And Alternative Communication Research Articles

Supporting augmentative and alternative communication (AAC) in classrooms: sustainable supports within the education context

Supporting augmentative and alternative communication (AAC) in classrooms: sustainable supports within the education context

Percepciones del profesorado sobre el papel de los sistemas aumentativos y alternativos de comunicación

Abstract The number of students using augmentative and alternative communication (AAC) systems in mainstream schools has increased in recent years, in line with the principles of inclusive education. Teacher perceptions of AAC significantly influence school practices and the overall effectiveness of these systems as a tool for communication and inclusion, which can enhance the presence, progress, and participation of students who use it. The present study seeks to analyze these perceptions and find out if aspects such as training or previous experience influence them. To this end, an analysis is conducted using the Spanish Questionnaire “Perceptions on the Inclusion of Students who use AAC in mainstream classrooms (PSIASAAC)” with a sample of 122 teachers from the Spanish Autonomous Community of Valencia. The results show favorable perceptions towards the inclusion of students who use AAC. However, there are notable differences between teachers with and without training and/or professional experience with AAC. The findings align with those of several previous studies conducted in different contexts. This leads us to believe that while there are generally positive perceptions of students who use AAC systems, it is important to intensify efforts in the initial and ongoing training of teachers. It is also crucial to share successful practical experiences demonstrating how the use of AAC systems contributes to improving the educational inclusion of the students who use it.

Including People Who Use Augmentative and Alternative Communication in Qualitative Research: Can You Hear Us?

People who use augmentative and alternative communication (AAC) are frequently excluded from research, yet their voices can significantly enhance the applicability, acceptability, and translation of qualitative research findings. Accessible and adapted research methods welcome and empower participants who use AAC, and enable meaningful involvement. In this article, we describe the collaborative development of a framework to conceptualise inclusive research and aspects of an accompanying inclusive research toolkit. The framework identifies balancing power as a critical factor, primarily achieved by ensuring that research methods and materials are accessible to people who use AAC. We propose that this is achieved through three interacting elements: collaboration with AAC users, skills and knowledge to achieve accessibility, and ensuring adequate time is available to achieve involvement. We identify five areas where applying these elements has impact for AAC users: recruiting AAC users, working with communication supporters, adapting research methods, securing ethics approval, and consent. In presenting the framework, we demonstrate how qualitative researchers can foster a research environment that values and actively includes AAC users, ultimately advancing the field towards more comprehensive and inclusive research practices. While our work is situated in the cerebral palsy and AAC communities, our proposed framework and toolkit can be applied by researchers seeking perspectives from individuals with communication disabilities more broadly. We have created a corresponding plain language video of this article as an additional means of optimising accessibility of the content. See supplemental material .

Teachers' use of augmented input and responsive strategies in schools for students with intellectual disability: A multiple case study of a communication partner intervention.

Teachers serve as critical communication partners for students with intellectual disability (ID) who face communication difficulties. However, teachers may lack sufficient training in using communication partner strategies and augmentative and alternative communication (AAC) in the classroom. This study aimed to explore teacher application of a communication partner intervention (AKKtiv ComPal) in schools for students with ID. Video observations were conducted at four schools during a teacher-led group activity at pre- and postintervention, with follow-up 7 months later, focusing on communication partner strategies and AAC use applied as a universal approach in the classroom. Differences and similarities in intervention application and contextual factors that may influence teacher application were investigated using a multiple case study approach, in which the four teachers and their contexts served as the four examined cases. All cases increased the access to communication boards in the classroom and used more augmented input and responsive strategies following intervention. Follow-up measures revealed variability in augmented input and sustained or more use of responsive strategies. Despite increased strategy use, access to communication boards remained inconsistent, and augmented input was used with variability across observation minutes. Influencing factors to teacher application seemed to be classroom setups (such as having a table), previous AAC skills, student characteristics, and postintervention efforts such as repeating the intervention or participating in follow-up sessions. This study demonstrates that classroom teachers for students with ID can use augmented input and responsive strategies as a universal design approach in the classroom following the AKKtiv ComPal intervention. However, teachers may utilize the strategies somewhat differently, partly influenced by their contextual factors. The findings suggest that while teachers for students with ID can successfully use communication partner strategies in the classroom, their use of augmented input should be nurtured over time to ensure sustained use and possibly improve consistency. Additionally, adapting to the physical environment of the classroom is crucial to optimize the application of these strategies.

Expanding Qualitative Interviewing for Studies Involving Adults With Different Communication Needs: Reflections on Research With People Living With Motor Neurone Disease

This article explores the challenges and adaptations we undertook to engage people with different communication needs, specifically those living with motor neurone disease (MND), in qualitative research interviews. While interviewing those in advanced stages of illness has raised ethical concerns, participants continue to report value in contributing to research. We reflect on our experiences of conducting qualitative interviews with people living with MND and provide guidance for researchers facing similar challenges. MND significantly impairs communication abilities, impacting speech, gestures, and facial expressions. Communication aids such as augmented and alternative communication (AAC) devices are often key tools for communication. We draw on two research studies using expanded interview techniques to accommodate these devices and provide space for participants to express their views. Interview methods were modified to cater for participant fatigue, setting and individual communication needs. While acknowledging the limitations, we explore how digital platforms, such as MS Teams and Zoom, enabled online interviews, offering advantages for both participants and researchers. Joint interviews involving participants and family members were found to be crucial, considering the interdependence of experiences in illness. Family members often aided communication and enriched data by providing context. Email interviews were another valuable method, allowing participants time to respond and consider their answers, which was particularly useful for those with limited speech. By incorporating a variety of qualitative methods and adapting approaches, we aimed to create inclusive and meaningful research experiences for individuals with different communication needs, ensuring their voices and experiences were captured effectively.

보조기기센터 종사자의 보완대체의사소통(AAC)에 관한 경험 및 인식 조사

Background and Objectives: Workers at assistive technology centers play the role of finders and provide consultations to individuals who need augmentative and alternative communication (AAC). This study aimed to examine assistive technology center workers’ experience and perception of AAC. Method: An online survey targeting 151 workers at 29 assistive technology centers across the country was conducted, and a total of 80 survey responses were collected and analyzed. Results: First, it was found that the longer the work experience, the more the workers had AAC education experience. The greatest number of initial consultations and provisions of AAC tools was at least one to less than 10 times those of the past year, and the most common type of disability was brain lesion disorder. Second, the workers believed that a minimum level of cognitive ability was required for AAC intervention and also considered cognitive ability as the most important criterion for recommending AAC intervention. Third, the workers with education, consultation, and provision experience appeared to have a better understanding of AAC. However, the difference in perception between groups with education, consultation, and provision experience and those without was not statistically significant. Conclusion: This study examined the experiences and perceptions of AAC of assistive technology center workers who perform AAC-related consultation, assessment, and tool provision tasks. The results of this study provide useful basic data for strengthening the competence of the workers who play the role of AAC finders and developing specific action plans to improve the quality of AAC services.

국내 AAC 애플리케이션의 기본 인터페이스 화면과 어휘 산출 단계 분석을 통한 의사소통 효율성 고찰

Background and Objectives: This study examined the users’ efficiency of communication based on the initial user interface screens and sentence production stages of Korean augmentative and alternative communication (AAC) applications. Method: Twelve AAC applications were analyzed in terms of their initial screen components and the differences in the sentence production process. In addition, the personalized interface was analyzed to determine whether it allows for efficient device switching and symbol editing. Results: The most common function placed on the initial screen in most AAC applications was the text input box, followed by the delete function. The analysis of the sentence production stages revealed that one sentence exhibited differences ranging from a minimum of 2 steps to a maximum of 23 steps, and another sentence showed differences ranging from a minimum of 10 steps to a maximum of 16 steps. There were a total of four AACs that provided functions to set and save personal profiles. Conclusion: This study discussed ways to improve communication efficiency so that users can quickly and accurately express their intentions by analyzing domestic high-tech AAC applications.

자폐스펙트럼장애 아동의 장면 기반 감정상징 인식 및 표현능력

Background and Objectives: The purpose of this study was to examine the ability of preschool children with autism spectrum disorder (ASD) and typically developing children to recognize and express scene-based emotion symbols. Method: 15 children with ASD and 15 typically developing children aged 3-6 participated. In the scene-based emotion recognition task, 4 scene-based symbols were presented on a screen and the children were asked to select the scene-based symbol related to the target emotional vocabulary. In the emotional expression task, 14 scene-based symbols were randomly listed and the children were asked to identify the emotions of the main character. Results: First, there were significant differences in emotional recognizing between ASD and TD children. Second, except for dislike, there were significant differences in emotional expression in the sence-based graphic symbols for joy/pleasure, sadness, anger, and scared. Analysis of error types in the emotional expression task showed that children with ASD had a higher rate of nonmeaningful errors compared to meaningful errors. Conclusion: The results of this study suggest that the emotional expression and recognizing abilities of children with ASD are lower than those of TD children, which may be attributed to difficulties in grasping emotional approaches and overall situational contexts. The results indicate the need for training in scene-based graphic symbol learning when applying augmentative and alternative communication (AAC) systems for children with ASD.

Semantic Similarity of Common Verbal Expressions in Older Adults through a Pre-Trained Model

Health problems in older adults lead to situations where communication with peers, family and caregivers becomes challenging for seniors; therefore, it is necessary to use alternative methods to facilitate communication. In this context, Augmentative and Alternative Communication (AAC) methods are widely used to support this population segment. Moreover, with Artificial Intelligence (AI), and specifically, machine learning algorithms, AAC can be improved. Although there have been several studies in this field, it is interesting to analyze common phrases used by seniors, depending on their context (i.e., slang and everyday expressions typical of their age). This paper proposes a semantic analysis of the common phrases of older adults and their corresponding meanings through Natural Language Processing (NLP) techniques and a pre-trained language model using semantic textual similarity to represent the older adults’ phrases with their corresponding graphic images (pictograms). The results show good scores achieved in the semantic similarity between the phrases of the older adults and the definitions, so the relationship between the phrase and the pictogram has a high degree of probability.

"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.

Nonverbal Communication through Expressive Objects

Augmentative and alternative communication (AAC) devices enable speech-based communication, but generating speech is not the only resource needed to have a successful conversation. Being able to signal one wishes to take a turn by raising a hand or providing some other cue is critical in securing a turn to speak. Experienced conversation partners know how to recognize the nonverbal communication an augmented communicator (AC) displays, but these same nonverbal gestures can be hard to interpret by people who meet an AC for the first time. Prior work has identified motion through robots and expressive objects as a modality that can support communication. In this work, we work closely with an AAC user to understand how motion through a physical expressive object can support their communication. We present our process and resulting lessons on the designed object and the co-design process.

Parents' Perspectives of Augmentative and Alternative Communication: From Assessment to Implementation

Purpose: Parents are known to be effective communication partners in their children's augmentative and alternative communication (AAC) intervention. This study aimed to better understand the parent perspective in the AAC acquisition, implementation, and handing processes across various primary disability labels and ages. Method: Twenty-two parents of children who use AAC engaged in phone interviews to discuss their family's experiences with AAC obtainment and intervention. A thematic analysis of the interview data was conducted. Results: The following five themes emerged: assessment procedures, early recommendations for AAC, external variables that influence device access, supports and barriers parents face when navigating AAC use with their child, and what participants would do differently. Further subthemes were also established to categorize parent responses. Conclusions: Findings support the inclusion of family-centered care for children with complex communication needs who use AAC. Parent responses indicate a greater need for interprofessional communication between children's team members and their family to provide comprehensive support. Parents also emphasized a desire to introduce AAC earlier into their family.

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.

Common ground in AAC: how children who use AAC and teaching staff shape interaction in the multimodal classroom

Children who use augmentative and alternative communication (AAC) are multimodal communicators. However, in classroom interactions involving children and staff, achieving mutual understanding and accomplishing task-oriented goals by attending to the child’s unaided AAC can be challenging. This study draws on excerpts of video recordings of interactions in a classroom for 6–9-year-old children who used AAC to explore how three child participants used the range of multimodal resources available to them – vocal, movement-based, and gestural, technological, temporal – to shape (and to some degree, co-control) classroom interactions. Our research was concerned with examining achievements and problems in establishing a sense of common ground and the realization of child agency. Through detailed multimodal analysis, this paper renders visible different types of practices rejecting a request for clarification, drawing new parties into a conversation, disrupting whole-class teacher talk-through which the children in the study voiced themselves in persuasive ways. It concludes by suggesting that multimodal accounts paint a more nuanced picture of children’s resourcefulness and conversational asymmetry that highlights children’s agency amidst material, semiotic, and institutional constraints.

Exploring the Augmented and Alternative Communication (AAC) for Promoting Independence in Daily Skills of Students with Learning Disabilities

Augmented and alternative communication (AAC) mobile apps are increasingly being used to support students with learning disabilities in developing their communication and daily skills. Mobile AAC apps offer portability, user-friendliness and customisation that enables students with learning disabilities to communicate by using symbols, pictures and words for clear expression. This study investigated the experiences of two teachers with AAC mobile apps in promoting daily skills among students with learning disabilities. Semi-structured interviews were conducted with the teachers, exploring their perspectives on the effectiveness of specific AAC mobile app features. The interview questions were adapted from the Mobile Application Rating Scale (MARs). The findings revealed that AAC mobile apps featuring these features were particularly effective in assisting students with learning disabilities in developing their daily skills. The teachers highlighted the benefits of AAC mobile apps in enhancing communication, promoting independence and facilitating the acquisition of essential daily skills. This study contributes valuable insights into the practical application of AAC mobile apps in educational settings and emphasise the significance of customisable features to cater for the individual needs of students with learning disabilities. Additionally, the study highlights the need for further research to explore the long-term impact of AAC mobile apps on the communication and daily skills development of students with learning disabilities. The findings of this study have the potential to inform the development and implementation of innovative AAC mobile app-based interventions for students with learning disabilities to help these students to achieve their full potential and become independent.

Teacher perspectives on the use of augmentative and alternative communication systems for learners with complex communication needs

For learners with complex communication needs (CCN), teachers in special schools are encouraged to use a variety of communication techniques to help them participate in various classroom activities. Studies show limited data on the use of effective augmentative and alternative communication (AAC) strategies in special schools. The primary purpose of this study was to describe teacher perspectives on the use of AAC devices that they use in their classrooms in rural areas. We employed a qualitative methodology that included in-person interviews and focus groups. The focus group and face-to-face sessions each had 3 and 8 participants, respectively. Three main themes, namely modes of communication, training, and challenges and 12 subthemes were identified. We found that teachers employed pictures to improve communication of learners with CCN. We also discovered that since teachers didn’t use speech generating devices (SGD) frequently, they had trouble using them. The use of SGDs, one of the assistive technology tools that could be used to improve communication of learners with CCN, requires extensive teacher training, according to research. Further research is required to establish the efficacy on the use of AAC devices in special schools in rural areas.

Nurse perspectives on supporting children and youth who use augmentative and alternative communication (AAC) in the pediatric intensive care unit

Many children who require hospitalization in the pediatric intensive care unit (ICU) are unable to or have difficulty communicating through speech, whether because of preexisting or acute conditions. Children who are unable to be heard and understood using only speech benefit from aided augmentative and alternative communication (AAC), including in hospital settings. This qualitative interview study sought to understand the perspectives of nurses on care and support for children who use or would benefit from aided AAC in the pediatric ICU. Participants were six nurses who worked in pediatric intensive care at a tertiary care unit of a children’s hospital in the United States. Three main themes were identified related to nurses’ views about supporting children’s communication: (a) Caring for the Whole Child, (b) Needing Support from Others and Moving between Roles, and (c) Working with Available Resources and Demands. Nurses emphasized the importance of a holistic approach to care, the impact of others’ support and knowledge, and a desire for building greater capacity for promoting children’s access to effective communication. Findings offer insight that could improve patient-centered care for children with complex communication needs and support for nurses themselves, particularly within the broader context of ICU liberation.

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.

Increasing linguistic and prelinguistic communication for social closeness during naturalistic AAC instruction with young children on the autism spectrum

This study examined the effects of an intervention package using high-tech augmentative and alternative communication (AAC) with Naturalistic Instruction (NI), time delay, and prompting during social routines for preschoolers on the autism spectrum. The AAC was a communication application on a tablet programmed with color photo representations of participants and communication partners engaged in social routines. The primary dependent measure was a linguistic communication turn on the AAC device completing the instructor’s cloze phrase related to the routine. A secondary dependent measure was prelinguistic communication –nonspecific vocalizations and smiling – within each turn of the routine. Results indicated that all communication types increased and maintained for all three participants with two participants meeting mastery criteria within the minimal number of sessions. These results are significant in providing additional evidence for the effectiveness of AAC intervention beyond teaching simple object requests and in teaching more socially meaningful communication to children on the autism spectrum. Additionally, this study supports the use of color photo representations to promote social interaction. Future research should continue to evaluate such interventions on a larger scale and include naturally occurring communication partners, such as siblings and peers.