Pre-service Education in Augmentative and Alternative Communication

Supporting Families of Children Who Use AAC

Access to Justice: An SLP’s Guide to Helping Persons with Complex Communication Needs Voice Their Case

Despite evidence for the usefulness of augmentative and alternative communication (AAC) for young children with complex communication needs (CCN), several barriers prevent children from accessing AAC intervention. This qualitative study is focused on understanding the lived experiences of parents accessing and learning how to use speech-generating devices with their young children (3-6 years) with CCN. Findings generate insight into the similarities and differences across families’ experiences through several categories and themes: (a) foundational perspectives (determination and resilience; finding balance); (b) experiences getting access to an AAC device (initiating access; navigating barriers); (c) experiences using an AAC device (learning and navigating challenges; supporting their child’s communication at home and in the community; seeing progress); and (d) surrounding factors (family structure, informal supports, and demands; access to services and professional supports; the COVID-19 pandemic). Implications for practice and policy are discussed related to how to improve AAC access and intervention.

Augmentative and Alternative Communication (AAC) systems are a common assistive technology (AT) intervention for learners with complex communication needs (CCN) – those learners who are unable to use speech and language as a primary mode of communication. AAC systems can be a powerful intervention; however, these systems must be integrated with strong, early and conventional literacy instructional opportunities. In this chapter, we provide parents, educators, researchers, academics, and other professionals with the most up to date and innovative information as well as practical resources regarding early literacy and AAC for learners with CCN. Emphasis will be on young children with CCN in preschool and early elementary school settings. Features of AAC systems and evidence-based literacy assessment and intervention, as well as the benefits and challenges, are presented to provide the reader with information on the current state of the field. The chapter concludes with directions for future research and provides a comprehensive list of resources and organizations.

Adolescents with complex communication needs require interventions based on community communication skills for effective communication within the expanding scope of their lives. This study aimed to compare two augmentative and alternative communication (AAC) interventions by using script for their effectiveness in helping four adolescents with complex communication needs to express themselves in the community. The devices used in the study were a location-based and a category-based high-tech AAC device used in an alternative treatment design. The two intervention methods were alternated during the intervention phase of the study to determine the more effective one. The effect size was calculated using an improvement rate difference (IRD) analysis. Then, the more effective method was applied instead of the less effective one in the replication phase, within the setting where the less effective method had previously been employed, to assess its effectiveness. and effective AAC communication methods were employed within the community during the generalization phase. As a result of the interventions, all four participants showed increased accuracy of expression in the local community compared with the baseline, and the location-based tool showed greater treatment effects than the category-based tool. Additionally, the location-based device also showed generalization effects in the local community. The findings confirmed the efficacy of the two different AAC tools to improve the accuracy of expression among adolescents with complex communication needs, facilitating their integration into the community.

Despite the benefits of augmentative and alternative communication (AAC) systems for children with complex communication needs, these systems are not consistently accepted by parents. This study aimed to explore factors that contribute to the acceptance, rejection, or abandonment of AAC systems. Semi-structured interviews were conducted with 16 speech-language pathologists (SLPs) who had introduced at least one AAC system that was rejected or abandoned by the parent of a young child, as well as one that had been accepted. Thematic analysis revealed six themes that describe influences on parent acceptance of AAC systems: (a) The Way Parents View their Child, (b) Parents’ Views on AAC Intervention, (c) Support Networks Around Parents, (d) The Capacity of and Demands on Parents, (e) Services Provided by SLPs, and (f) Specific Features of AAC Systems. Themes were largely consistent with the existing literature; however, SLPs raised the novel concept of parent grief and loss as a potential contributor to AAC abandonment. To increase AAC acceptance, SLPs should consider not only the child with complex communication needs, but also the child’s parents, the AAC systems available, and their own clinical limitations.

Augmentative and alternative communication (AAC) services for people with complex communication needs in New Zealand were investigated by surveying speech-language therapists. Two separate survey forms were developed and mailed to speech-language therapists who worked with either students or adults. In both survey forms, information was requested about (a) the provision of AAC intervention, (b) the professional needs of speech-language therapists providing AAC services, and (c) demographic information about students with complex communication needs. Low-tech communication options and sign language were the most commonly reported AAC strategies used by adults and students with complex communication needs. Students aged 5 – 10 years received the most AAC intervention. Cerebral palsy, intellectual disabilities and autism spectrum disorders were the most commonly reported etiologies of students who used AAC. A total of 86% of the respondents indicated a desire for further AAC information or training.

With recent data reporting approximately 40–50% of Deaf or hard of hearing (DHH) individuals as having a diability, complex communication needs are not uncommon within this population and can present unique communicative challenges. Implementing augmentative and alternative communication (AAC) systems can provide this population with an effective means of communication, assist them in developing specific language skills, and support them in effectively accessing their social environment. The purpose of this scoping review was to (a) identify the facilitators and barriers to AAC provision for this group of individuals, (b) discuss observable trends throughout studies, and (c) highlight areas for further research in AAC for this group of learners. This review compiles the results from seven studies within the last 10 years and focuses on the facilitators and barriers when implementing AAC systems for DHH individuals with a disability (DWD) and complex communication needs. The facilitators and barriers are categorised as interpersonal, intervention and assessment related. The trends that were identified included (a) the overall success of AAC, (b) the prevalence of speech-generating devices (SGD) use, (c) the lack of communication within interdisciplinary teams, (d) the lack of DHH-specific research, and (e) the lack of standardised methods for AAC selection.

The World Health Organization's (WHO's) 2001 International Classification of Functioning Disability and Health (ICF) has as one of its central tenets the full inclusion of persons with disabilities in society. It acknowledges the need for medical and rehabilitation intervention in its biopscychosocial framework. However, the WHO realizes that society must do its part to facilitate this full participation and empowerment. Persons with complex communication needs (PWCCN) often need augmentative and alternative communication (AAC) in order to express themselves. However, in order to access and successfully use AAC, PWCCN need access to the necessary AAC devices and services, as well as a willing society to interact with them as full contributing members of society. The factors outside of a person's specific physical and/or cognitive functional limitations are addressed in the ICF via the Personal and Environmental Factors. Personal Factors include the individual's personality traits, lifestyle, experiences, social/educational/professional background, race, gender, and age. Environmental Factors include community support systems, social service agencies, governments, social networks, and those persons that interact with the PWCCN. This article addresses the sociopolitical influences on PWCCN and their functioning from a human rights perspective. The necessary introspective role of speech-language pathologists in this process is explored.

<p style="text-align: justify;"><strong>Context and relevance. </strong>A substantial proportion of children with autism spectrum disorder (ASD) have limited functional speech, which increases the relevance of augmentative and alternative communication (AAC). This article is the first part of a broader work analysing AAC tools used with children with ASD. <strong>Objective</strong>. To identify the AAC systems most commonly used with children with ASD, define key developmental domains relevant to AAC system selection, and describe selection criteria and indicators for specific AAC systems. <strong>Methods</strong>. A systematic literature review was conducted in PubMed, MEDLINE, and eLibrary.ru. Search terms included autism spectrum disorder/ASD, augmentative and alternative communication/AAC, and speech impairment. Thirty-four domestic and international publications meeting the topic relevance criteria were included. <strong>Results</strong>. The AAC systems most relevant for children with ASD were identified: the Picture Exchange Communication System (PECS), communication boards, natural gestures, single- and multi-message speech-generating devices, and AAC mobile applications. Evidence-based selection requires consideration of five developmental domains: expressive communication, visual perception, cognition, motor skills, and self-regulation. For each AAC system, selection criteria are described to accommodate the heterogeneity of children with ASD and different functional profiles. <strong>Conclusions</strong>. AAC systems address diverse needs of children with ASD. AAC selection should be individualized and based on the child’s asynchronous developmental profile and skill level, which may facilitate more effective AAC acquisition and potentially reduce social-communication difficulties.</p>

PurposePeople who have complex communication needs (CCN), and who use augmentative and alternative communication (AAC) to help them express themselves, can be difficult to engage in decision making about their healthcare. The purpose of this review was to identify what patient-reported outcome measures (PROMs) have been employed with people who use AAC. Of the tools identified, the review aimed to establish what conceptual frameworks were used and how the reports describe completion of the PROM.MethodsA systematic literature review was carried out. A pre-defined set of search terms was entered into five main health and education databases. Titles and abstracts were sifted for relevance. Full text papers were screened against inclusion/exclusion criteria. Data pertaining to the type and nature of the PROM used was extracted. Complementary data sources were analysed to construct a narrative synthesis of the papers identified.ResultsWithin 15 papers that met the review criteria, 25 PROMs were used with people who rely on AAC comprising of 15 separate measures. The conceptual frameworks for 12 of these tools were reported from which 62 items, or concepts being measured, were identified. Following synthesis of these items, 9 conceptual domains and 11 sub-domains were generated. Limited information was available about who completed the PROM nor how much, if any, support they received.ConclusionsNo PROM that has been developed specifically for people who use AAC was identified by this review. Of the tools that have been used with people who use AAC, the concepts measured were broad and varied. The quality of reporting concerning who completed the PROM was limited, undermining the trustworthiness of many of the studies.

Augmentative and alternative communication (AAC) technologies provide individuals who have complex communication needs with an effective means to communicate. Yet the effect of these technologies on long-term memory is unclear. In addition, little is known regarding the impact of learning modality on memory performance of individuals who rely on AAC. The aim of this study was to explore the effect of AAC technologies on the visual and auditory verbal long-term memory abilities of 12 young persons who relied on AAC and had intact cognitive abilities. Participants performed 2 verbal memory tasks, in which familiar words were visually or aurally (i.e., auditorily) presented. The words were either actively produced using the AAC system or not produced (merely read or heard; a production effect paradigm). Memory tests followed. A production benefit (higher recognition rates for produced than no-produced words) was documented in both the visual and the auditory tasks. These findings support the active production of words via the AAC system as a memory strategy. Such technique may be easily used in everyday situations as well as in educational contexts. The results showcase the cognitive benefits of AAC system usage and provide significant insights into rehabilitation.

PurposeThe purpose of this paper is to document augmentative and alternative communication (AAC) training provision by clinical services in England.Design/methodology/approachA questionnaire was used to obtain the following information concerning AAC training provision; frequency, length, type, content and cost, trainee occupations and numbers, and future training priorities, and information concerning training providers – service type, geographical area.FindingsIn total, 98 clinical service training providers in England responded. Services commonly reported providing AAC training to speech and language therapists, teaching assistants and teachers. Training around “use of specific AAC products, systems and technology” and “introducing/awareness raising of AAC products” were rated as high priority for future training and were two of the three subject areas where services reported the highest percentage of training. Training was predominantly provided at a foundation (basic) level.Originality/valueThere is no consensus on the amount or content of AAC training which professionals in England must receive. Evidence suggests that AAC training for pre-qualification professionals is limited and this paper has identified variation in the amount and type of post-qualification AAC training. While knowledge concerning specific AAC systems is necessary, focussing training primarily on this area may not address critical gaps in knowledge. There is a need for specific recommendations regarding AAC training for professionals in this field, to ensure professionals can fully support people who use AAC.

mHealth is becoming increasingly data-driven in healthcare professions. Clinicians use a variety of data collection methods to capture the language use and communication performance of clients with complex communication needs. One solution for collecting and analyzing augmentative and alternative communication (AAC) data is through automatic data logging from high-tech AAC devices, also known as speech generating devices (SGDs). However, there is no interoperable method to analyze data logs across various SGDs. To address this, our work presents an interoperable data log format and a parser as a prototype solution. The prototype was used successfully to analyze two common AAC data log formats, and can easily be extended to other formats. This approach has significant potential to improve AAC outcome measurement for individual users, as well as comparison of outcomes across multiple users and devices.

Using a descriptive quantitative approach, this study examined the role of caregiver self-perceived comfort level (SPCL) in the success of augmentative and alternative communication (AAC) system implementation. The role of SPCL as a mediator variable affecting the relationship between the predictor variable (caregiver training resources) and the outcome variable (AAC use) was investigated. Related factors examined as covariates include caregiver demographics (gender, education level, and setting), the primary disability of the child or youth with complex communication needs, the type of AAC system (low-technology vs high-technology), and caregiver involvement in system selection. To examine the contribution of these variables to AAC use, the innovation decision model was used as a guide to propose a new framework describing how these factors are related as well as how they directly or indirectly impact AAC use. Data from a pre-administered Caregiver Training Survey was analyzed to answer the research question. There were 291 participants who completed the original survey. An inspection of the initial data revealed that 52.86% of the overall data was missing. Following Multiple Imputation using the fully conditional specification method, the data was analyzed including test of model fit, and multiple regression to test the direct and indirect effects of the independent variables on the dependent variable. For low-technology AAC, there was no statistically significant direct or indirect effect observed between the study variables. Thus, SPCL cannot be said to mediate the relationship between training resources and low-technology AAC use. For high-technology AAC, although SPCL cannot be said to mediate the relationship between training resource and AAC use, there were statistically significant direct and total effects of training resource on AAC use. The results suggest that SPCL does not mediate the relationship between caregiver training resources and AAC use for both low-technology and high-technology AAC. However, there were a few limitations that must be considered when interpreting the results. The significant amount of missing data meant that there was a significant inability to detect the studied effects using statistical analysis. This was further compounded with the fact that the survey was pre-administered and causal relationships between the variables in the study could not be established before a mediation analysis was conducted. Conducting a mediation analysis with observational data leaves room for multiple confounding variables. These limitations notwithstanding, the role of training resources in the communicative outcomes of children and youth with complex communication needs was established. The nature of this relationship should be further investigated, including the role of SPCL as a moderator that strengthens or weakens the observed relationship between training resources and AAC use.