*4.1. Initiations and Information Provision by Children in Communicative Interaction*

The results of an increasing frequency of initiations in children/youths when using EGAT was encouraging. Previous video-coding research [5,14,15] showed that children with complex needs more frequently act as respondents than initiators. Their messages through body movements or gestures might be difficult to be correctly interpreted as potentially communicative by the communication partners, and their minimal movements restrict their opportunities to access many aided AAC options [5,6]. Stronger control over communicative interactions may be gained by initiating communicative interaction. Gaining more control is critical in this population in order to enjoy shared participation and build self-efficacy in communicative interaction [23]. This study demonstrated that even though these participants practiced EGAT for only three to six months, they could use it to initiate communicative interactions during play or school learning tasks. EGAT could serve as an effective method for them to gain opportunities to initiate a topic, express their opinions and increase social interactions with fewer physical demands and precisely shared referent. As a consequence, their roles as active participants could be enhanced.

The findings showed that the children/youths tended to provide information in their initiations by means of EGAT, which revealed that it could be easier for them to introduce

a topic and enlarge the extent of a conversation via this AT. In contrast, in the NEGAT condition, children initiated less frequently and provided less information via gestures, vocalization or in a combination of low-tech devices. Based on the results, it is possible to inform practice that use of EGAT has the potential to provide the children/youths with better communication situations and to facilitate sharing information through ageappropriate interactions in daily life, for example, play or learning. Recent research has highlighted that the scope of communication needs to go beyond the expressions of needs and wants, and extends to development of social relationships, exchange of information and participation in social etiquette routines [42,43]. Therefore, communication partners need to facilitate access to various communication opportunities [25,44], and encourage the use of EGAT for a wider range of communicative functions in daily contexts.

#### *4.2. Turns, Initiations, and Requests by Communication Partner in Communicative Interactions*

As in previous studies, the result of this study revealed that communication partners showed dominance in the dyadic conversation by occupying more communicative turns, e.g., exhibiting a high frequency of initiations and requests to encourage the involvement of children in conversation in both the EGAT and NEGAT conditions. They dominated the conversation, probably as a means to scaffold and facilitate the children's contributions according to their available repertoires [5]. Such patterns were particularly strong in structured instruction activities, for instance, as in the atypical case, Laura. However, the findings showed that in the EGAT condition, most communication partners took fewer turns and made fewer initiations and requests compared to the NEGAT condition. Because previous articles have seldom compared the communicative interactions with and without for both communicative partners and children using aided AAC, this finding adds knowledge to how eye-gaze AT could influence dyadic interactions and ameliorate the communication asymmetry. As mentioned earlier, children showed a higher frequency of initiations and information provision when using EGAT, which might reduce the burden on communicative partners in conversations. The use of EGAT may decrease the need to refer to contextual clues and prior knowledge of the children, and facilitate the interpretation of their communicative utterances [45,46]. Conversation is a bi-directional interaction, and when communication intelligibility increases in children, the efforts by communication partners to engage children in topics or clarify the content of their expression could be alleviated.

Another possible explanation for the differences seen between the conditions is that the communication partners were aware that their children were learning to use EGAT and needed time to develop their operation skills and therefore, intentionally extended the duration of waiting and encouraged children to respond or initiate their own topic using EGAT. This argument is supported by the result that more symmetrical turns in dyadic interactions were demonstrated when these children used EGAT. Since communication partners have an influence on the interactional process, their use of sensitive responding and interaction strategies (e.g., providing an expectant delay, modeling the use of communication modes, open-ended question-asking) could have positive impacts on communicative interaction for children/youths using AAC [44,47]. Further research to address the interaction strategies that communication partners use when children use EGAT or other modes could provide more insights and guide communication partner coaching on enhanced communication technologies.
