And Alternative Communication Research Research Articles

The prevalence of relational basic concepts on core vocabulary lists for AAC: is frequency enough?

The selection of appropriate vocabulary is a crucial and challenging aspect of augmentative and alternative communication (AAC) intervention. Core vocabulary lists are frequently used to support vocabulary selection for children who require AAC. A vocabulary domain that has garnered limited attention within the AAC literature is relational basic concepts (RBCs). RBCs describe relationships between objects, persons, or situations, and play a pivotal role in language development, communication, and academic success. For the present study, we created a list of 156 RBCs, drawing primarily from assessments that measure basic concept knowledge in preschool and early elementary school students. We examined the overlap of these words on nine core vocabulary lists. We found that most concepts were not represented on any core lists. Additionally, there was relatively little overlap of RBCs between the core lists. These findings suggest that vocabulary selection resources created using exclusively a core vocabulary approach may have limited utility for identifying many concepts that preschool and early elementary students are expected to know and use. Implications for AAC research and practice are discussed with emphasis on the need for further consideration of RBCs within vocabulary selection practice and the field of AAC at large.

Leveraging Communication Partner Speech to Automate Augmented Input for Children on the Autism Spectrum Who Are Minimally Verbal: Prototype Development and Preliminary Efficacy Investigation.

Augmentative and alternative communication (AAC) technology innovation is urgently needed to improve outcomes for children on the autism spectrum who are minimally verbal. One potential technology innovation is applying artificial intelligence (AI) to automate strategies such as augmented input to increase language learning opportunities while mitigating communication partner time and learning barriers. Innovation in AAC research and design methodology is also needed to empirically explore this and other applications of AI to AAC. The purpose of this report was to describe (a) the development of an AAC prototype using a design methodology new to AAC research and (b) a preliminary investigation of the efficacy of this potential new AAC capability. The prototype was developed using a Wizard-of-Oz prototyping approach that allows for initial exploration of a new technology capability without the time and effort required for full-scale development. The preliminary investigation with three children on the autism spectrum who were minimally verbal used an adapted alternating treatment design to compare the effects of a Wizard-of-Oz prototype that provided automated augmented input (i.e., pairing color photos with speech) to a standard topic display (i.e., a grid display with line drawings) on visual attention, linguistic participation, and (for one participant) word learning during a circle activity. Preliminary investigation results were variable, but overall participants increased visual attention and linguistic participation when using the prototype. Wizard-of-Oz prototyping could be a valuable approach to spur much needed innovation in AAC. Further research into efficacy, reliability, validity, and attitudes is required to more comprehensively evaluate the use of AI to automate augmented input in AAC.

Visual Scene Displays for Children and Adults: Using Case Studies to Bridge Research and Clinical Practice

Purpose: The purpose of this clinical focus article is to share research and clinical perspectives related to visual scene display (VSD) technology for people who use augmentative and alternative communication (AAC). Furthermore, the authors will help bridge the gap between research and clinical practice as speech-language pathologists (SLPs) consider supplementing AAC systems with VSD technology. The authors will review research and clinical practice about the development and use of VSD technology for both children and adults as a tool to support language, literacy, and social interactions. SLPs will be informed about key principles from VSD research to assist them to use this technology to supplement multimodal communication methods. Case studies will provide examples for SLPs to consider how they can create and use VSD technology in their clinical practice. Conclusions: Previous AAC research supports the development and use of VSDs for emerging communicators and people with aphasia. Based on the authors' clinical observations and review of the relevant research, challenges remain with VSD implementation as SLPs determine how to develop and effectively integrate this newer technology with current AAC interface design. Recommendations and ideas will be provided to SLPs who are considering VSDs as a visual support to promote language development and increase social interactions.

Lessons for the AAC field: a tribute to Dr. David Beukelman

On February 5, 2022, the field of augmentative and alternative communication (AAC) lost a giant when Dr. David “Dave” Beukelman passed away. As the readership of this journal is aware, Dave was one of the principal founders of the AAC field and devoted his career to providing a voice to those without one. Before AAC became a field, people who could not talk were invisible or seldom noticed, unless they were in the way. For more than 40 years, he was a catalyst for change in AAC clinical practice, research, dissemination, teaching, and public policy development. This tribute aims to honor Dave’s lifelong mission of serving others by sharing some of his most timeless and valued lessons. Each lesson begins with one of Dave’s most enduring quotes that is then followed by a brief synopsis of the lesson Dave hoped to convey.

Augmentative and Alternative Communication in an Elementary School Setting: A Case Study.

Although there is a strong evidence base supporting the use of augmentative and alternative communication (AAC) in school settings, the research-to-practice gap in this area remains a concern. Few studies have examined how AAC systems are implemented in school settings and whether these systems adequately promote communicative competence for students with complex communication needs. The aim of this case study was to better understand the ways in which elementary-age students with complex communication needs used AAC throughout daily routines. Observations of five students, four receiving services under the category of autism and one under intellectual disability, in school settings were conducted to document the communication function, type of AAC systems used, and the times and activities during which AAC systems were accessible. In addition, supplemental interviews were conducted to understand the rationale for AAC implementation from the perspective of the special education teacher and speech-language pathologist. Overall, findings from the observations and interviews indicated that a variety of AAC modes were utilized. Interactions represented a range of communicative functions, with the exception of social closeness, and were primarily observed during academic activities. However, there were some discrepancies between observations and interview data. Although these findings provide insight into how students with complex communication needs may use AAC in elementary school settings, more research is needed to explore AAC use across a range of students, classrooms, and schools. We present specific future research directions, along with implications and recommendations for AAC teams and researchers.

Advances in AAC intervention: some contributions related to applied behavior analysis

This article extends Dr. Bob Remington’s call for collaborations between those supporting behavioral approaches and those supporting more natural developmental approaches to beginning communication intervention. This article expands areas previously discussed by Dr. Remington. Topics that are addressed include pivotal behaviors that may facilitate communication acquisition, matching law and response efficiency, generalization, maintenance, and the related topics of general case instruction (which involves an understanding of stimulus and response classes). These topics reflect contemporary areas of research that could be better integrated into translational research and have not been extensively integrated into augmentative and alternative communication (AAC) practice. Dr. Remington’s article discussed the value of behavioral approaches and corresponding methodology to AAC researchers and practitioners. We agree and discuss the need for greater interaction among proponents of varying approaches to intervention.

Creating a Path for Systematic Investigation of Children With Cortical Visual Impairment Who Use Augmentative and Alternative Communication.

Purpose There is limited information about how to support children with cortical visual impairment (CVI) who require augmentative and alternative communication (AAC). An initial review designed to explore the available evidence was used to outline critical needs in moving research and intervention forward for children who use AAC and have CVI. Method Previous systematic reviews, six databases, and theses and dissertations were systematically searched, along with reviews of the resulting works cited. An initial yield of 575 articles was narrowed to 10, which discussed AAC interventions that included children with CVI. Results Three interventions were technology based, and seven were instructional based. The use of textured microswitches was the most frequent form of technology intervention, with the frequency of switch activations being the most frequently coded outcome. Overall, the studies represent explorations in the area rather than systematic lines of inquiry. Conclusions While evidence shows at least some children with CVI have been included in AAC research to date, the inclusion is more incidental than deliberate. Issues such as clear descriptions of the vision capabilities and needs of participants may have impacted study results.

How Are Stakeholders With Autism Spectrum Disorder Included in the Social Validation of Augmentative and Alternative Communication Research? A Scoping Review.

Introduction Social validation or the inclusion of stakeholders in the research process is beneficial, as it may decrease bias, increases efficacy, and prevents harm. For direct stakeholders such as individuals with autism spectrum disorder (ASD), social validation has mostly included participants who do not experience significant speech, language, and communication limitations while frequently omitting individuals with ASD who have complex communication needs (CCN). The presence of CCN indicates that augmentative and alternative communication (AAC) strategies are needed for individuals to express themselves. Social validation should not be limited to being participants in an intervention but should include involvement in the research process. This requires an understanding of the current trends, levels, and mechanisms of involvement in AAC research. Purpose This review aimed to identify and describe the inclusion of direct stakeholders with ASD in the social validation of AAC research. Method A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews) methodology to identify AAC research that included stakeholders with ASD (direct and indirect) for social validation and to evaluate their level of involvement using the Typology of Youth Participation and Empowerment pyramid framework. Results Twenty-four studies were identified. Studies primarily included indirect stakeholders (e.g., caregivers) giving in-depth perspectives, while direct stakeholders were limited to being intervention participants. Conclusions Voices of direct stakeholders with ASD and CCN remain limited or excluded in research. Reasons for the exclusion of individuals with ASD and CCN from research and strategies for future inclusion are raised and discussed.

The Ethics of Inclusion in AAC Research of Participants with Complex Communication Needs

If qualitative researchers in lifelong disability are to produce authentic findings on the experiences, perceptions and expectations of people with disabilities, research methods must include people with disabilities as participants. People with complex communication needs (CCN) are often excluded from participating in generic research, disability research and augmentative and alternative communication (AAC) research because of negative assumptions by researchers, Human Research Ethics Committees [HRECs] and collaborating disability organisations about their cognitive capability and ability to consent to participation. Such attitudes disadvantage people with CCN, perpetuate their social exclusion and are a breach of human rights under the United Nations Convention on the Rights of Persons with Disabilities (United Nations, 2006). However, there are indications of improvements in ethical approaches to inclusive research that enable people with CCN to execute their right to be involved in research and have their voices heard.

Methodological advances, opportunities, and challenges in AAC research

Since its inception in 1985, the AAC journal has been publishing scientific articles related to the field of augmentative and alternative communication (AAC) that (a) report research concerning assessment, treatment, rehabilitation, and education of people who use or have the potential to use AAC systems and (b) cover theory, technology, and systems development relevant to AAC. The journal has maintained a consistent focus on the science and practice of AAC while also advancing in varied and impressive ways. Among the many developments apparent in AAC over the years, methodological advancements emerge as pivotal within the evolution of the science of AAC. This report examines the state of the science in behavioral AAC research with specific regard to changes and opportunities in research methodology. Illustrations from articles published in Volume 1 (1985) and Volume 32 (2016) of AAC are used in this paper to frame commentary on (a) contextual consideration in conducting AAC research, (b) types of research design, (c) considerations of procedural rigor, and (d) future methodological directions and resources. If the AAC field is to meet the goal of ensuring that all individuals with complex communication needs achieve their full potential, meaningful questions must be posed to address key problems, and rigorous scientific methods must be employed to answer these questions.

Designing interaction, voice, and inclusion in AAC research

The ISAAC 2016 Research Symposium included a Design Stream that examined timely issues across augmentative and alternative communication (AAC), framed in terms of designing interaction, designing voice, and designing inclusion. Each is a complex term with multiple meanings; together they represent challenging yet important frontiers of AAC research. The Design Stream was conceived by the four authors, researchers who have been exploring AAC and disability-related design throughout their careers, brought together by a shared conviction that designing for communication implies more than ensuring access to words and utterances. Each of these presenters came to AAC from a different background: interaction design, inclusive design, speech science, and social science. The resulting discussion among 24 symposium participants included controversies about the role of technology, tensions about independence and interdependence, and a provocation about taste. The paper concludes by proposing new directions for AAC research: (a) new interdisciplinary research could combine scientific and design research methods, as distant yet complementary as microanalysis and interaction design, (b) new research tools could seed accessible and engaging contextual research into voice within a social model of disability, and (c) new open research networks could support inclusive, international and interdisciplinary research.

重度言語障害者の補助代替コミュニケーション(AAC) : 最近の言語臨床と研究の動向から

重度言語障害者の補助代替コミュニケーション(AAC) : 最近の言語臨床と研究の動向から

Engagement in social media environments for individuals with who use augmentative and alternative communication.

Communicative interactions, despite the mode (e.g., face-to-face, online) rely on the communication skills of each individual participating. Some individuals have significant speech and language impairments and require the use of augmentative and alternative communication (AAC) (i.e., signs, speech generating devices) to maximize their communication participation across a variety of on and offline contexts. Use of social media has brought about changes to communication environments, contributing new contexts for engagement. To provide a framework for considering application of engagement theory for interventions around social media use by individuals who use AAC. The author has applied examples from qualitative social media and AAC research to a framework of engagement. No formal data collection was used. Social media use has become a conventional form of communication. Yet recognition of the value of social media (and other electronic modalities) for individuals who use AAC has not been fully translated into practice. The examples used illustrated how the proposed framework can assist in clinical practice and future research directions. Engagement, including the proposed framework for considerations of social media engagement activities, can provide a systematic way to approach social media use for individuals who use AAC.

Patient Communication in Health Care Settings: new Opportunities for Augmentative and Alternative Communication

ABSTRACTDelivering quality health care requires effective communication between health care providers and their patients. In this article, we call on augmentative and alternative communication (AAC) practitioners to offer their knowledge and skills in support of a broader range of patients who confront communication challenges in health care settings. We also provide ideas and examples about ways to prepare people with complex communication needs for the inevitable medical encounters that they will face. We argue that AAC practitioners, educators, and researchers have a unique role to play, important expertise to share, and an extraordinary opportunity to advance the profession, while positively affecting patient outcomes across the health care continuum for a large number of people.

Towards Advancing Knowledge Translation of AAC Outcomes Research for Children and Youth with Complex Communication Needs

The production of new knowledge in augmentative and alternative communication (AAC) requires effective processes to leverage the different perspectives of researchers and knowledge users and improve prospects for utilization in clinical settings. This article describes the motivation, planning, process, and outcomes for a novel knowledge translation workshop designed to influence future directions for AAC outcomes research for children with complex communication needs. Invited knowledge users from 20 pediatric AAC clinics and researchers engaged in the collaborative development of research questions using a framework designed for the AAC field. The event yielded recommendations for research and development priorities that extend from the early development of language, communication, and literacy skills in very young children, to novel but unproven strategies that may advance outcomes in transitioning to adulthood.

Augmentative and Alternative Communication for Individuals with Autism Spectrum Disorder and Intellectual Disability

Many individuals with autism spectrum disorder and intellectual disability are candidates for augmentative and alternative communication (AAC). We review two current trends in AAC research involving persons with ASD and intellectual disability. The first trend is the use of smartphone and tablet devices in AAC interventions. The second trend is the direct comparison of the relative efficacy of differing AAC options, for example comparing the use of manual signs versus picture-based communication systems versus speech-generating devices. Studies in the first group suggest that this new technology can be effectively used in AAC intervention. Studies in the latter group have found differences in how quickly some individuals have learned to use different options and differences in preference for the various options. These research trends suggest a possible new direction for AAC intervention that incorporates aspects of self-determination.

Putting People First: Re-Thinking the Role of Technology in Augmentative and Alternative Communication Intervention

Current technologies provide individuals with complex communication needs with a powerful array of communication, information, organization, and social networking options. However, there is the danger that the excitement over these new devices will result in a misplaced focus on the technology, to the neglect of what must be the central focus – the people with complex communication needs who require augmentative and alternative communication (AAC). In order to truly harness the power of technology, rehabilitation and educational professionals must ensure that AAC intervention is driven, not by the devices, but rather by the communication needs of the individual. Furthermore, those involved in AAC research and development activities must ensure that the design of AAC technologies is driven by an understanding of motor, sensory, cognitive, and linguistic processing, in order to minimize learning demands and maximize communication power for individuals with complex communication needs across the life span.

Social Validation of Vocabulary Selection: Ensuring Stakeholder Relevance

The vocabulary needs of individuals who are unable to spell their messages continue to be of concern in the field of augmentative and alternative communication (AAC). Social validation of vocabulary selection has been suggested as one way to improve the effectiveness and relevance of service delivery in AAC. Despite increased emphasis on stakeholder accountability, social validation is not frequently used in AAC research. This paper describes an investigation of the social validity of a vocabulary set identified in earlier research. A previous study used stakeholder focus groups to identify vocabulary that could be used by South African adults who use AAC to disclose their experiences as victims of crime or abuse. Another study used this vocabulary to create communication boards for use by adults with complex communication needs. In this current project, 12 South African adults with complex communication needs who use AAC systems used a 5-point Likert scale to score the importance of each of the previously identified 57 vocabulary items. This two-step process of first using stakeholder focus groups to identify vocabulary, and then having literate persons who use AAC provide information on social validity of the vocabulary on behalf of their peers who are illiterate, appears to hold promise as a culturally relevant vocabulary selection approach for sensitive topics such as crime and abuse.

Personnel Roles in the AAC Assessment Process

Completing an augmentative and alternative communication (AAC) assessment is a complex process that involves many stakeholders and professionals. To help clarify professional roles and provide assessment guidelines, an AAC Assessment Personnel Framework was developed. This framework was adapted from the work of Beukelman, Ball, and Fager in 2008, which focused on general AAC needs (not just assessment) and concentrated specifically on adults. In contrast, the present model examines the assessment process for all individuals who require AAC. The following AAC assessment personnel are discussed: AAC finders, general practice SLPs, AAC clinical specialists, facilitators and communication partners, collaborating professionals, AAC research and policy specialists, manufacturers and vendors, funding agencies and personnel, and AAC/assistive technology agencies and personnel. Current barriers for successful assessment outcomes are discussed, and suggestions for addressing personnel-related barriers are explored.

Current and Future AAC Research Considerations for Adults with Acquired Cognitive and Communication Impairments

ABSTRACT Adults with acquired language impairments secondary to stroke, traumatic brain injury, and neurodegenerative diseases are candidates for communication supports outside of the traditional restoration-based approaches to intervention. Recent research proves repeatedly that augmentative and alternative communication (AAC) provides a means for participation, engagement, conversation, and message transfer when individuals can no longer expect full return of pre-morbid communication skills and that inclusion of communication supports should begin early. We discuss current research and future directions for integrated systems of technical supports that include low-technology, high tech, and partner-dependent strategies for adults with severe and chronic aphasia, cognitive-communication problems resulting from traumatic brain injuries, and primary progressive aphasia.