And Alternative Communication Services Research Articles

Multilingualism and Augmentative and Alternative Communication: A Review of the Literature

Purpose: Individuals from culturally and linguistically diverse backgrounds who use augmentative and alternative communication (AAC) are often offered English-only AAC systems that do not meet their language needs. The aim of this review article was to describe the research published on multilingual AAC, define any emerging best practices, and highlight gaps in the literature that exist to ensure equal language access for all learners. Method: The authors reviewed the literature by searching relevant databases using a variety of search terms. Following our inclusionary and exclusionary criteria, 15 articles were yielded for coding and then patterns were reported. Results: The authors found that more than half of the included articles were expert opinion papers on AAC delivery, barriers to AAC and multilingualism, and code-switching using AAC. The included qualitative studies aimed to summarize the perceptions on AAC services—their impact, facilitating and limiting factors in communication, and the importance or relevance of using an AAC device. Only two quantitative studies were included. Conclusions: Practitioners have an obligation to support multilingual clients who use AAC across all languages they speak at school, at home, and in the community. Much of the literature supports encouraging multiple languages, but limited access to multilingual AAC systems are available. There is also a dire need for empirically based studies and more perspectives by way of interviews or surveys.

Augmentative and alternative communication: the experience of Malaysian speech-language pathologists and caregivers of individuals with aphasia

ABSTRACT Background Augmentative and Alternative Communication (AAC) serves as a compensatory intervention approach for individuals with aphasia and is often introduced by speech-language pathologists (SLPs) after outcomes from restorative approaches plateau. Communication partners (i.e., caregivers) have a pivotal role in ensuring the successful use of AAC by adults with aphasia. Despite there being a large body of research on the use of AAC by adults with aphasia little is known about the experience of caregivers of individuals with aphasia who use AAC in supporting its use. Aims This study conducted in Malaysia was aimed to (a) explore the practices of Malaysian SLPs when introducing AAC to adults with acquired communication disorders (ACD) including aphasia and (b) describe the experience of caregivers regarding the use of AAC by adults with aphasia under their care. Method & Procedures This mixed-methods study had two phases. In Phase 1, a survey was distributed to 200 SLPs throughout Malaysia. Thirty-seven SLPs who met the inclusion criteria of having a caseload of more than 80% adults and at least 20% adults with aphasia responded to the survey and provided information about their use of AAC. For Phase 2, eight caregivers of adults with aphasia who had been introduced to AAC were interviewed to obtain information about their experience using AAC. Outcomes & Results Findings from Phase 1 indicated that Malaysian SLPs most often introduced unaided and low-tech AAC to adults with ACD (including aphasia). Most of them felt that they lacked knowledge and skills in the provision of AAC services to adults and hoped for more training. Three themes emerged from the qualitative content analysis conducted on interview transcripts from Phase 2: (a) the positive impact of the use of AAC, (b) challenges faced when using AAC, and (c) hopes for the future. The findings of this study suggest that both SLPs and caregivers recognize the importance of AAC for adults with ACD including aphasia and need to work together closely to promote inclusion of adults with aphasia who use AAC and acceptance of AAC as a form of aphasia rehabilitation.

Examining the Family-Centeredness of Speech-Language Pathologists Working With Children Who Use Augmentative and Alternative Communication.

Family-professional partnerships are important for youth learning to use aided augmentative and alternative communication (AAC). This study examined the family-oriented beliefs and practices of speech-language pathologists (SLPs) working with preschool and school-aged children learning to use aided AAC (aged 3-21 years), specifically during the COVID-19 pandemic. Participants were 25 SLPs who participated in an individual semistructured interview. Qualitative analysis was used to identify and describe groups of SLPs based on commonalities and differences in their beliefs and practices working with families. The characteristics of SLPs in each group was also explored descriptively (e.g., race/ethnicity, work setting, caseload). SLPs clustered into three groups based on their beliefs and practices: (a) professionally centered, (b) family-allied, and (c) family-focused. SLPs varied across these groups in how they planned services, offered training/coaching, communicated, shared resources, offered emotional support, and adapted to and with different families. Findings indicate the need to support greater family-centeredness in AAC services by building on the strengths of SLPs in the field. Promoting strong family-professional partnerships could in turn improve outcomes for students who use AAC. https://doi.org/10.23641/asha.25044125.

A Comprehensive Scoping Review of Caregivers' Experiences With Augmentative and Alternative Communication and Their Collaboration With School Professionals.

Parent engagement and involvement is essential for the successful implementation of augmentative and alternative communication (AAC) systems in the home. The purpose of the current study is to gain a deeper understanding of caregivers' experiences with AAC systems and their collaboration with school professionals during the implementation of AAC, which may have led to subsequent abandonment. This review intentionally included qualitative studies that employed semistructured interviews, focus groups, and ethnographic investigations that documented the experiences and perceptions of families implementing AAC at home. Electronic database search, ancestral search, and forward search procedures resulted in a total of 27 peer-reviewed studies portraying the voices of 319 caregivers. An inductive analysis was conducted to record recurring themes into codes. The codes were thematically synthesized into three main themes: (a) the family unit, (b) the service providers, and (c) the AAC system. The results emphasized the need for participatory practices of family involvement in co-constructing a collaborative AAC service provision. Future research directions should implement this practice and explore the outcomes of this process to validate its efficacy.

“Feeling our way around in the dark” AAC team collaboration in the context of service change: Special education teachers’ perceptions

Team collaboration is an essential component of augmentative and alternative communication (AAC) services that directly impacts outcomes for students in special schools. Given the central role of the Special Education Teacher (SET) in the AAC team, there is a need to explore and understand SETs’ perceptions to support effective team collaboration. This study explored the perceptions of SETs on team working and collaboration in AAC service delivery in Ireland during a period of significant systemic change. A qualitative interview approach was utilised to explore the perceptions of five SETs working with students who use AAC in special education settings in Ireland. The dataset was analysed through the process of reflexive thematic analysis and identified four themes. Participants valued team collaboration but perceived it as inconsistent or non-existent in current practice. The impact of recent service changes on collaboration was highlighted, with all participants recognising a need for enhanced collaboration. Facilitators to collaboration identified included child centredness, shared goals, role clarity, sharing of knowledge and resources, and effective working relationships.

Voices from the field: exploring service providers’ insights into service delivery and AAC use in Canada

Use of augmentative and alternative communication (AAC) often relies on the involvement of AAC service providers; however little is known about how AAC services are delivered across Canada. This study aimed to explore AAC service provision and factors influencing use of AAC from the perspectives of service providers across Canada who are involved in providing and/or supporting use of AAC systems. The 22 participants from nine (of the 10) provinces participated in online focus groups. Participants were speech-language pathologists, occupational therapists, communicative disorders assistants, and a teacher. Transcripts of the audio recordings were analyzed using reflexive thematic analysis. Four themes were generated that reflect service-related factors contributing to the use of AAC in Canada: Support of Organizational Structures, Concordant Relationships and Goals, Making the Right Decisions, and Influence of Knowledge and Attitudes. These themes highlight how government systems, key stakeholders, assessment practices, and knowledge of AAC influence service provision and use of AAC. Voices from across Canada highlighted shared experiences of services providers as well as revealed variability in service delivery processes. The findings bring to attention a need for further research and development of service provision guidelines to support consistency, quality in practice, and equity in AAC services.

"You Just Want to Be Able to Communicate With Your Child": Parents' Perspectives on Communication and AAC Use for Beginning Communicators on the Autism Spectrum.

For young children on the autism spectrum who are beginning communicators, augmentative and alternative communication (AAC) can support language development and participation in meaningful interactions. AAC is more likely to be effective when services align with the needs and priorities of the child's family. To better understand family perspectives, this study investigated the communication and AAC experiences of parents of young beginning communicators on the autism spectrum. The study used a phenomenological qualitative design. Eight caregivers of seven children on the autism spectrum participated in semistructured interviews, and thematic analysis was used to identify themes within the data. Five main themes and 15 subthemes emerged from the data. Parents situated communication and AAC experiences within the context of complex, busy lives. They discussed the value of communication and benefits of AAC, but described numerous challenges related to obtaining, learning, and implementing AAC that evolved over time as needs and skills changed. Parents discussed their children's individuality and the need for AAC systems and services to fit the unique needs of their child and their family. They also emphasized ways in which communication outcomes were affected by factors external to the child and the family, including factors related to professional services and the U.S. health care and educational systems. The results affirm the need to consider the family and the broader social system when providing AAC services to young children on the autism spectrum. Provision of family-centered services is critical to successful AAC. https://doi.org/10.23641/asha.24881562.

Applying a Developmental Model to Preliterate Aided Language Learning.

Childhood spoken language interventions and augmentative and alternative communication (AAC) interventions share a common purpose: maximizing communication and language outcomes. To ensure that interventions for children who require AAC also address expressive language acquisition, this clinical focus article focuses on how to apply a developmental model of language acquisition to guide AAC decision making for preliterate aided communicators, with a particular focus on vocabulary selection. A brief review of early expressive language development is presented, along with arguments for why relying on a developmental model to guide AAC decision making is so critical. A series of detailed examples of how to apply a developmental model to various AAC vocabulary selection approaches are provided, including analyses of how well each approach aligns with pragmatic, semantic, grammatical, and narrative development. No single AAC approach for preliterate AAC language learners adequately addresses both immediate and longer-term expressive language needs; every approach has both strengths and weaknesses. Clinical decision making requires an analysis of each approach to ensure that AAC service delivery teams clearly understand the inevitable linguistic gaps, with plans put into place to fill in those gaps with different approaches. Future efforts to improve preliterate AAC service provision should use a developmental model of language as a starting point, in combination with input from families, educators, and clinicians to ensure the feasibility of the chosen approaches.

Linking Clinic With Classroom in Intensive Focused Preservice Education on Augmentative and Alternative Communication.

This article reports a pilot study that combined clinical training and academic instruction in a graduate-level augmentative and alternative communication (AAC) course. The authors aim to (a) provide a detailed description of the AAC course and (b) present preliminary data regarding the graduate students' perception on the AAC course and their own competencies in AAC. Forty-three graduate students completed an intensive focused course that included AAC fieldwork (i.e., direct clinical service and caregiver training) as well as academic content. In delivering the clinical and academic content, the course instructor followed the principles of problem-based learning. During their final semester in the graduate program, the students completed a survey regarding the AAC course and their self-efficacy in AAC services. Thirty-eight among the 43 students perceived that the AAC fieldwork, embedded into the AAC course, made them feel competent or strongly competent. The entire 43 respondents listed the AAC fieldwork as the component that they liked in the AAC course. When students were asked about their self-efficacy in AAC services at three different time points (i.e., before taking the AAC course, after taking the AAC course, and at the time of the survey), their ratings were significantly higher for after taking the AAC course and at the time of the survey, compared to before taking the course. This study suggests the significance of compulsory fieldwork embedded in the AAC training as evidenced by the graduate students' subjective perception of competence and preparedness in AAC services following the AAC course.

Reported Barriers to Augmentative and Alternative Communication Service Delivery and Learning Preferences Among Speech-Language Pathologists.

Speech-language pathologists (SLPs) report extensive barriers to delivering augmentative and alternative communication (AAC) services, including the knowledge and skills necessary for AAC service delivery. Although nearly all graduate programs report the inclusion of preservice training for SLPs to provide AAC services, existing research on SLPs' characteristics of AAC service provision does not reflect these changes. This study aimed to identify current AAC service delivery characteristics, barriers, and learning preferences reported by SLPs. A survey invitation was distributed to SLPs with American Speech-Language-Hearing Association (ASHA) Certificate of Clinical Competence through social media and the ASHA Community discussion groups. Participants were 530 SLPs who predominantly identified as general practice SLPs. Participants reported 1%-25% of their weekly patient caseload has AAC needs for communication or receives AAC intervention. SLPs reported feeling at least "knowledgeable" in more than half of the targeted competency areas. The reported primary barriers to AAC service provision are knowledge, caseload, and time. Preferences for topic, format, and frequency and duration for AAC-related continuing education were highly variable among SLPs. SLPs' barriers to AAC service delivery are consistent with research from the last 15 years, revealing a lack of systematic, organizational, and informational mechanisms to support SLPs as vital members of the AAC team. Those involved in post-service instruction and training must consider the training needs of SLPs with varying competence and their experience with AAC modalities, clinical practice backgrounds, and learning preferences. AAC-related training and continuing education must reflect SLP's daily practice, learning needs, and preferences. https://doi.org/10.23641/asha.23503809.

Predictors for Augmentative and Alternative Communication Clinical Service Provision: Closing the Gap.

At the core of the clinical services provided by a speech-language pathologist (SLP) is upholding the human right to communicate. Augmentative and alternative communication (AAC) modalities support communication across environments by offering temporary or permanent solutions. Barriers to AAC service provision include translation of knowledge into clinical practice, which remains problematic despite changes to AAC preservice training addressing the knowledge barrier. This study aims to understand the importance of factors impacting the provision of AAC clinical services. From the survey data of SLPs (N = 530) regarding current AAC service delivery practices, barriers, and professional development preferences in the United States, a hierarchical multiple regression identified the importance between individual and clinical practice variables of knowledge and current use of AAC modalities. A binomial logistic regression predicted the probability of one or more independent variables for barriers to AAC service delivery and learning preferences for AAC-related professional development. The factors impacting SLPs' knowledge and barriers to practice are related to clinical practicum experiences. Engagement in AAC-related continuing education (CE) is the primary contributor to the use of AAC service provision. Predictors for barriers to AAC clinical provision are associated with clinical practicum experiences, the average number of patients seen weekly, and geographic region. Preference for CE topics and frequency depend on the work setting. Hands-on clinical practicum experience addresses opportunity barriers in AAC service provision, contributing explicitly to the value of collaboration in AAC service delivery and highlights the importance of evidence-based professional development content. The findings from this study are reassuring in that clinicians are using AAC and suggest that high-quality professional development is an effective means to address the gap between knowledge generation and translation in the field. https://doi.org/10.23641/asha.23202170.

Chinese-English speaking family perspectives of augmentative and alternative communication use with their children.

Culturally and linguistically diverse families who have children with complex communication needs (CCN) often have limited access to augmentative and alternative communication (AAC) devices and interventions due to the lack of services that acknowledge their families' cultural and linguistic needs. Despite the increasing need for culturally responsive services, little is known about Chinese-English speaking families' perspectives and experience related to AAC use and services. The objective of this study was to understand the perspectives and experiences of Chinese-English speaking family members of children who use AAC use. This study employs a qualitative descriptive methodology approach. The researchers conducted individual or group semi-structured interviews with 10 adult family members (mother, father, and grandparent) from four Chinese-English speaking families in the U.S. and Canada who have a child who uses AAC (ages 3-8). Chinese-English speaking families have high acceptance and satisfaction with their child's AAC as long as they see the benefits of the AAC system. Mothers and siblings play unique roles in supporting home AAC practice given frequent engagement with and observed influence on the child who uses AAC. Family members indicated goals in building stronger family connections, but noted that the child's speech difficulties interfered with this goal. Chinese-English speaking families felt they can overcome limitations resulting from lower English language proficiency, but still find difficulties in obtaining resources because of the Western expectations of advocacy. Additionally, service providers' lack of responsiveness related to family goals could prevent families in obtaining AAC resources. The findings suggest the need for family-centered services with cultural sensitivity and humility for those serving Chinese-English speaking families with children who use AAC. Additionally, involving family members beyond the mother within services may improve both family functioning and child communication.

Augmentative and alternative communication services during the COVID-19 pandemic: impact on children, their families and service providers

The closure of schools and healthcare facilities across the United States due to COVID-19 has dramatically changed the way that services are provided to children with disabilities. Little is known about how children who use augmentative and alternative communication (AAC), their families and their service providers have been impacted by these changes. This qualitative study sought to understand the perspectives of parents and speech-language pathologists (SLPs) on how COVID-19 has affected children, families, services providers and the delivery of AAC-related communication services. For the study, 25 parents and 25 SLPs of children who used aided AAC participated in semi-structured interviews, with data analyzed using qualitative thematic analysis. Parents and SLPs highlighted wide disparities in how children have been impacted, ranging from views of children making more progress with communication and language than before the pandemic to worries about regression. A complex system of factors and processes may explain these differences. COVID-19 will have lasting impacts on the lives of children with complex communication needs. This research highlights the crucial role of family-service provider partnerships and access to quality AAC services for children during the pandemic and into the future.

Black Children With Developmental Disabilities Receive Less Augmentative and Alternative Communication Intervention Than Their White Peers: Preliminary Evidence of Racial Disparities From a Secondary Data Analysis.

Ensuring equitable access to augmentative and alternative communication (AAC) intervention services for children with complex communication needs (CCN) is crucial. Evidence suggests that racial disparities exist in access to communication interventions, disadvantaging Black children. However, no research has investigated specifically the evidence for racial disparities in AAC services for children with developmental disabilities and CCN. The current study applied post hoc data analysis methods within a preexisting, open-access data set to explore preliminary evidence of racial disparities in AAC intervention. Amount of AAC intervention was compared for Black versus white 1 preschool students at study initiation (M age = 3;8 [years;months]) and 2 years later at study completion (M age = 5;10). Black preschool students were reported to receive significantly less AAC intervention per week as compared to their white peers, both at study initiation and 2 years later. By study end, 75% of the Black children were receiving less than 60 min of AAC intervention per week, an inadequate amount to achieve meaningful gains given their significant disabilities. It is unclear what mechanisms may contribute to the observed disparities; however, it is critical that concrete steps are taken by individual speech-language pathologists, school districts, preservice preparation programs, and researchers to identify inequities in AAC services and take actions to rectify them. Future research is essential to investigate the potential factors contributing to inequalities and determine effective interventions to address them.

Identity-Focused Practice in Augmentative and Alternative Communication Services: A Framework to Support the Intersecting Identities of Individuals With Severe Disabilities.

The purpose of this clinical focus article is to consider a framework of identity in provision of services to individuals with severe disabilities who use augmentative and alternative communication (AAC). Components of the framework for identity include personal, social, and cultural areas. These aspects are identified in extant literature on AAC services and discussed through the lens of the Communication Bill of Rights (National Joint Committee for the Communication Needs of Persons with Severe Disabilities in 1992). Identity-focused practice is discussed as being relevant to self-determination and quality of life among individuals with severe disabilities. A case study illustrates identity-focused practice in delivery of services to an adolescent who uses AAC, considering personal, social, and cultural identities. This clinical focus article proposes a theoretical framework and provides a practice example for addressing the intersecting identities of individuals with severe disabilities. Furthermore, this clinical focus article argues that identity is a basic human right and area in which additional efforts are needed in the application of AAC solutions.

Supporting Emergent Bilinguals Who Use Augmentative and Alternative Communication and Their Families: Lessons in Telepractice From the COVID-19 Pandemic.

The purpose of this project was to examine the effect of the COVID-19 pandemic on speech-language pathologist (SLP) service provision for emergent bilinguals who use augmentative and alternative communication (AAC). One prominent issue in AAC service delivery is the efficacy and feasibility of providing AAC services via telepractice. The COVID-19 pandemic intensified this issue as most providers, clients, and families adjusted to remote service delivery models. While emerging evidence supports telepractice in AAC, little is known about the potential benefits and challenges of telepractice for emergent bilinguals who use AAC and their families. Data were collected via a nationwide survey. Licensed SLPs (N = 160) completed an online questionnaire with Likert-type, multiple-choice, and open-ended questions, analyzed using mixed methods. Findings illustrated a shift in service delivery from in-person to telepractice and hybrid (both telepractice and in-person) models. Overall, child intervention outcomes declined for emergent bilinguals who used AAC during the COVID-19 pandemic, regardless of service delivery format. However, collaboration increased for many providers and families. Qualitative analyses highlighted barriers to AAC service provision for emergent bilinguals who use AAC that were exacerbated by the COVID-19 pandemic, as well as factors that facilitated collaboration and family engagement. These findings suggest that, despite challenges, telepractice or hybrid services may be a promising approach to provide more culturally responsive, family-centered care for emergent bilinguals who use AAC. https://doi.org/10.23641/asha.20405673.

Parent perspectives on augmentative and alternative communication in Sri Lanka

Parental support is an important part of introducing an augmentative and alternative communication (AAC) system to a child. Professionals providing AAC services to children with complex communication needs should practice family-centered service provision. The aim of this study was to explore Sri Lankan parents’ perspectives on AAC and their lived experiences. Semi-structured interviews were conducted with 10 parents of children with complex communication needs. Thematic analysis was used to analyze the findings, with the following themes identified: (a) External Systems, (b) Impact on the Family, (c) Impact on the Child, and (d) Communication (including AAC). Findings from this study provide important information for speech-language therapists providing services to families from low- and middle-income countries. In particular, parents reported several positive aspects of AAC. However, parents also reported challenges, including speech-language therapist’s lack of knowledge of and training in AAC.

Working with children with cortical visual impairment who use augmentative and alternative communication: implications for improving current practice

The aim of this study was to describe how professionals from multiple disciplines (e.g., speech-language pathologists, teachers, occupational therapists) in the United States reported challenges they face in delivering services to children with cortical visual impairment (CVI) who use augmentative and alternative communication (AAC). Three surveys were utilized to identify barriers to and priorities for improving educational and clinical services and in-service and preservice education from the perspectives of professionals in school, community, and university settings. Results suggest that current service delivery models may not be meeting the needs of either children with CVI who use AAC or the professionals whose job it is to provide them with services. Professionals in community-based settings appeared to encounter more barriers. Findings help to support a discussion about approaching AAC interventions for children with CVI who use AAC by adopting interprofessional collaborative practice (IPCP) and interprofessional education (IPE) models, which reflect long-standing best practice guidelines for AAC service delivery and are encouraged by multiple professional organizations.

Voices From the Field: Strategies for Effective Telepractice for Children With Autism Who Use Augmentative and Alternative Communication

Purpose: Providing telepractice services to young children with autism who use augmentative and alternative communication (AAC) can present many challenges for speech-language pathologists (SLPs). At the same time, telepractice can be a valuable service delivery option with unique benefits, such as improving partnerships with families, integrating AAC services with other educational services, promoting communication skills in natural settings, and addressing the need for clinicians with AAC experience in locations that have been underserved. The purpose of this study was to learn from SLPs utilizing telepractice about the strategies they found most effective in serving children learning to use aided AAC, particularly young children with autism. Method: Participants were 230 SLPs who responded to a national survey about using telepractice to serve children who use aided AAC. The survey occurred during the COVID-19 pandemic, when more SLPs than ever before were navigating how to use telepractice effectively. Open-ended survey questions asked SLPs about advice and strategies they found to increase effectiveness. These responses were analyzed using an iterative, team-based approach to qualitative content analysis. Results: SLPs raised strategies to support the effectiveness of telepractice in three areas: (a) Be strategic about how to provide services. (b) Communicate and collaborate with others. (c) Keep learning and hold onto reasonable expectations. Conclusions: Telepractice can be an advantageous service delivery option for SLPs serving children with autism who use aided AAC. These strategies can help SLPs navigate challenges and support the effectiveness of their services.

Centering the family in their system: a framework to promote family-centered AAC services

Families are the most significant communication partners for an individual with complex communication needs. Even though family-centered approaches are recommended to support augmentative and alternative communication (AAC) services for an individual, it is difficult to establish a successful plan that fits each individual’s family. A framework for practitioners is proposed to effectively obtain and understand information about a family’s unique dynamics as part of service delivery to positively impact AAC device uptake and long-term use. The goal of using this model is to minimize the disruption to the family while maximizing the integration of the AAC system. This paper proposes and illustrates a framework to enrich AAC services through the integration of several theoretical models of family systems theory, family paradigms, and a procedure called the self-created genogram. This paper begins by reviewing ecological family systems theory and family systems to guide and provide a framework to support effective AAC implementation. The process of self-creating genograms is then introduced as a means to obtain a rich perspective on family characteristics and dynamics that is informed by the individual who uses AAC. All of this information allows professionals to provide relevant information and tailor options for the family. As a result, the family is able to make informed decisions about AAC intervention in a manner most consistent with how they typically operate. Finally, we apply this framework to a hypothetical case of a child with autism and complex communication needs across three timepoints (preschool, late elementary/early middle school, and high school/post-secondary transition) to demonstrate how this framework can be used in clinical practice.