title: A scoping review of interventions to supplement spoken communication for children with limited speech or language skills.
abstract: BACKGROUND
  Augmentative and Alternative Communication (AAC) is used for treating children with severe disorders of speech-language production and/or comprehension. Various strategies are used, but research and debate on their efficacy have remained limited to a specific area and have rarely reached the general medical community.
  
  
  OBJECTIVE
  To systematically evaluate outcomes of AAC interventions in children with limited speech or language skills.
  
  
  METHODS
  Searches were conducted (up to December 2012) in the MEDLINE, EMBASE, PsycINFO, CINAHL, DARE, and Cochrane Library databases. Furthermore, relevant journals were searched by hand. References from identified studies were examined. Only RCTs were considered. Trial quality was assessed according to a standardized and validated set of criteria.
  
  
  RESULTS
  Fourteen of 1661 retrieved papers met inclusion criteria. A total of 666 children were included in the review and 7 papers involved only children <5 years old. Papers were of average quality and all but one had been published during the previous 10 years by one of 8 research groups, 5 of which from the United States. Seven studies directly addressed AAC use by children with different disabilities. Seven studies enrolled typically developing children: 5 evaluated the use of AAC technologies by children without disabilities in order to obtain results that could be used to improve interventions in peers with disabilities, and 2 evaluated peers' attitudes towards children who used AAC. Both interventions and outcome measures varied widely between studies. Overall findings demonstrate the effectiveness of the AAC interventions considered, but the focus on RCTs alone appears too restrictive.
  
  
  CONCLUSIONS
  Solid evidence of the positive effects of AAC interventions in children with severe communication disorders must be generated, and different methods are needed besides RCTs. Moreover, it is important that knowledge, research, and debate extend to the medical community in order to ensure clinically effective AAC provision for these children (and their parents).
authors.affiliation: Child and Adolescent Neuropsychiatric Unit, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Maria Antonella
authors.initials: MA
authors.lastname: Costantino
authors.affiliation: Laboratory for Mother and Child Health, Department of Public Health, IRCCS - "Mario Negri" Pharmacological Research Institute, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bonati
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003142:Communication; D003143:Communication Devices for People with Disabilities; D003147:Communication Disorders / Q000534:rehabilitation*; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D013060:Speech; D013064:Speech Disorders / Q000534:rehabilitation*