And Alternative Communication 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.

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.

The confidence and competence of speech language pathologists in augmentative and alternative communication: a scoping review

Augmentative and alternative communication (AAC) is a core component of speech pathology practice. However, international literature has highlighted that speech language pathologists (SLPs) may not feel confident or competent in this area. Confidence and competence are critical factors in therapy as they can impact the quality-of-service provision. The purpose of this scoping review was to investigate the confidence/competence of SLPs in AAC. A systematic scoping search was conducted using four databases to identify relevant literature. The first two authors reviewed 30% of abstracts and the remaining 70% were reviewed by the first author. Full-text screening applied the same review approach. Data was then extracted and organized according to the research questions. Thirteen studies were included in the review. All thirteen used self-assessment to measure confidence or competence with one study also using an objective evaluation. Overall, confidence and competence levels varied based on the specific clinical task and etiology of the client in addition to being influenced by prior training, clinician age, workplace and AAC caseload. While current research provides a snapshot of the SLP workforce, it is limited in that the research predominantly uses self-assessment measures, is cross-sectional and is quantitative in nature. Further research into the confidence and competence of SLPs in AAC is required, specifically how confidence and competence can be defined and developed.

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.

Alternative Augmentative Communication in paediatric dentistry: a mighty tool to amplify mother tongue's power.

The role of a child's mother tongue in shaping his/her identity and emotional development is crucial. In the context of paediatric dentistry, this principle should always be reminded. The child's right to effective communication, even when a language barrier exists, is a fundamental principle, as recently stated in the 'Rights from the Start' rights fact sheet. Preserving a child's native language in the dental setting, especially in the context of an increasingly diverse society with a significant number of refugee children, is essential. Augmentative and Alternative Communication (AAC) strategies can assist in bridging language gaps and improving treatment outcomes, blending with the traditional approaches used in paediatric dentistry. The article promotes flexibility, innovation, and empathy in paediatric dentistry to provide optimal care and ensure that every child's rights are respected. • The relationship with one's mother language plays a central role in children's growth and in the relationship they can develop with the world, "motherised" by the words of the caregiver. • The interaction between immigrant children from different linguistic and cultural backgrounds and dentists providing their care requires the integration of traditional paediatric dental techniques with AAC strategies that can compensate for deficient oral communication. • Dentists treating immigrant children should follow the suggestions proposed in this article to establish the best and most tailored paediatric setting for the child's specific needs.

Primitive way country come look inside

Abstract A disabled poet with Rett syndrome and a disabled performing artist with type 1 diabetes document their 12-month artistic collaboration to illuminate ground-time: the nonverbal, expressive dynamics of embodied communication. Five “communication moments” between the artists (documented in writing, video, and photo) are described. Potentials and limitations of augmentative and alternative communication (AAC) technologies, specifically Tobii Dynavox eye-tracking technology and Communicator 5, are discussed. Additionally, the authors question the clinical diagnostic category of “intellectual disability” on the grounds of disability justice, decolonial science, and philosophy. Communication-assistive technology platform developers are challenged to consider relational embodiment as the foundation of communication in design decisions regarding platform function. Technologies should facilitate improvisation and nonlinear expression—verbal and nonverbal— while maintaining freedom of nondisclosure. The right to opacity in communication is also discussed.

Project Building Bridges: A Framework for Preparing Highly Qualified Speech-Language Pathologists to Serve Culturally and Linguistically Diverse Students With Augmentative and Alternative Communication Needs.

Project Building Bridges was funded by the U.S. Department of Education Office of Special Education Programs to address the shortage of speech-language pathologists qualified to serve students with complex communication needs who benefit from augmentative and alternative communication (AAC) and are culturally and linguistically diverse. The purpose was to train future speech-language pathologists in culturally responsive AAC practices through coursework and fieldwork in AAC integrated into the Master of Science degree in Speech, Language and Hearing Sciences. Fifty-seven graduate students completed the project. The scholars' curriculum consisted of two AAC courses, both on-campus and externship AAC clinical practicum experiences to provide services to multicultural and linguistically diverse students, a U.S. or international service-learning opportunity, and cumulative portfolio presentations. Mixed-methods outcome measures consisted of four sets of pre- and postsurveys and qualitative feedback from exit interviews to assess changes in graduate student competencies. Significant differences were demonstrated between scholars' pre- and post-assessments of confidence ratings. Significant differences were also demonstrated in both scholars' and school mentors' pre- and post-assessments of competency ratings. No significant differences were found between evaluations of AAC preparation by Clinical Fellowship (CF) candidates and their CF mentors at 1 year postgraduation. Project Building Bridges provides a framework for preparing highly qualified speech-language pathologists to serve culturally and linguistically diverse students who benefit from AAC as evidenced by pre- and postsurvey results. The project can serve as a model for other university programs in the development of preservice preparation programs focusing on culturally and linguistically diverse students with AAC needs.

Increasing Reciprocal Social Interactions Between Children Who Use Augmentative and Alternative Communication and Peers Using a Collaborative Learning Framework.

Children with complex communication needs who rely on augmentative and alternative communication (AAC) strategies to express themselves face significant difficulties interaction with peers. This study sought to design, implement, and evaluate a collaborative photography intervention designed to increase reciprocal social interaction between children who use AAC and their same-age peers. A single-subject, withdrawal design (ABAB) was used to explore the functional relationship between engagement in a collaborative photography intervention and the frequency of reciprocal social interactions between children who use AAC and their same-age peers. Partial-interval time sampling was used to code the number of reciprocal social interactions across four dyads. Increased frequencies of reciprocal social interactions were observed in intervention phases across all four dyads. Very large levels of effect and 100% nonoverlapping data were noted for Dyads 1 and 4. Moderate levels of effect and 70% of nonoverlapping data were noted for Dyads 2 and 3. Collaborative learning frameworks may be used to increase reciprocal social interactions between children who use AAC and their peers. Speech-language pathologists should consider utilizing collaborative learning elements in activities with children who use AAC. Future research is needed to further explore collaborative learning frameworks for interventions for children who use AAC. https://doi.org/10.23641/asha.25464064.

A Randomized Controlled Trial Comparing Face-to-Face Versus Remote Delivery of Low-Tech Augmentative and Alternative Communication in Nonspeaking Children With Autism Spectrum Disorder.

Thirty percent of children diagnosed with autism spectrum disorder (ASD) do not develop spoken language. To provide a means of communication for this subset of the population, augmentative and alternative communication (AAC) systems are often utilized. Low-tech options have traditionally been delivered through the in-person modality. However, due to the COVID-19 pandemic, changes to service delivery models have been required. This randomized controlled trial was conducted in order to assess the efficacy of low-tech AAC delivered face-to-face versus remotely on communication outcomes in nonspeaking children with ASD. Both participant groups demonstrated similar gains in AAC proficiency, number and type of nonspeaking acts, and number of spoken communication acts. Remote delivery of low-tech AAC treatment is a viable alternative to face-to-face instruction.

Instructional Decision-Making of Professionals Who Support Children Who Use AAC

Despite advances in the field of augmentative and alternative communication (AAC), outcomes among children who require AAC remain discouraging. Practitioners may benefit from guidelines to aid decision-making in relation to supporting pre-linguistic communicators. We conducted an open-ended questionnaire of 30 AAC professionals from six countries—Australia, Denmark, the Netherlands, New Zealand, the United Kingdom, and the United States—to determine if consensus existed regarding the assessment information needed, the communication skills to teach, and the instructional strategies to employ to support AAC learning for pre-linguistic communicators. We analyzed the responses using qualitative content analysis in four iterative phases. We provide five statements that reflect areas of consensus and divergence among the participating AAC professionals. These findings provide important insights related to assessment, communicative competence, instructional strategies, decision-making, and communication partner instruction. Findings of this preliminary exploration indicate the need for ongoing and targeted research related to AAC decision-making guidance that attends to context (e.g., languages spoken, service structures) and pre- and in-service training in AAC decision-making.

Still having his say: David Yoder’s legacy in AAC

On February 2 2023, one of the guiding lights in the field of augmentative and alternative communication (AAC) for more than four decades, David E. Yoder, passed away at the age of 90. A voracious reader and gifted storyteller, David was particularly fond of a quote from George Bernard Shaw’s Back to Methuselah, “You see things; and you say ‘Why?’ but I dream things that never were; and I say ‘Why not?’” That vision led him to take on multiple leadership roles and influence the field of AAC in multiple ways. He played a pivotal role in establishing both the International Society for Augmentative and Alternative Communication (ISAAC) and the United States Society for Augmentative and Alternative Communication (USSAAC). Additionally, he chaired the panel for the National Institute on Disability and Rehabilitation Research (NIDRR)’s inaugural Consensus Validation Conference on AAC, advocated for the American Speech-Language-Hearing Association to recognize AAC within the profession’s scope of practice, and served as the first editor for the Augmentative and Alternative Communication journal. In this tribute, we describe David’s diverse and unique contributions to improving the lives of people with communication challenges with a focus on some of his central insights and actions.

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.

Reported and Enacted Emergent Literacy Instruction: Understanding Young Students With Extensive Support and Complex Communication Needs, Opportunity to Learn

Literacy instruction has an important role in augmentative and alternative communication (AAC) because spelling and writing support precise communication. Unfortunately, few students with extensive support needs and complex communication needs (ESN/CCN) develop literacy skills at or above the first grade reading-level. Given that learning to read and write begins with extensive emergent literacy learning opportunities, limited skills may result from insufficient opportunity to learn (OTL) emergent literacy skills. This study examined the instruction provided in early U.S. childhood classrooms to students with ESN/CCN to understand OTL during this critical period. This study used a concurrent embedded mixed methods design integrating a survey of teachers of students with ESN/CCN ( n = 26) with a qualitative multiple case study ( n = 2). Results suggest the time teachers are devoting to instruction is not translating into increased OTL for individual students. Solutions that may increase learning opportunities and implications for future research are discussed.

Designing is Imagining: What Futures and Identities Do Activists With Developmental Disabilities Imagine When Designing For Learners With Developmental Disabilities?

As learners engage in learning environments, they constantly co-develop ideas about who they are (their identities), and who they can become (their futures). Designers of learning activities make assumptions about what learner identities and imagined futures learners will ultimately take up. Learning activity designers with developmental disabilities who identify as activists may make assumptions about learners with developmental disabilities that other designers would not. Working from a critical disability praxis orientation, the research was led by a person with a developmental disability. This study utilized a grounded theory approach to discourse analysis to analyze the design talk between two adult activists with developmental disabilities while they engaged in a co-design process to create a learning activity intended for learners with developmental disabilities who use Augmentative and Alternative Communication (AAC). The activity was a game that explores inductive logic. Discourse was analyzed to understand what imagined futures and learner identities these activists assumed learners with developmental disabilities might take up. These activists imagined learners with developmental disabilities who use AAC as being inquisitive, interdependent, and ableism literate, and capable of achieving futures that were validating, inquisitive, accessible, and ableism-literate. These futures and identities suggest that future participatory design research with adults and youth with developmental disabilities might yield innovative curriculum designs.

Speaking across cultures: decolonization and disability in a multilingual world

This qualitative study, inspired by a decolonizing Advaita (non-dualistic) perspective, examines the intricate relationship between language, literacy, and disability. It centers on my daughter Kalika, a child with Rett syndrome who is medically categorized as “nonverbal” and navigates communication through eye-tracking Augmentative and Alternative Communication (AAC) technology. This journey illustrates the challenges and triumphs of integrating the Bengali language and cultural identity within a diasporic context using AAC. The study employs Saraswati Puja, the celebration of the Hindu goddess of learning, as a metaphor to investigate disability in language learning, pushing the boundaries of traditional notions of literacy. It highlights an urgent need for AAC devices that are not only technologically adept but also culturally attuned and linguistically diverse. Ultimately, this research contributes to the dialogue on literacy and disability, advocating for a non-dual approach that values the entire spectrum of human communication and interaction.

Speech and language in DDX3X-neurodevelopmental disorder: A call for early augmentative and alternative communication intervention.

Pathogenic variants in DDX3X are associated with neurodevelopmental disorders. Communication impairments are commonly reported, yet specific speech and language diagnoses have not been delineated, preventing prognostic counseling and targeted therapies. Here, we characterized speech and language in 38 female individuals, aged 1.69-24.34 years, with pathogenic and likely pathogenic DDX3X variants (missense, n = 13; nonsense, n = 12; frameshift, n = 7; splice site, n = 3; synonymous, n = 2; deletion, n = 1). Standardized speech, language, motor, social, and adaptive behavior assessments were administered. All participants had gross motor deficits in infancy (34/34), and fine motor deficits were common throughout childhood (94%; 32/34). Intellectual disability was reported in 86% (24/28) of participants over 4 years of age. Expressive, receptive, and social communication skills were, on average, severely impaired. However, receptive language was significantly stronger than expressive language ability. Over half of the assessed participants were minimally verbal (66%; 22/33; range = 2 years 2 months-24 years 4 months; mean = 8 years; SD = 6 years) and augmented speech with sign language, gestures, or digital devices. A quarter of the cohort had childhood apraxia of speech (25%; 9/36). Despite speech and language impairments, social motivation was a relevant strength. Many participants used augmentative and alternative communication (AAC), underscoring the need for early, tailored, and comprehensive AAC intervention.

An Online Communication Partner Training Program: POWR+ Intervention Results for Teachers, Paraeducators, and Children

Paraeducators frequently support children who use augmentative and alternative communication (AAC) but often lack access to effective training opportunities. Similarly, special education teachers are responsible for supervising paraeducators but often lack effective training on AAC and paraeducator supervision. The POWR+ (Prepare the activity and AAC, Offer opportunities for communication, Wait for the child’s communication, Respond to the child’s communication, + model AAC) intervention provides training to both paraeducators and supervising teachers to support communication for children who use AAC. In this study, a single-case multiple probe design was used to examine the effects of the POWR+ intervention (e.g., communication opportunities, responses to child communication, and plus AAC models provided by paraeducators) for three teacher–paraeducator–child teams. As a result of the POWR+ intervention paraeducator communication opportunities and paraeducator AAC models increased for all paraeducators. Increases were also noted for communication turns for one child and paraeducator responses to child communication for two paraeducators. Results indicate that the POWR+ intervention may be a viable training option for paraeducators and teachers who support children who use AAC.

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.