And Alternative Communication Assessment Research Articles

Developing a screening instrument for underlying core domains of communicative competence in children with communication support needs

A socio-neurocognitive approach to augmentative and alternative communication (AAC) shows several underlying domains of communicative competence: Attention, perception, cognition, memory, orientation, socio-emotional development, motor skills, and language. To determine developmental markers of these underlying core domains of communicative competence in children with communication support needs, we developed a new screening instrument. The present article consists of three consecutive studies. In study 1, we constructed the first version of the screening instrument based on a sample of both children without disabilities and children with Down syndrome. In study 2, we confirmed the reliability (i.e., internal consistency) of the screening instrument in a new group of young children with typical development and established concurrent validity with the Early Language Scale. In study 3, we established concurrent validity with the Communication Matrix in a clinical sample of children with communication support needs. The screening instrument can be used in clinical practice as part of AAC assessment to provide comprehensive insights into strengths and weaknesses in the underlying core domains of communicative competence of children with communication support needs.

The Perceptions of Speech-language Pathologists toward Augmentative and Alternative Communication in China

The purpose of this study is to investigate the awareness and use of Augmentative and Alternative Communication (AAC) systems, as well as the related training received by speech therapists in China. A questionnaire survey was designed and distribute to speech therapists in hospitals, rehabilitation organizations and universities in China. A total of 50 valid questionnaires were returned. The results showed that 94% of the speech therapists had heard of various AAC tools. However, only 10% of the speech therapists considered themselves proficient in providing AAC assessment and intervention services. 30% of them had never received AAC training, 48% had attended seminars or lectures related to AAC but had not received systematic training, and 20% had only received less than 1 day of training. 80% of the speech therapists expressed a strong interest in participating in AAC training, and most of the speech therapists believed that the AAC tools helped improve their patients’ communication skills. This research provided insights into how Chinese speech therapists perceived AAC devices. However, the research also revealed a lack of training and experience with AAC in China.

Autistic Communication: A Survey of School-Based Professionals

Purpose: Access to communication is a basic human right, yet autistic adults have reported challenges fully and effectively expressing themselves throughout childhood. This may be due to the historical (and ongoing) focus and prioritization of speech skills as a barometer of communicative success. The result is a lack of support for other forms of communication for children who may speak but still require support to fully meet their communication needs. This study aimed to examine the knowledge, experience, and training of school-based professionals in order to better understand one possible barrier to early communication access for autistic children. Method: Using a participatory research method, we designed and administered a 35-question online survey. A total of 567 participants completed the survey, including 465 special educators, 71 speech-language pathologists (SLPs), and 31 other professionals. A segment of the survey data was analyzed in R. Comparisons between and within the largest groups (SLPs and special educators) were made with nonparametric statistics, including Fisher's exact, Wilcoxon signed-ranks, and Quade tests. Results: SLPs and special educators differed significantly on a variety of survey measures, including undergraduate coursework in augmentative and alternative communication (AAC) and autism, caseloads, and confidence related to working with autistic students and AAC users. Regardless of profession, most respondents reported completing what they considered to be an AAC assessment. Conclusions: Increasing school-based professionals' knowledge related to autism and AAC, as well as opportunities to improve skills, is critical to resolving access and opportunity barriers for autistic children who speak but may benefit from AAC. Partnering with autistic people to better understand autistic speech and careful collaboration among team members are recommended. Supplemental Material: https://doi.org/10.23641/asha.24299422

Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience.

Communication changes following acquired brain injury (ABI) may necessitate use of augmentative and alternative communication (AAC). Speech pathologists regularly assist people with ABI and their families with AAC assessment and recommendations, as well as education and training on AAC use. To date, there has been no Australian research investigating the perspectives of speech pathologists working in the field of ABI and AAC. This research aimed to 1) Explore speech pathologists' insights regarding enablers and barriers to considerations and uptake, and ongoing use, of AAC by people with ABI and 2) Understand their perspectives on AAC acceptance, abandonment and rejection. A qualitative research design, with semi-structured interviews, was used with seven speech pathologists working across three Australian states. Interviews were transcribed verbatim, and thematically analysed. To triangulate results, the lived experience reflections of one co-author, who has an ABI and uses AAC, were drawn on. Seven themes were identified, relating to four of the five domains of the World Health Organization's assistive technology model. These included that AAC should be person-centred, with consideration of both products and personnel required, and with effective policy aiding AAC trial, uptake and use. This research has highlighted considerations for AAC use by people with ABI, from the perspective of speech pathologists and aided by lived experience reflections. Speech pathologists need to understand the breadth of products, and good practice service steps, to ensure successful AAC use and skill development. Listening to the perspectives of people with ABI is central to that understanding.

Perspectives of Part-Time Augmentative and Alternative Communication Use in Adults and Implications for Pediatric Service Delivery

Purpose: Speaking autistic adults who use augmentative and alternative communication (AAC) part-time increasingly share their experiences of insufficient, unreliable, or inconsistent speech. Their experiences detail how forced communication through verbal speech alone causes harm and how AAC systems allow them to communicate freely. The purpose of this clinical focus article is to (a) define intermittent, unreliable, and inconsistent speech as experienced by autistic adults; (b) discuss implications for service delivery of AAC to autistic children; and (c) present an example of a pediatric part-time AAC assessment through a case study. Method: This clinical focus article presents a case study of an AAC assessment completed at a university clinic for a speaking child who experiences intermittent speech. Data from the case study were collected through chart review, a semistructured interview with the parent, and short surveys sent to the family. The case study presents the background and history of the client, planning for the assessment procedures, and details of the assessment procedures and data collected, and summarizes the results of the assessment. Results: The results of the assessment led to the successful funding of an AAC system through a third-party insurance provider. A summary of the follow-up session with the family after the device was received is provided. Conclusions: Characteristics of the mother's advocacy for her child's communication and its implications for the case study are discussed. Future directions of this research include the development of communication choice–affirming assessment and intervention protocols created in collaboration with autistic adults to support children who experience insufficient, intermittent, or unreliable speech.

Profiles of Children With Cortical Visual Impairment Who Use Augmentative and Alternative Communication: A Retrospective Examination.

Cortical visual impairment (CVI) is the most common cause of visual impairment in children today and can impact the outcomes of children who rely on augmentative and alternative communication (AAC). This study provides baseline data of 13 children with CVI who used AAC during their first year of participation in an integrated CVI program. One purpose was to describe similarities and differences in the student's demographic, functional vision, communication, and educational profiles. A second purpose was to examine differences in students described with different communicator profiles. Archived student records were de-identified and reviewed using a systematic coding scheme. Two researchers independently reviewed and coded all student records. Reliability was established. Measures included CVI Range scores; supports for positioning, mobility, vision, and writing; AAC systems, including modes, access methods, and language representation; communicative competence; self-determination; literacy; and mathematics. The study yielded a rich description of similarities and differences among students at baseline and led to careful consideration of differences among the participants with emergent communicator and context-dependent communicator profiles. Currently, limited evidence exists that informs practice regarding AAC assessment and intervention for children with CVI. This article describes a small sample of children with CVI who use AAC. Results underscore the need for educators and practitioners to ensure that vision functioning in students with CVI is evaluated carefully and regularly when conducting AAC assessment and intervention and formulating communication or education goals. https://doi.org/10.23641/asha.21357684.

Ensuring communication access for all during the COVID-19 pandemic and beyond: supporting patients, providers, and caregivers in hospitals

The COVID-19 pandemic has revealed substantial gaps in communication access for patients across hospital settings. With the rise in positive cases globally, the need for communication enhancement strategies, including augmentative and alternative communication (AAC), has emerged as a critical need. Many resources exist that describe AAC assessment and intervention processes in the acute care setting; however, AAC service provision in the COVID-19 pandemic is fraught with many unanticipated challenges. Patients, providers, and caregivers have encountered significant communication strain both at the bedside and beyond hospital walls, resulting in a communication crisis induced by many COVID-19 related variables. This article describes the sequelae of symptoms a person with COVID-19 may experience, progression of communication needs, and evidence-based solutions to supporting communication access. Barriers related to the COVID-19 pandemic are outlined (e.g., evolving infection control practices, personal protective equipment requirements, visitor policies, and more) along with response recommendations to support communication enhancement efforts for people with and without COVID-19 benefiting from access to AAC.

Evaluating user-personas as supplementary tools in AAC intervention and clinician decision making

ABSTRACT Models used for the design and service delivery of Augmentative and Alternative Communication (AAC) systems are limited. There are no standardized protocols for gathering user requirements beyond clinical/diagnostic information relating to AAC access needs (i.e., physical and cognitive capabilities). Nonetheless, information on the social, cultural, and psychological aspects of technology orientation and use are important to understanding how an AAC system will complement the user’s lifestyle, personal goals, values, and activities. Persona development is a user-centered design method that creates descriptive user models of different segments of a user population. Personas describe users’ personal characteristics, and the ways in which they think, behave, and engage in activities (with or without technology). The objective of this study is to investigate the utility of user personas as a supplementary tool to aid SLPs in AAC assessment and service delivery. Three personas of individuals with Amyotrophic Lateral Sclerosis (ALS) were developed and validated in our prior research. Twelve SLPs engaged in mock AAC assessments of the three ALS case studies under two conditions: with or without the use of personas as a supplemental informational tool. By and large, there were no statistically significant differences between groups across objective measures; however, interview sessions with the SLP participants revealed benefits to using personas during clinical decision-making, particularly for training novice SLPs. Discussion also focuses on ways in which user personas can be adapted and improved to mitigate some of the challenges and risks identified.

Augmentative and Alternative Communication Assessment in Adults With Amyotrophic Lateral Sclerosis: Results of Semi-Structured Interviews

This phenomenological qualitative study explored how eight speech-language pathology specialists in augmentative and alternative communication (AAC) (who self-identified as adult-focused) would approach the AAC assessment process when presented with a case study of an adult with amyotrophic lateral sclerosis (ALS). The general research questions were: What areas are assessed by AAC specialists evaluating individuals with ALS? How do specialists evaluate the areas identified: In all, four themes emerged: (a) Area of Assessment, (b) Method of Assessment, (c) Patient Education, and (d) Decision Criteria. These results support authoritative models of AAC assessment. AAC assessment is a complex task and understanding the behaviors of specialists, as outlined in this article, may be a first step in assisting general practice SLPs to complete AAC assessments for individuals with ALS with greater confidence and comfort.

A Survey of American Speech-Language Pathologists' Perspectives on Augmentative and Alternative Communication Assessment and Intervention Across Language Domains.

Purpose The aim of the study was to collect information about American speech-language pathologists' preprofessional training, practice, self-perceived competence, adequacy of resources, and interest in continuing education related to augmentative and alternative communication (AAC) assessment and intervention strategies addressing each of the five language domains: semantics, pragmatics, phonology, morphology, and syntax. Method An anonymous online survey of American speech-language pathologists was conducted. Results A majority of participants rated their preprofessional training for assessing semantic and pragmatic skills positively. Otherwise, a majority of participants rated preprofessional training for assessment and intervention negatively across language domains. High interest in continuing education opportunities addressing assessment and intervention was found across language domains. A discrepancy between responses to questions addressing semantic and pragmatic skills and responses to questions addressing phonological, morphological, and syntactic skills was consistently found for ratings of preprofessional training, practice, perceived competence, and adequacy of resources. In all cases, higher frequencies of positive ratings were found for questions addressing semantic and pragmatic skills. Conclusions Improved preprofessional training and continuing education opportunities are needed to support AAC assessment and intervention across language domains. Perspectives and practice patterns reflect a historical emphasis on semantic and pragmatic skills in the external evidence base, even though there are several recent journal articles addressing morphology and syntax in clients who use AAC.

School-Based Speech-Language Pathologists: Confidence in Augmentative and Alternative Communication Assessment.

Purpose The purpose of this study was to examine confidence levels and identify predictors of increased confidence of school-based speech-language pathologists (SLPs) relative to different aspects of the augmentative and alternative communication (AAC) assessment process. Method Surveys were completed by 272 school-based SLPs. Questions were designed to capture demographic information and confidence in areas of assessment such as student capabilities, participation, and feature matching. Results There were variable levels of confidence across aspects of assessment. Respondents were less confident in tasks related to assessing students with severe physical impairments and incorporating aspects related to cultural and linguistic diversity in their assessment. SLPs were more confident assessing student participation and unaided communication. Additionally, respondents had less confidence in matching the features of high-tech speech-generating devices to their students. Self-identification as an AAC specialist, years of experience, percentage of caseload of students with complex communication needs, and length of longest continuing education experiences all contributed to predicting confidence in most areas of assessment. However, years of experience did not contribute to predicting confidence in feature matching. Conclusions Results from this study acknowledge that SLPs are likely to have varied degrees of confidence in aspects of assessment related to preparation, clinical experience, and self-identification of specialty. Findings from this study support increasing training opportunities in AAC assessment. As specialization was the strongest predictor of confidence, further research should investigate the characteristics and preparation of self-identified AAC specialists. This is an important first step in pinpointing ways to increase confidence in school-based SLPs.

Effectiveness and Determinant Variables of Augmentative and Alternative Communication Interventions in Cerebral Palsy Patients with Communication Deficit: a Systematic Review.

Assess the effectiveness of augmentative and alternative communication (AAC) interventions in patients with CP and to reveal determinant variables of main intervention outcomes: receptive and expressive language. The search was performed in following databases: MEDLINE (Ovid); PubMed (NLM); Embase (Ovid); Cochrane Database of Systematic Reviews; Cumulative Index to Nursing and Allied Health Literature; Database of Abstracts of Reviews of Effects; Cochrane Central Register of Controlled Trials; Health Technology Assessment database and PEDro. Full-text and peer-reviewed studies in English studying the effectiveness of AAC in patients with cerebral palsy were included. Studies with patients (<18 years) diagnosed with CP were included. A narrative analysis was conducted to evaluate the efficacy of AAC methods. A random-effects model meta-analysis was used to assess determinants of AAC intervention outcomes. The online database and manual reference search revealed 445 records. Nine studies investigating a total of 294 subjects with CP met predefined eligibility criteria: 4 studies with single subject, multiple baseline research designs, 3 longitudinal cohort studies, 1 case control study and 1 case series. Results revealed moderate-quality evidence that AAC interventions improve the receptive and expressive communication skills in patients with CP. The random-effects model meta-analysis revealed the power of identified determinant variables affecting the AAC intervention outcomes. Diversity of CP patients requires proper analysis of determinant variables to ensure the efficacy of AAC assessment and intervention. More studies of high methodological and practical quality assessing the efficacy of AAC interventions are needed to clarify the evidence.

Dynamic assessment of augmentative and alternative communication application grid formats and communicative targets for children with autism spectrum disorder

Six children with autism spectrum disorder (ASD) participated in dynamic assessment to determine whether the complexity of grid-based augmentative and alternative communication (AAC) application displays impacted the level of instructional supports needed for responding across different communicative functions/parts of speech. Dynamic assessment was integrated into a single-case multi-element design. The researchers examined the effects of three different display formats that varied in (a) array size, and (b) the number of steps needed to make a response, on the average levels of support needed to make item requests and action/social word responses. Three participants demonstrated high levels of independence when requesting items with displays that utilized small arrays and did not require navigation. These participants also showed rapid increases in their ability to make item requests with displays that required two-step navigation, and began to use action and social words across displays with decreasing levels of support. In comparison, the three remaining participants did not demonstrate consistent independence with any display or communicative function, but did show differences in levels of supports (e.g., overall less support needed for less complex displays and for item requests in comparison to action and social words). Implications for individualized AAC assessment and display selection for children with ASD are discussed.

Investigating the Assessment Procedures for Children With Complex Communication Needs

Successful intervention outcomes and comprehensive assessment is important for people who rely on augmentative and alternative communication (AAC). However, the literature surrounding AAC assessment remains sparse. The purposes of this project were to describe the AAC assessment process followed by speech-language pathologists (SLPs) and to suggest areas for a comprehensive assessment. The research questions were (1) to identify the training received and (2) to explore the key elements of the assessment process. A questionnaire was developed based on the Participation Model and completed by 89 SLPs. The findings show that SLPs base their AAC assessment on clinical decisions, taking into consideration a number of elements, such as language, communication, and social skills. However, the process uncovered through this research cannot be characterized as either comprehensive or systematic. The findings indicate that further training on AAC assessment is warranted, thus ensuring high quality of services for people with complex communication needs.

Implementing Aided Augmentative Communication Systems With Persons Having Complex Communicative Needs.

Augmentative and alternative communication (AAC) systems can support communication skills for people with significant developmental disabilities who experience complex communication needs (CCNs). There is a need to tailor best practices in AAC assessment and intervention to create individualized communication systems with this population. In this article, we outline the important components of AAC systems that can be implemented in authentic settings. However, given the limited evidence on AAC interventions specific to people with CCNs, we also identify some priority areas for future inquiry. Among these involve strategies to enhance decision making regarding (a) matching communication mode(s) to learner skills and contextual demands, (b) identifying communicative opportunities and obligations, (c) individualizing aided communication display features, (d) selection of vocabulary specificity, and (e) considering dosage parameters needed to acquire and maintain a communicative repertoire. In addition, we briefly discuss the use of telehealth to enhance intervention capability.

"Augmentative and Alternative Communication (AAC) Will Give You a Voice": Key Practices in AAC Assessment and Intervention as Described by Persons with Amyotrophic Lateral Sclerosis.

The purpose of this study was to describe the perceptions of persons with amyotrophic lateral sclerosis (pALS) who use augmentative and alternative communication (AAC) with the AAC assessment and intervention process. Twenty-one pALS with complex communication needs participated in a multipart survey (and follow-up e-mails) to provide information on their experiences with AAC assessment and intervention. A majority of the participants agreed with the importance of three key AAC intervention principles: appropriate staging of the timing of assessment and intervention activities, inclusion of communication partners, and the use of multiple modalities and strategies as communication supports. Most participants reported that their assessment and intervention experiences included at least some aspect of these three key practices. The results of this study suggest that the identified best practices in AAC should be reviewed and implemented on an individualized basis for pALS with complex communication needs.

Guidelines for Feature Matching Assessment of Brain-Computer Interfaces for Augmentative and Alternative Communication.

Brain-computer interfaces (BCIs) can provide access to augmentative and alternative communication (AAC) devices using neurological activity alone without voluntary movements. As with traditional AAC access methods, BCI performance may be influenced by the cognitive-sensory-motor and motor imagery profiles of those who use these devices. Therefore, we propose a person-centered, feature matching framework consistent with clinical AAC best practices to ensure selection of the most appropriate BCI technology to meet individuals' communication needs. The proposed feature matching procedure is based on the current state of the art in BCI technology and published reports on cognitive, sensory, motor, and motor imagery factors important for successful operation of BCI devices. Considerations for successful selection of BCI for accessing AAC are summarized based on interpretation from a multidisciplinary team with experience in AAC, BCI, neuromotor disorders, and cognitive assessment. The set of features that support each BCI option are discussed in a hypothetical case format to model possible transition of BCI research from the laboratory into clinical AAC applications. This procedure is an initial step toward consideration of feature matching assessment for the full range of BCI devices. Future investigations are needed to fully examine how person-centered factors influence BCI performance across devices.

Assessment With Children Who Need Augmentative and Alternative Communication (AAC): Clinical Decisions of AAC Specialists.

The purpose of this study was to explore how speech-language pathologists (SLPs) who are augmentative and alternative communication (AAC) specialists approach the assessment process for 2 case studies, 1 child with cerebral palsy and 1 with autism spectrum disorder. The aim of the study was to answer the following questions: (a) How do clinicians with expertise approach the AAC assessment process for children with developmental disabilities? (b) Can any initial hypothesis be drawn about how SLPs approach the assessment of children with motor versus social interactive deficits? This study used a phenomenological qualitative design. The researchers conducted 2 in-depth, semistructured interviews with 8 SLPs who specialized in AAC and self-identified as primarily working with children. Four major themes emerged from the data: area of assessment, method of assessment, evaluation preparation, and parent education. Each major theme contained multiple subthemes and categories within those subthemes. Participants discussed similar areas of assessment for both cases, indicating that some aspects of AAC assessment are universal. However, the specific aspects of what they were assessing and how they went about assessing them differed between the 2 cases. The results of the current study provide an outline of an assessment protocol for children with complex communication needs.

Assessing the acquisition of requesting a variety of preferred items using different speech generating device formats for children with autism spectrum disorder

ABSTRACTFive children with autism spectrum disorder (ASD) were taught to request preferred items using four different augmentative and alternative communication (AAC) displays on an iPad®-based speech-generating device (SGD). Acquisition was compared using multi-element designs. Displays included a symbol-based grid, a photo image with embedded hotspots, a hybrid (photo image with embedded hotspots and symbols), and a pop-up symbol grid. Three participants mastered requesting items from a field of four with at least three displays, and one mastered requesting items in a field of two. The fifth participant did not acquire requests in a field of preferred items. Individualized display effects were present, and the photo image appeared to have provided the most consistent advantages for three participants. Some errors were more or less common with specific displays and/or participants. The results have important implications for AAC assessment and implementation protocols.

Recommended Augmentative and Alternative Communication Competencies for Special Education Teachers

Abstract Empirical evidence supports the notion of special education teachers receiving limited pre-service training in augmentative and alternative communication (AAC). This lack of training is not only evident in the United States but in other countries such as United Kingdom, India, and Israel. Yet the teaching demands for the use of AAC are increasing as more students with complex communication needs are entering the school systems. As a result, this paper outlines four special education teacher competencies needed to effectively address the communication needs of these students. The four competencies consist of the needs for training in the areas of (1) communication development and communicative competencies, (2) teamwork and collaborative practices, (3) role and functions of AAC systems, and (4) AAC assessment and instructional strategies. These competencies are aligned to the standards from the Council for Exceptional Children and the literature available on AAC training. Evidence suggests there is a lack of training for special education teachers and other professionals in this area and limited research to guide teacher preparation programs.