Costantino Maria Antonella, Bonati Maurizio
Child and Adolescent Neuropsychiatric Unit, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Laboratory for Mother and Child Health, Department of Public Health, IRCCS - "Mario Negri" Pharmacological Research Institute, Milan, Italy.
PLoS One. 2014 Mar 13;9(3):e90744. doi: 10.1371/journal.pone.0090744. eCollection 2014.
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.
To systematically evaluate outcomes of AAC interventions in children with limited speech or language skills.
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.
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.
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).
辅助与替代沟通（AAC）用于治疗严重言语产生和/或理解障碍的儿童。人们采用了各种策略，但关于其疗效的研究和争论仍局限于特定领域，很少能触及广大医学群体。
系统评价辅助与替代沟通干预对言语或语言能力有限儿童的效果。
检索了MEDLINE、EMBASE、PsycINFO、CINAHL、DARE和Cochrane图书馆数据库（截至2012年12月）。此外，还手动检索了相关期刊。对已识别研究的参考文献进行了审查。仅纳入随机对照试验。根据一套标准化且经过验证的标准评估试验质量。
1661篇检索到的论文中有14篇符合纳入标准。本综述共纳入666名儿童，7篇论文仅涉及5岁以下儿童。论文质量一般，除一篇外，其余均由8个研究团队中的一个在过去10年发表，其中5个来自美国。7项研究直接探讨了不同残疾儿童对辅助与替代沟通的使用情况。7项研究纳入了发育正常的儿童：5项评估了无障碍儿童对辅助与替代沟通技术的使用情况，以便获得可用于改善对残疾同伴干预效果的结果，2项评估了同伴对使用辅助与替代沟通儿童的态度。研究之间的干预措施和结局指标差异很大。总体研究结果表明所考虑的辅助与替代沟通干预是有效的，但仅关注随机对照试验似乎过于局限。
必须得出辅助与替代沟通干预对严重沟通障碍儿童有积极影响的确凿证据，除随机对照试验外还需要不同的方法。此外，重要的是知识、研究和争论要扩展到医学群体，以确保为这些儿童（及其父母）提供临床有效的辅助与替代沟通服务。
