Increasing communicative interactions of young children with autism using a voice output communication aid and naturalistic teaching.

We evaluated the effects of a voice output communication aid (VOCA) and naturalistic teaching procedures on the communicative interactions of young children with autism. A teacher and three assistants were taught to use naturalistic teaching strategies to provide opportunities for VOCA use in the context of regularly occurring classroom routines. Naturalistic teaching procedures and VOCA use were introduced in multiple probe fashion across 4 children and two classroom routines (snack and play). As the procedures were implemented, all children showed increases in communicative interactions using VOCAs. Also, there was no apparent reductive effect of VOCA use within the naturalistic teaching paradigm on other communicative behaviors. Teachers' ratings of children's VOCA communication, as well as ratings of a person unfamiliar with the children, supported the contextual appropriateness of the VOCA. Probes likewise indicated that the children used the VOCAs for a variety of different messages including requests, yes and no responses, statements, and social comments. Results are discussed in regard to the potential benefits of a VOCA when combined with naturalistic teaching procedures. Future research needs are also discussed, focusing on more precise identification of the attributes of VOCA use for children with autism, as well as for their support personnel.