Client Communicative Acts and Therapist Prompts With and Without Aided Augmentative and Alternative Communication Systems

Abstract

Communication is essential to each individual's quality of life. One must be able to communicate with others to build relationships, to contribute to society through a vocation, and most of all, to live independently. However, many people are unable to communicate in the most prevalent mode: speech. As many as eight to twelve per 1 ,000 people require a means to communicate in addition to, or as an alternative to, speech since they are unable to meet their communication needs with speech (Beukelman & Ansel, 1995; Light, Beukelman, & Reichle, 2003).When an individual cannot use speech to communicate competently enough to meet their daily needs, another means of communication is needed. Augmentative and alternative communication (AAC) is the use of expressive mediums, in addition to or in place of speech, to communicate. It is represented in two forms: unaided and aided (Johnston, Reichle, & Evans, 2004). Unaided AAC does not require the use of additional objects or materials; aided does require materials that are external to the user. Unaided AAC may take the form of pointing, gestures, or sign language. In contrast, aided AAC requires materials such as pictures, objects, or electronic aids.While various AAC systems offer options and benefits for communication, most individuals utilize a combination of aided and unaided AAC (Mirenda, 2009). In addition to aided AAC, individuals employ other forms of communication such as eye gaze, vocalizations, gestures, and facial expressions. Persons with AAC systems may use these conventional means of communication in addition to his/her AAC system, as the premise behind AAC is to allow the individual to utilize as many available skills and means of communication to promote effective and efficient communication (Downey & Hurtig, 2003). A multi-modal approach recognizes that an individual needs a communication system that is flexible and responsive to their needs in various communicative environments and situations. Other means of communication that may be paired with an aided AAC system are sign language and the use of residual speech (Beukelman & Mirenda, 2005).Music therapists provide therapeutic services to individuals with communication disorders. Though music therapists frequently work with clients to improve their communication skills, their training does not typically include use and maintenance of AAC systems. Therefore, simply having an AAC system does not guarantee its optimal use by the client or by the music therapist. Many times, the system may not be present in the communicative environment, the system might not be turned on, or the individual may not be prompted to use the AAC system (Johnston, Reichle, & Evans, 2004). Indeed, survey results of music therapists working with clients with autism indicated that few music therapists are consistently utilizing aided AAC with their clients who already have aided AAC systems (Gadberry, 201 1).Intentional CommunicationWhen a person is learning to communicate with the AAC system, focus is placed on supporting intentional communication. Since intentional communication requires another individual to be involved, intentional communication requires joint attention. Joint attention is a shared focus between two or more people on a common object, topic, or event (Reichle, Beukelman, & Light, 2002). Most authors agree that intentional communication involves joint attention and the purposeful conveyance of a message to another person.PromptsWhen assisting a person in development of expressive, intentional communication a therapist, educator, or caregiver often needs to prompt the individual to respond. Prompts are behaviors that encourage individuals to communicate. There are three types of prompts: (a) verbal, (b) gestural, and (c) physical (Bingham, 2005). Pointing is considered gestural; touching the individual's arm (as an indication for him to move it towards his AAC system) is a physical prompt. …