Most children transition from presymbolic (e.g., gestures and vocalizations) to symbolic (e.g., words) communication during the first year of life. This transition enables children to communicate more efficiently and leads to further developments in language acquisition. The exact mechanisms that facilitate this transition are still not fully understood, although social-interactionist theories describe both endogenous and environmental factors affecting early word learning. The transition into symbolic communication is at risk for many children with developmental delays including autism. When delays persist into preschool ages, children are frequently taught to communicate with some form of augmentative or alternative communication (AAC). These forms may include signs, picture selection, and/or voice output communication aids (VOCA). Although use of AAC by preschool children is increasing, little evidence exists linking specific child and environmental variables to communication outcomes. Children learning AAC present with very different characteristics and histories but there is no existing evidence base to guide researchers or practitioners in differentially applying interventions or interpreting results based on these variables. We hypothesize that, of the many variables that could relate to communication outcomes, a child's representational capacity- as indicated by cognitive development, comprehension, symbolic play, and prelinguistic communication level- is a significant predictor of communication outcomes. Further, we hypothesize that the effects of this predictor are mediated by the amounts of supports and input offered by the social environment. Through a longitudinal study, we propose to test hypothesized relationships between predictor and mediating variables and three different outcomes- symbolic vocabulary development, communication success, and symbol substitutions during communication repairs. Participants will be 100 young children with developmental disabilities and 20 young children with autism spectrum disorders (ASD), all of whom will be learning to communicate with AAC. Separate analyses will be completed with the cohort of children with ASD to determine the extent to which our model applies to symbolic communication development by this important subgroup. The proposed research would produce the largest data set collected thus far from a prospective study of young children learning AAC. This research is likely to improve assessment and intervention practices for these children by identifying potential predictors of response to AAC interventions. Our focus on children learning AAC will inform theoretical accounts of symbolization by documenting the extent to which processes observed in learning speech also apply to learning other symbolic modes.

National Institute of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Research Project (R01)
Project #
Application #
Study Section
Language and Communication Study Section (LCOM)
Program Officer
Shekim, Lana O
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Kansas Lawrence
Organized Research Units
United States
Zip Code
Brady, Nancy C; Anderson, Christa J; Hahn, Laura J et al. (2014) Eye tracking as a measure of receptive vocabulary in children with autism spectrum disorders. Augment Altern Commun 30:147-59
Brady, Nancy C; Thiemann-Bourque, Kathy; Fleming, Kandace et al. (2013) Predicting language outcomes for children learning augmentative and alternative communication: child and environmental factors. J Speech Lang Hear Res 56:1595-612
Brady, Nancy C; Fleming, Kandace; Thiemann-Bourque, Kathy et al. (2012) Development of the communication complexity scale. Am J Speech Lang Pathol 21:16-28
Thiemann-Bourque, Kathy S; Brady, Nancy C; Fleming, Kandace K (2012) Symbolic play of preschoolers with severe communication impairments with autism and other developmental delays: more similarities than differences. J Autism Dev Disord 42:863-73
Michael Barker, R; Saunders, Kathryn J; Brady, Nancy C (2012) Reading instruction for children who use AAC: considerations in the pursuit of generalizable results. Augment Altern Commun 28:160-70
Warren, Steven F; Brady, Nancy; Sterling, Audra et al. (2010) Maternal responsivity predicts language development in young children with fragile X syndrome. Am J Intellect Dev Disabil 115:54-75
Snell, Martha E; Brady, Nancy; McLean, Lee et al. (2010) Twenty years of communication intervention research with individuals who have severe intellectual and developmental disabilities. Am J Intellect Dev Disabil 115:364-80
Brady, Nancy C; Herynk, James W; Fleming, Kandace (2010) Communication Input Matters: Lessons From Prelinguistic Children Learning to Use AAC in Preschool Environments. Early Child Serv (San Diego) 4:141-154
Brady, Nancy C (2010) Teaching requesting and rejecting sequences: An important step in early communication programming. Evid Based Commun Assess Interv 4:145-147
Brady, Nancy; Warren, Steven F; Sterling, Audra (2009) Interventions Aimed at Improving Child Language by Improving Maternal Responsivity. Int Rev Res Ment Retard 37:333-357