Knowledge Library

Factors that Underpin the Delivery of Effective Decision-making Support for People with Cognitive Disability

Over one million Australians have some form of cognitive impairment due to intellectual disability or acquired brain injury and require significant levels of support for decision-making. To date, the range and quality of support available has been poor, often tending toward undue paternalism, with deleterious consequences for the individual’s sense of identity and quality of life. Efforts to rectify this situation have recently been championed by law reform commissions, which have focused on establishing new legal structures for support with decision-making. However, the crucial issue of how decision-making support is delivered in practice  in terms of quality and effectiveness  remains in urgent need of attention. The aim of this article is to describe four empirically based propositions that characterise effective decision making support; orchestration by the primary supporter; commitment to person; support principles; and a repertoire of strategies that can be used flexibly depending on the type and context of particular decisions. These propositions are based on evidence from a series of qualitative studies conducted by the authors. Results of these studies enabled the identification of factors that underpin delivery of effective support and can be utilised to develop capacity-building education programs for people providing decision-making support to those with cognitive disability, either intellectual disability or acquired brain injury, which will substantially improve the quality of support given.

Systematic Review of Interventions Involving Aided AAC Modeling for Children With Complex Communication Needs

Building the communicative competence of individuals who use augmentative and alternative communication (AAC) requires intervention and support. This systematic review examined experimental studies involving aided AAC modeling to promote the expressive communication of children and youth (i.e., birth to age 21) with complex communication needs. A search yielded 48 studies involving 267 participants. Interventions were categorized according to three different approaches to aided AAC modeling—augmented input, models as prompts, and models within instructional demonstrations. Although the procedures varied, interventions were generally effective at improving diverse measures of expressive communication. This review provides insight for both researchers and practitioners by describing interventions involving three distinct approaches to aided AAC modeling, highlighting areas needing future research, and offering implications for practice.


The purpose of this study was to determine the effect of manual sign mand training combined with prompt delay and vocal prompting on the production of vocal responses in nonvocal children with developmental disabilities. A multiple baseline design across participants verified the effectiveness of this intervention. All participants showed increases in vocal responses following the implementation of the independent variables.

The Benefits of Skinner’s Analysis of Verbal Behavior for Children with Autism

Behavior analysis has already contributed substantially to the treatment of children with autism,
and further gains can result from more use of Skinner’s analysis of language in Verbal Behavior
(1957) and in the resulting conceptual and experimental work. The approach emphasizes a unit
of analysis consisting of the relations between behavior, motivative and discriminative variables,
and consequences. Skinner identifies seven types of verbal operants—echoic, mand, tact,
intraverbal, textual, transcriptive, and copying a text—which function as components of more
advanced forms of language. This approach focuses on the development of each verbal operant
(rather than onwords and their meanings) and on the independent training of speaker and listener
repertoires. Five more specific contributions are described that relate to the importance of (a) an
effective language assessment, (b) mand training in early intervention, (c) establishing operations,
(d) an intraverbal repertoire, and (e) automatic reinforcement.