And Alternative Communication Systems Research Articles

AAC Business as Usual: Clinical Practice of School-Based Speech-Language Pathologists

AAC Business as Usual: Clinical Practice of School-Based Speech-Language Pathologists

AAC in AACtion: Collaborative Strategies for Special Education Teachers and Speech-Language Pathologists

Augmentative and alternative communication (AAC) refers to a wide variety of communication devices, systems, tools, and strategies that support or replace spoken language. Augmentative and alternative communication users represent a range of ages, abilities, and communication needs. Support for AAC often begins in the public school setting. Although the Individuals with Disabilities Education Act (IDEA) mandates public schools to provide adequate assistive technology for communication and training to support implementation, researchers estimate that fewer than 40% of students with communication impairments using AAC are proficient communicators. Barriers to implementation include a lack of training opportunities, limited preparation time, unfamiliarity with AAC systems, and difficulty finding evidence-based strategies for AAC. To address these, we present evidence-based strategies that speech-language pathologists (SLPs) and special education teachers may use in collaboration to support students using AAC and practical tips for implementation. Strategies described include aided language modeling, core vocabulary, and communication partner support behaviors. Planning considerations for collaboration are discussed.

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 and deaf children with disabilities

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

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.

"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.

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.

Speech-Language Pathologists' Approach to Alternative Access for Augmentative and Alternative Communication for Children With Motor Impairments.

This study examined the processes that speech-language pathologists (SLPs) use during an augmentative and alternative communication (AAC) assessment with children with motor impairments to determine alternative access solutions. These children often are the most vulnerable to a poor fit of their AAC system, which alternative access is an integral part. Although there is an abundance of information as to what types of considerations should be made during these assessments, there is no guidance as to how the assessment is completed. The goal of this study is to build evidence about the process. A collective case design was used to gain detailed insights into the decision-making process. Interviews and vignette responses were two components of the data collection. Each of the five SLPs, or cases, who participated in the study transcripts was analyzed in isolation as part of a within-case analysis. Once each SLP's process was understood, a cross-case comparison was completed to ascertain similarities or differences across the five. The cross-case assertions are presented in this article. Although the SLPs individually reported a lack of defined process, a clear systemization became evident when considered collectively. The SLPs all focused on the child, isolated motor access skills, and used a process of experimentation over time to build their final recommendations. These results have implications for SLPs working with children with motor impairments who may benefit from AAC intervention. The shared framework can serve as a roadmap to other SLPs, especially those with less experience with these types of complex cases. The varying teaming approaches to support these cases are also discussed.

A proof-of-concept study for automatic speech recognition to transcribe AAC speakers’ speech from high-technology AAC systems

ABSTRACT Automatic speech recognition (ASR) is an emerging technology that has been used in recognizing non-typical speech of people with speech impairment and enhancing the language sample transcription process in communication sciences and disorders. However, the feasibility of using ASR for recognizing speech samples from high-tech Augmentative and Alternative Communication (AAC) systems has not been investigated. This proof-of-concept paper aims to investigate the feasibility of using AAC-ASR to transcribe language samples generated by high-tech AAC systems and compares the recognition accuracy of two published ASR models: CMU Sphinx and Google Speech-to-text. An AAC-ASR model was developed that transcribes simulated AAC speaker language samples. The AAC-ASR model’s word error rate (WER) was compared with those of CMU Sphinx and Google Speech-to-text. The WER of the AAC-ASR model outperformed (28.6%) compared with CMU Sphinx and Google when tested on the testing files (70.7% and 86.2% retrospectively). Our results demonstrate the feasibility of using the ASR model to automatically transcribe high-technology AAC-simulated language samples to support language sample analysis. Future steps will focus on developing the model with diverse AAC speech training datasets and understanding the speech patterns of individual AAC users to refine the AAC-ASR model.

Design of aided augmentative and alternative communication systems for children with vision impairment: psychoacoustic perspectives

Children with complex communication needs often have multiple disabilities including visual impairments that impact their ability to interact with aided augmentative and alternative communication (AAC) systems. Just as the field benefited from a consideration of visual cognitive neuroscience in construction of visual displays, an exploration of psychoacoustics can potentially assist in maximizing the possibilities within AAC systems when the visual channel is either (a) not the primary sensory mode, or (b) is one that can be augmented to ultimately benefit AAC outcomes. The purpose of this paper is to highlight background information about psychoacoustics and present possible future directions for the design of aided AAC system technologies for children with visual impairments who rely on auditory information to learn and utilize AAC.

Key Elements of Screening Checklists for Needs of Augmentative and Alternative Communication

With the use of augmentative and alternative communication (AAC), people with complex communication needs could participate in social situations even if they had severe speech impairments. Even though speech-language therapists in Thailand are aware of AAC, they still mainly teach young children with complex communication needs to mainly use speech as a means to communicate. This could lead to fewer opportunities for people with complex communication needs to use AAC systems. Therefore, this article aimed to analyze and classify the items related to communication success, as a guideline to generate a screening checklist for determining whether individuals with a communication impairment would benefit from using AAC. Three previously available screening checklists pertaining to communication success were analyzed to identify the 3 domains: 1) verbal communication intelligibility, 2) verbal functional communication, and 3) verbal communication comprehension. These 3 domains were divided into 2 aspects: 1) familiar/unfamiliar communication partners, and 2) familiar/unfamiliar settings. To create a standard screening checklist that speech-language pathologists in Thailand could utilize, more research would need to be done in the future.

Imperfect Surrogate Users: Understanding Performance Implications of Augmentative and Alternative Communication Systems through Bounded Rationality, Human Error, and Interruption Modeling

Nonspeaking individuals with motor disabilities frequently rely on augmentative and alternative communication (AAC) systems that allow users to communicate through a text entry interface coupled with a speech synthesizer. Such systems are notoriously difficult to evaluate with end-users. However, recent research has proposed envelope analysis as a method to estimate text entry rates and keystroke savings by simulating the interaction of an expert surrogate user entering sentences on a conceptual word-predictive text entry system. While only a part of the evaluation process of an AAC system, this method enables AAC designers to benefit from quantitative insights early on in the design process. This paper extends prior work by (1) demonstrating how to incorporate natural language generation, such as sentence generation, in such analyses; (2) presenting a model of an imperfect surrogate user that incorporates bounded rationality, human error, and interruptions to provide a more realistic simulation of text entry behavior; and (3) demonstrating how to estimate model parameters by observing users' actual typing behavior. We validate the model with data collected from eight participants using an AAC system on a touchscreen.

Stakeholder validation of a Sepedi core vocabulary list as a resource for augmentative and alternative communication

Purpose The development of culturally and linguistically appropriate resources to support communication interventions for underserved communities is an urgent necessity. The purpose of the study was to obtain stakeholder feedback on vocabulary items from a Sepedi core vocabulary list developed as a resource for vocabulary selection for augmentative and alternative communication (AAC) systems, and to expand the list based on stakeholders’ vocabulary recommendations. Method A questionnaire was used to obtain the ratings of 57 stakeholders regarding the importance of including 155 Sepedi words from the Sepedi core vocabulary list on an AAC system for a child with receptive language skills at the level of a 4-year-old or higher. Stakeholders also suggested additional words to include on the system. Result All words were rated as important or very important. However, there was a statistically significant inverse relationship between the average frequency of occurrence of words belonging to a specific category and the average importance rating that stakeholders assigned to words in that category. A total of 48 words were additionally suggested by three or more stakeholders. Conclusion Stakeholder ratings validated the list as relevant to consult in vocabulary selection for Sepedi AAC systems for children. Stakeholder-suggested words may be a useful supplement to this list.

A Systematic and Quality Review of Augmentative and Alternative Communication Interventions that use Core Vocabulary

AbstractCore vocabulary is defined as “lexical items that are accepted as being central and indispensable to language use” (Bell, 2012, p. 1). Use of core vocabulary is common amongst professionals who teach augmentative and alternative communication (AAC) to individuals with disabilities. Although the use of AAC is often classified as an evidence-based practice (EBP) (Steinbrenner et al., 2020; Wong et al., Journal of Autism and Developmental Disorders, 45(7), 1951–1966, 2015) an analysis of the relevant intervention procedures as well as the vocabulary used is often missing from syntheses of the literature. Therefore, a systematic review was conducted to determine the quality and strength of the evidence for AAC interventions that use core vocabulary. A systematic database search and a subsequent screening process resulted in a total of 10 peer-reviewed studies that involved an AAC intervention that used core vocabulary. Each study’s outcomes were then categorized as positive, mixed, or negative and a quality review was performed using the Council for Exceptional Children’s (CEC) standards for evidence-based practices (Cook et al., Teaching Exceptional Children, 46(6), 206-212, 2015a; Remedial and Special Education, 36, 220-234, 2015b). Overall, the results suggest a lack of strong evidence in favor of AAC interventions that use core vocabulary. The results are discussed in the context of general suggestions for vocabulary selection and teaching practices for AAC systems.

Canadian manufacturer and technician perspectives on the design and use of augmentative and alternative communication technology

Purpose Device manufacturers and technicians (MaTs) of augmentative and alternative communication (AAC) systems play key roles in the design and successful uptake of communication devices. This study aims to investigate MaT perspectives on AAC device design and effective use. Materials and Methods To investigate their perspectives, a focus group of MaTs within Canada was conducted. Reflexive thematic analysis was used to analyze data. Findings Three major themes resulted from analysis, which reflect MaT’s views: AAC hardware and software flexibility, AAC knowledge and implementation, and social good versus financial resources. Conclusions This study provides insights into the complexities faced by MaTs in balancing technical support of system end-users and the financial resources necessary for that support. These insights indicate a need for increased financial resources and the expansion of individuals who qualify for AAC system candidacy. MaTs suggest that an increase in resources and candidacy could lead to more successful AAC implementation and a greater understanding of AAC for all stakeholders.

Exploring Classroom Factors and Augmentative and Alternative Communication Use in Qualitative Interviews.

This qualitative study explores classroom contextual factors influencing augmentative and alternative communication (AAC) use in early childhood classrooms. Semistructured interviews were conducted with six special education teachers, 13 speech-language pathologists (SLPs), and one SLP assistant. Interviews were analyzed inductively in a systematic, multistep coding process using the constant comparative method with member checking. Seven themes were identified that affected AAC use in the classroom. Each theme was organized into three categories: individual-, classroom-, or school-level factors. Three themes were categorized as individual-level factors: Students' AAC systems are unavailable, professionals face challenges obtaining AAC knowledge and skills, and students' disruptive behaviors reduce access to AAC. One theme was a classroom-level factor: Classroom demands prevent AAC use. Finally, three themes were considered school-level factors: The culture of AAC influences AAC acceptance, team collaboration is essential for successful implementation, and teams need administrative support to deliver AAC interventions effectively. Conclusions: Teachers and SLPs felt that collaborative teams with AAC expertise, a school culture that endorsed AAC, and solid administrative support accelerated AAC adoption by normalizing AAC use in the classroom. Due to classroom demands, they struggled to use strategies such as aided AAC modeling and responsiveness during group instruction. Finally, participants emphasized that while it was necessary to customize AAC systems for each student, this individualization makes it harder for staff to learn each system and integrate them into classroom activities. https://doi.org/10.23641/asha.23681718.

Towards E-textiles in augmentative and alternative communication – user scenarios developed by speech and language therapists

Purpose E-textiles have been the focus of interest in health technology, but little research has been done so far on how they could support persons with complex communication needs. A global estimate is that 97 million people may benefit from Augmentative and Alternative Communication (AAC). Unfortunately, despite the growing body of research, many persons with complex communication needs are left without functional means to communicate. This study aimed to address the lack of research in textile-based AAC and to build a picture of the issues that affect novel textile-based technology development. Materials and methods We arranged a focus group study for altogether 12 speech and language therapists to elicit user scenarios to understand needs, activities, and contexts when implementing a novel, textile-based technology in a user-centred approach. Results and conclusion As a result, we present six user scenarios that were created for children to enhance their social interaction in everyday life when using textile-based technology that recognizes touch or detects motion. The persistent availability and the individual design to meet a person’s capability along with ease of use and personalization were perceived important requirements. Through these scenarios, we identified technological constraints regarding the development of e-textile technology and its use in the AAC field, such as issues regarding sensors and providing power supply. Resolving the design constraints will lead to a feasible and portable e-textile AAC system. Implications for rehabilitation E-textiles are a novel approach to Augmentative and Alternative Communication (AAC) for children with motor dysfunctions and intellectual disabilities. -A portable AAC system implementing e-textiles for children with complex communication needs will enable several activities in daily-life situations. Therefore, further research is needed to resolve the design constraints to reduce the bulkiness of technology embedded in textiles, e.g., looking into the possibilities of passive and battery-free solutions. The developed user scenarios offer a starting point for developing initial prototypes for touch-based and motion-detection systems to enhance social interaction and motivation for persons with complex communication needs.

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.

Speech-language pathologists’ perceptions of augmentative and alternative communication in Thailand

Augmentative and alternative communication (AAC) systems are not well-known and broadly used in Thailand. To begin introducing AAC systems and interventions to children with complex communication needs in Thailand, understanding speech-language pathologists’ (SLPs) perceptions toward various AAC systems is an important first step. This study assessed SLPs’ perceptions of three AAC modalities: gestural communication, communication boards, and iPad 1 -based speech-output technologies. A total of 78 SLPs watched three video vignettes of a child using each mode and rated their impressions of intelligibility, ease of learnability and use, effectiveness, and preference. Then they were asked to rate factors on visual analog scales that provided additional insights into their rationales and their preferences for AAC modalities for nonverbal clients and for themselves if they were nonverbal. The results indicated that most of the SLPs rated iPad-based speech-output technologies as being the more intelligible, effective, and preferred mode of communication. Gestural communication was rated as the easiest mode to learn and use for a child with complex communication needs. Despite infrequent use of iPad-based speech-output technologies in Thailand, SLPs’ ratings indicated high social acceptance of this modality for promoting communication abilities of children with complex communication needs. Results also revealed some biases and lack of knowledge about AAC systems in Thailand.

The use of augmentative and alternative communication by children with developmental disability in the classroom: a case study

Purpose Augmentative and alternative communication (AAC) systems are often introduced to children with disabilities who demonstrate complex communication needs. As attending school is an essential part of these children’s lives, it is important that they use their AAC system to communicate in the classroom. This study aimed to describe the nature of the use of AAC by students with developmental disabilities in the classroom. Materials and Method This study was conducted in Malaysia. Six students were observed twice each in their classroom and their classroom interactions were video recorded. The video recordings were transcribed and coded for the presence of a communication event, the student’s mode of communication and communication function, the communication partner involved, and access to the AAC system. Results Contrary to past studies, most students in this study spontaneously initiated interaction almost as many times as they responded. They primarily communicated with gestures and verbalizations/vocalizations despite having been introduced to an AAC system. When students communicated using their AAC system, they mainly interacted with the teachers, and for the function of either behavioral regulation or joint attention. It was found that for 39% of communicative events, the student’s aided AAC system was not within arm’s reach. Conclusion The findings highlight the need for efforts to encourage students with complex communication needs to use AAC more frequently in their classroom to be able to communicate more effectively and for a wider range of communicative functions. Speech-language pathologists can work closely with teachers to provide the necessary support to these students.