Reciprocal Innovation to Optimize Low-Tech Augmentative and Alternative Communication (AAC) for Individuals
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age3-14
SponsorIndiana University
About this trial
Many people with autism and other developmental conditions have difficulty speaking or do not use speech and need other ways to communicate. Augmentative and alternative communication (AAC) includes tools such as picture boards, communication books, and gestures that support communication. In low-resource settings and underserved rural areas in the United States, high-tech AAC devices are often too expensive or difficult to access, and trained specialists are limited.
Low-tech AAC options are more affordable but are often not used successfully because tools may not match the individual's abilities or daily environment, caregivers and providers may lack training, and stigma or low awareness may discourage use. These challenges can lead to AAC abandonment and social isolation.
Rural Virginia and western Kenya face similar barriers, including limited AAC expertise, inconsistent assessment, and insufficient training for families, educators, and community providers. This project uses a shared learning approach that combines western Kenya's experience implementing low-tech AAC in new settings with rural Virginia's expertise in individualized assessment, training, and scalable service delivery. The goal is to better match individuals to appropriate low-tech AAC systems and support communication partners to use them effectively.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Communication partners (e.g., caregivers, parents, teachers, community health workers, or aides) aged 18 years or older
Primary communication partner of a child aged 3 to 14 years
Child has a documented diagnosis of autism spectrum disorder or a related neurodevelopmental condition
Child is minimally verbal or non-verbal
Disqualifiers
Communication partners younger than 18 years of age
Communication partners of children younger than 3 years or older than 14 years
Communication partners of children who use fluent spoken language
Inability to communicate in the required study languages
Trial design
Design model
Sequential
Treatments tested in this trial
Automated AAC Assessment and Low-Tech AAC Implementation Support
BehavioralThis intervention includes a computer-based assessment that identifies individual communication needs and generates personalized recommendations for low-tech augmentative and alternative communication (AAC) strategies. Recommended AAC materials, such as picture-based boards, object symbols, and communication routines, are culturally adapted for use in western Kenya and rural Virginia. Communication partners use these recommendations to support consistent and appropriate AAC use in daily activities.
Standard AAC Support
BehavioralCommunication partners receive standard of care, defined as usual AAC referral pathways and locally available AAC training and support resources.
Treatment groups
500 Participants
are divided into 2 treatment groupsGroup A: Automated AAC TrainingExperimental treatment 1 intervention
Group B: Standard AAC SupportActive comparator 1 intervention
Trial outcomes
Primary outcomes
1
Functional Communication
Change in child functional communication, measured by the Communication Matrix total score. The Communication Matrix assesses intentional communication behaviors across communication functions and modalities.
Time frame
Baseline, 6 months, and 12 months2
AAC Implementation Fidelity
Fidelity of augmentative and alternative communication (AAC) implementation by communication partners, measured using a standardized AAC fidelity checklist based on recommended system use and communication strategies.
Time frame
Baseline to end of intervention (approximately 12 weeks)Secondary outcomes
1
Provider Competence
Communication partner knowledge and skills related to AAC implementation, measured using a structured competency assessment.
Time frame
Baseline to end of intervention (approximately 12 weeks)2
Provider Compliance
Adherence to recommended AAC strategies during daily routines, measured as the proportion of recommended AAC strategies implemented, based on caregiver-reported use across daily activities.
Time frame
Baseline to end of intervention (approximately 12 weeks)3
Observed Communication Behaviors
Change in observed child communication behaviors, measured using video-recorded communication samples coded with the Communication Complexity Scale (CCS) for a randomly selected subset of participants
Time frame
Baseline, 6 months, and 12 months4
Caregiver-Child Interaction Quality
Quality of interactions between communication partners and children, measured using structured observational ratings derived from video-recorded interaction samples.
Time frame
Baseline to end of intervention (approximately 12 weeks)Other outcomes
1
AAC System Retention
Proportion of children continuing to use the recommended AAC system, as reported by communication partners.
Time frame
6 months after intervention completion2
Sustainability of AAC Implementation
Continued use of recommended AAC strategies by communication partners, assessed by caregiver report at follow-up.
Time frame
6 months after intervention completion3
AAC Use and Dosage
Frequency of AAC use, caregiver implementation dosage, and availability of AAC systems during daily routines, measured using ecological momentary assessment (EMA) delivered via smartphone application.
Time frame
Twice weekly during the 12-week intervention periodSponsors and contacts
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Source ClinicalTrials.gov
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