Children and adolescents with severe to profound neurodevelopmental disorders (e.g., attention deficit hyperactivity disorders, autism, cerebral palsy, rare genetic syndromes) may have intellectual, motor, and sensorial delays. Additionally, they may experience communication difficulties and exhibit isolation, passivity, and withdrawal. Challenging behaviors (e.g., aggression, impulsivity, stereotypic movements, and tantrum behavior) may occur. Their clinical conditions may seriously hamper their social desirability, image, and status with deleterious outcomes on their quality of life [1-4]. To tackle this issue, one may refer to assistive technology-based rehabilitative programs (AT) [5,6]. Thus, AT-based interventions include any technological aid combined with specific tools and/or devices with adapted software capable of reducing and minimizing the existing gap between the individual abilities and the environmental requests [7-10]. Among AT-based treatments, aided-alternative and augmentative strategies (AAC) may be envisaged, which pursue the primary goal of enhancing and fostering communicative skills [11,12].

Different solutions are embedded within the aided-AAC strategies, depending on the individual's functioning and the rehabilitative goals [13]. For instance, a picture exchange communication system (PECS) protocol may be considered [14]. Otherwise, a vocal output communication device (VOCA) may be implemented [15]. Furthermore, a systematic comparison between PECS and VOCA to demonstrate the experimental control in children or adolescents with neurodevelopmental delays and communication disorders should be detailed [16]. Else, computerized hierarchical systems may be suggested to support independent request and choice of preferred items for leisure or academic purposes [17,18]. The hierarchy is justified by the need of minimizing unintentional responses [19]. Moreover, one may include literacy access through a keyboard emulator [20]. Smart-phones, GSM systems and adapted software may be adopted to ensure the communication with distant partner [21,22]. Tablets, IPAD, and IPOD are technological devices capable of enabling individuals with severe to profound developmental delays with an adapting responding and/or decreasing a challenging behavior contingently similarly to a microswitch-cluster technology [23,24].

Regardless of the technological option, AT and AAC-based interventions represent crucial educational and rehabilitative resources to promote self-determination and independence of children and adolescents with significant impairments. Thus, by using an AT-based device and/or aided AAC equipment, a participant with developmental disorders would play an active role towards the environment. Positive participation and constructive engagement could be relevantly fostered. Caregivers' burden should be meaningfully decreased accordingly [25]. Beneficial effects of the intervention on the participant's quality of life would be emphasized [26]. Although no specific rules exist, one may outline some helpful guidelines to consolidate the learning process. First, a plausible and adaptive behavioral response should be identified, which should be already available in the individual's repertoire, easily exhibited without effort. Second, a positive and highly rewarding stimulation to be contingently delivered should be adequately selected. Third, a suitable technological solution should be designed. Fourth, a systematic collection of the sessions once the program was started should be considered. Fifth, maintenance, follow-up, and generalization phases should be included. Whenever the aforementioned features were carefully respected, one may consistently argue that a child or an adolescent with neurodevelopmental disorders may favorably communicate with peers and other partners [27].

References

1. Frazier TW, Hyland AC, Markowitz LA, Speer LL, Diekroger EA (2020) Psychometric evaluation of the revised child and family quality of life questionnaire (CFQL-2). Res Autism Spectr Disord 70.
2. Hyman SL, Levy SE, Myers SM, Council on children with disabilities, section on developmental and behavioral pediatrics (2020) Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics 145.
3. Tangarorang J, Leonard H, Epstein A, Downs J (2019) A framework for understanding quality of life domains in individuals with the CDKL5 deficiency disorder. Am J Med Genet Part A 179: 249-256.
4. Jonsson U, Alaie I, Löfgren Wilteus A, Zander E, et al. (2017) Annual research review: Quality of life and childhood mental and behavioral disorders-a critical review of the research. J Child Psychol Psychiatry Allied Discip 58: 439-469.
5. Pham AV, Bennett KD, Zetina H (2019) Technology-aided interventions for individuals with autism: Implications for policy and practice. Policy Insights Behav Brain Sci 6: 202-209.
6. Robb N, Northridge J, Politis Y, Zhang B (2018) Parental intention to support the use of computerized cognitive training for children with genetic neurodevelopmental disorders. Front Public Health 6.
7. Boot FH, Owuor J, Dinsmore J, Maclachlan M (2018) Access to assistive technology for people with intellectual disabilities: A systematic review to identify barriers and facilitators. J Intellect Disabil Res 62: 900-921.
8. Stasolla F, Boccasini A, Perilli V, Caffò AO, Damiani R, et al. (2014) A selective overview of microswitch-based programs for promoting adaptive behaviors of children with developmental disabilities. Int J Ambient Comput Intell 6: 56-74.
9. Livingstone R, Paleg G (2014) Practice considerations for the introduction and use of power mobility for children. Dev Med Child Neurol 56: 210-221.
10. Wendt O, Miller B (2013) Systematic review documents emerging empirical support for certain applications of iPods® and iPads® in intervention programs for individuals with developmental disabilities, but these are not a "one-size-fits-all" solution. Evid-Based Commun Assess Intervent 7: 91-96.
11. McNaughton D, Light J (2015) What we write about when we write about AAC: The past 30 years of research and future directions. AAC Augmentative Altern Commun 31: 261-270.
12. Biggs EE, Carter EW, Gilson CB (2018) Systematic review of interventions involving aided AAC modeling for children with complex communication needs. Am J Intellect Dev Disabil 123: 443-473.
13. O'Neill T, Light J, Pope L (2018) Effects of interventions that include aided augmentative and alternative communication input on the communication of individuals with complex communication needs: A meta-analysis. J Speech Lang Hear Res 61: 1743-1765.
14. Bondy A, Frost L (2001) The picture exchange communication system. Behav Modif 25: 725-744.
15. Cosbey JE, Johnston S (2006) Using a single-switch voice output communication aid to increase social access for children with severe disabilities in inclusive classrooms. Res Pract Pers Sev Disabil 31: 144-156.
16. Stasolla F, De Pace C, Damiani R, Di Leone A, Albano V, et al. (2014) Comparing PECS and VOCA to promote communication opportunities and to reduce stereotyped behaviors by three girls with Rett syndrome. Res Autism Spectr Disord 8: 1269-1278.
17. Stasolla F, Caffò AO, Damiani R, Perilli V, Di Leone A, et al. (2015) Assistive technology-based programs to promote communication and leisure activities by three children emerged from a minimal conscious state. Cogn Process 16: 69-78.
18. Stasolla F, Caffò AO, Picucci L, Bosco A (2013) Assistive technology for promoting choice behaviors in three children with cerebral palsy and severe communication impairments. Res Dev Disabil 34: 2694-2700.
19. Lancioni GE, Belardinelli MO, Stasolla F, Singh NN, O'Reilly MF, et al. (2008) Promoting engagement, requests and choice by a man with post-coma pervasive motor impairment and minimally conscious state through a technology-based program. J Dev Phys Disabil 20: 379-388.
20. Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Chiapparino C, et al. (2007) Using an optic sensor and a scanning keyboard emulator to facilitate writing by persons with pervasive motor disabilities. J Dev Phys Disabil 19: 593-603.
21. Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Alberti G, et al. (2020) A tablet-based program to enable people with intellectual and other disabilities to access leisure activities and video calls. Disabil Rehabil Assistive Technol 15: 14-20.
22. Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Alberti G, et al. (2018) An upgraded smartphone-based program for leisure and communication of people with intellectual and other disabilities. Front Public Health 6: 234.
23. Perilli V, Stasolla F, Caffò AO, Albano V, D'Amico F (2019) Microswitch-cluster technology for promoting occupation and reducing hand biting of six adolescents with fragile X syndrome: New evidence and social rating. J Dev Phys Disabil 31: 115-133.
24. Stasolla F, Perilli V, Caffò AO, Boccasini A, Stella A, et al. (2017) Extending microswitch-cluster programs to promote occupation activities and reduce mouthing by six children with autism spectrum disorders and intellectual disabilities. J Dev Phys Disabil 29: 307-324.
25. Karlsson P, Allsop A, Dee-Price B, Wallen M (2018) Eye-gaze control technology for children, adolescents and adults with cerebral palsy with significant physical disability: Findings from a systematic review. Dev Neurorehabilitation 21: 497-505.
26. Rytterström P, Borgestig M, Hemmingsson H (2019) Hope and technology: Other-oriented hope related to eye gaze technology for children with severe disabilities. Int J Environ Res Public Health 16.
27. Griffiths T, Addison A (2017) Access to communication technology for children with cerebral palsy. Paediatr Child Health 27: 470-475.

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