be according to the
combination of its pictograms, this board by having several scenarios with the
same image can be expanded with more than one meaning and it adjusts to the
scenario in which it is found.
Materials and methods
The methodology used is based in first instance on
the review of existing literature related to communication systems for children
with ASD, from which relevant information related to the most used systems in
the development of communication boards was extracted.
In addition, a comparative table was structured in
which the elements and variables to be compared could be visualized, the
communication systems to be contrasted were incorporated; identifying the
dimensions, metrics and indicators on the compared systems, the elements and
quantitative scales to be used in the evaluation of the systems were
established.
As a data collection technique, questionnaires and
checklist were used to identify the elements to be evaluated in the alternative
communication systems useful for the creation of communication boards for
children with ASD, by the experts. An evaluation model was established, which
resulted from the consensus of the experts, therapists, teachers and computer
technicians.
With these criteria, the comparative table was
elaborated, defining the key aspects and a template of indicators that allowed
quantitatively measuring the best communicational system that would facilitate
the creation of communication boards according to the established metrics.
The analysis of different communication boards was
carried out, two for each alternative communication system under study,
considering applicable parameters for the use of children with autism spectrum
disorder. Additionally, parameters and indicators taken from the research of
the referenced articles were considered, adapted with metrics and the use of
the systems was evaluated.
Results
To evaluate an alternative communication system for
children with ASD, four dimensions were considered: pedagogy, content, design,
features. A template of indicators was detailed, correlated in 4 dimensions
that are the aspects that can be evaluated in a communicational system to
obtain the optimal board for the understanding of children with ASD. The first
dimension is given under the scope of design and form, where availability can
be detected as the main indicator, along with usability, popularity,
accessibility and ergonomics. The second dimension is content with its main
indicator sound quality, reading quality, notifications and tutorials with its
secondary indicators written format and audio. The third dimension based on
pedagogy with its main indicators Interactivity, learning, monitoring, evaluation
and progress. The last dimension of characteristics evaluates the
communicational systems under aspects such as: clarity, coherence, relevance,
objectivity and understanding. In order to obtain a better visualization of the
fulfillment of the indicators of each of the selected communicational systems.
Each dimension was evaluated with a percentage of 25% respectively, adding up
to a total of 100% in order to obtain a score of 100 points.
The measurement scale established is shown in Table
1, with which the evaluators rated 4 dimensions of each of the systems on a
100-point basis.
Table 1. Satisfaction criteria
|
Final Rating |
Satisfaction Criteria |
|
100 a 85 |
Excellent |
|
84 a 75 |
Good |
|
74 a 65 |
Fair |
|
64 a 55 |
Poor |
|
<54 |
Very bad |
With the ranges in Table 1, it can be determined
whether the communication system was evaluated as excellent if the range of the
score obtained is between 85 to 100; good if it is between 75 to 84; regular
between 65 to 74; bad between 55 to 64 and very bad if it is less than 54.
Table 2. Communication Systems Evaluation Table.
|
Systems |
|||||||||||||||||
|
SAAC |
SCT |
PECS |
SPC |
MINSPEAK |
BLISS |
TEACCH |
|||||||||||
|
Design
Dimension |
Availability |
4 |
21 |
4 |
22 |
4 |
21 |
4 |
21 |
4 |
21 |
3 |
19 |
5 |
23 |
|
|
|
Usability |
3 |
4 |
4 |
4 |
4 |
3 |
4 |
|
|||||||||
|
Popularity |
4 |
4 |
3 |
3 |
3 |
3 |
4 |
|
|||||||||
|
Accessibility |
5 |
5 |
5 |
5 |
5 |
5 |
5 |
|
|||||||||
|
Ergonomics |
5 |
5 |
5 |
5 |
5 |
5 |
5 |
|
|||||||||
|
Content Dimension |
Sound |
3 |
17 |
4 |
19 |
4 |
20 |
5 |
24 |
5 |
24 |
5 |
24 |
4 |
23 |
|
|
|
Reading |
3 |
4 |
4 |
5 |
5 |
5 |
5 |
|
|||||||||
|
Contents |
3 |
3 |
4 |
4 |
4 |
4 |
5 |
|
|||||||||
|
Notifications |
4 |
4 |
4 |
5 |
5 |
5 |
4 |
|
|||||||||
|
Tutorials |
4 |
4 |
4 |
5 |
5 |
5 |
5 |
|
|||||||||
|
Pedagogy
Dimension |
Interactivity |
4 |
21 |
4 |
21 |
4 |
21 |
4 |
21 |
4 |
20 |
4 |
20 |
4 |
22 |
|
|
|
Apprenticeships |
5 |
5 |
5 |
5 |
5 |
5 |
4 |
|
|||||||||
|
Follow-up |
4 |
4 |
4 |
4 |
3 |
3 |
5 |
|
|||||||||
|
Evaluation |
4 |
4 |
4 |
4 |
4 |
4 |
5 |
|
|||||||||
|
Progress |
4 |
4 |
4 |
4 |
4 |
4 |
4 |
|
|||||||||
|
Characteristics Dimension |
Clarity |
4 |
17 |
4 |
17 |
4 |
19 |
4 |
19 |
4 |
18 |
4 |
17 |
5 |
22 |
|
|
|
Consistency |
3 |
3 |
4 |
4 |
4 |
3 |
4 |
|
|||||||||
|
Relevance |
4 |
4 |
4 |
4 |
4 |
4 |
5 |
|
|||||||||
|
Objectivity |
3 |
3 |
3 |
3 |
3 |
3 |
4 |
|
|||||||||
|
Understanding |
3 |
3 |
4 |
4 |
3 |
3 |
4 |
|
|||||||||
|
TOTALS |
76 |
|
79 |
|
81 |
|
85 |
|
83 |
|
80 |
|
90 |
|
|||
Note. Adapted from Design of a system of indicators
for the evaluation and selection of applications for people with Autism
Spectrum Disorder, by Gallardo-Montes et al., 2021.
Table 2 shows that each sub-indicator was evaluated
on a scale of 1 to 5 and each dimension represented 25%, adding all the
dimensions a total of 100 points was obtained as a rating of the Communication
System.
Table 3. Communication Systems Rating Table.
|
System |
Score |
|
SAAC. |
76 |
|
SCT. |
79 |
|
PECS. |
81 |
|
SPC. |
85 |
|
MINSPEAK |
83 |
|
Bliss System |
80 |
|
TEACCH |
90 |
Table 3 shows the final results of the comparative
table, based on the scores given by the experts. It was determined that the
SAAC communication system obtained 76 points, categorized as Good, the Total
Communication System obtained 79 points, categorized as Good, PECS obtained 81
points categorized as Good, SPC obtained 85 points categorized as Excellent,
MINSPEAK obtained 83 points categorized as Good, Sistema Bliss obtained 80
points categorized as Good and finally TEACCH obtained one of the best results
with 90 points categorized as Excellent. The TEACCH system differs from the
others by denoting greater availability as it is present in most of the boards
used for communication with children with ASD. In the area of reading, content
and tutorials, TEACCH also stood out for a greater focus of perspective on
details, monitoring and evaluation with the pedagogy dimension and, as a last
aspect, clarity and relevance stand out as the most representative
characteristics compared to the other systems.
The present research focused on identifying the best
communicational system by selecting criteria that allow comparisons to be made
on a score of 100 points.
One of the key pillars for the identification of the
best system is the ease with which it can be used to create communication
boards.
The results achieved were significant, since it was
corroborated that thanks to the indicators determined it was possible to
establish the most appropriate system for the development of a communication
board, which will enable children with ASD to internalize information in a more
efficient way, they will be able to have greater concentration and focus, and
in the future they will show better progress in communication skills, as
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Master Salesian Polytechnic University
https://orcid.org/0009-0000-2839-7925
Master Salesian Polytechnic University
https://orcid.org/0000-0003-0252-4126
Master Salesian Polytechnic University
https://orcid.org/0000-0002-4386-2335