Use Of Alternative Communication Research Articles

Comparing and contrasting barriers in augmentative alternative communication use in nonspeaking autism and complex communication needs: multi-stakeholder perspectives.

Augmentative alternative communication (AAC) devices or systems are often prescribed to minimally verbal or nonspeaking autistic individuals and other individuals with complex communication needs to facilitate communication or as an alternative to spoken language. AAC use can result in communication gains and improved quality of life for minimally verbal or nonspeaking individuals. Despite this, AAC abandonment is high, limiting societal participation of the individual on the autism spectrum with complex communication needs. Our study is a novel exploration of the barriers of AAC use from a multi-stakeholder perspective, and a qualitative analysis of similarities and differences between stakeholders. We conducted semi-structured interviews and focus groups with 30 parent-carers, educators and clinicians currently supporting AAC users in Western Australia and analysed the data using reflexive thematic analysis. Barriers from each stakeholder group were coded, resulting in 17 subthemes forming five main themes common to all stakeholders: Stakeholder Knowledge, Stakeholder Attitudes and Stigma, Resources, AAC User Engagement, and Device Fit. Contrasting perspectives included actual and perceived stigma associated with AAC use (parent-carers vs clinicians); different struggles with resources and knowledge (parent-carers vs clinicians and educators); and a lack of clinician communication in the processes that determined AAC-fit for school environments (educators only). Findings are discussed in the context of improving inter-stakeholder collaboration and capacity building in Australian health service and practice to better support minimally verbal or nonspeaking autistic individuals and individuals with complex communication needs. Suggestions are also offered for communication partner training.

The Effect of Caregiver-Implemented Training on Augmentative Alternative Communication Use by Individuals with Rett Syndrome: Remote Coaching via Telehealth

ABSTRACT Limited published literature exists demonstrating functional relations between idiosyncratic responses or augmentative alternative communication (AAC) and social reinforcement for individuals with Rett syndrome. In this study, six females with Rett syndrome ages 2–25 demonstrated requesting for preferred items using both idiosyncratic responses (e.g, looking, reaching) and AAC (e.g. single response microswitches). Researchers connected remotely via telehealth to coach caregivers to implement all sessions in home environments. Researchers individualized response prompt delays during AAC sessions (request/mand training) based on each participants’ latency to respond during baseline. Implications for practice and directions for future research are discussed.

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.

The Relationship Between Augmentative and Alternative Communication Use by Pediatric Psychiatric Inpatients With Autism Spectrum Disorder and Interfering Behaviors.

Previous research conducted by Williams et al. (2018) using data from the Autism Inpatient Collection (AIC) found a weak and inconsistent association between verbal ability and the severity of interfering behaviors; however, adapting/coping scores were significantly associated with self-injury, stereotypy, and irritability (including aggression and tantrums). The previous study did not account for access to or use of alternative forms of communication in their sample population. This study uses retrospective data to investigate the association between verbal ability and augmentative and alternative communication (AAC) use and the presence of interfering behaviors in individuals with autism who have complex behavioral profiles. The sample included 260 autistic inpatients, ages 4-20 years, from six psychiatric facilities, enrolled during the second phase of the AIC when detailed information about AAC use was collected. Measures included AAC use, method, and function; comprehension and production of language; receptive vocabulary; nonverbal IQ; severity of interfering behaviors; and the presence and severity of repetitive behaviors. Lower language/communication abilities were related to increased repetitive behaviors and stereotypies. More specifically, these interfering behaviors appeared to be related to communication in those individuals who were candidates for AAC but who were not reported to have access to it. Although the use of AAC did not predict a decrease in interfering behaviors, receptive vocabulary scores-as measured by the Peabody Picture Vocabulary Test-Fourth Edition-were positively correlated with the presence of interfering behaviors in participants with the most complex communication needs. The communication needs of some individuals with autism may be unmet, prompting the use of interfering behaviors as a form of communication. Further investigation of the functions of interfering behaviors and the related functions of communication skills may provide greater support for an increased focus on the provision of AAC to prevent and ameliorate interfering behaviors in individuals with autism.

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.

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.

Desenvolvimento das habilidades comunicacionais em adolescente autista com uso de comunicação alternativa: relato de caso

ABSTRACT Alternative communication has been successfully used in interventions to develop communication skills in children with ASD. However, few studies in Brazil have approached nonverbal adolescents with autism. This article aimed to demonstrate the impact of using an alternative communication system on the development of communication skills in a nonverbal adolescent presented with ASD. This is a single-case study with longitudinal intervention. Skills were assessed with the Communication Assessment in Autism Spectrum Disorder (ACOTEA). There was progress in communicative and behavioral skills. Receptive communications had a greater variation between the first, second, and third applications, increasing from 50% to 66.60% and then 83.30%, followed by social behavior, which increased from 45.80% to 70.80% and then 75%. The use of alternative communication with a robust communication system indicated evidence of the development of communication skills and social behavior in the adolescent with ASD that received the treatment.

Progress in communication of two children with intellectual disability in child education: interventions using alternative communication resources

This research sought to analyze how the use of Alternative Communication in intervention sessions can contribute to the process of communication of children with intellectual disabilities in the stage of Early Childhood Education. The research had the participation of two children with intellectual disability and communicative difficulties, students of public schools in the city of Igarassu-PE. Intervention sessions were held with the use of Alternative Communication resources. The study demonstrated that the use of alternative communication resources contributed significantly to these children's communication. It showed that the use of alternative communication coupled with pedagogical activities to stimulate oral language in early childhood education can enhance the acquisition and development of the language of children with intellectual disabilities, which in the classroom can allow children with ID to have as many opportunities for development as other children without disabilities.

A recent survey of augmentative and alternative communication use and service delivery experiences of people with amyotrophic lateral sclerosis in the United States

Purpose The objective of this study was to explore and describe current trends in the augmentative and alternative communication (AAC) use and service delivery experiences of people with amyotrophic lateral sclerosis (PALS) in the U.S. Methods Cross-sectional data were collected from 216 PALS via an anonymous online questionnaire in 2021. Results Over 70% of participants reported at least some detectable speech disturbance, and approximately half used aided communication during face-to-face interactions. Among respondents with severe speech impairment, over 90% reported using speech-generating devices, and just over half reported using low-tech AAC. Most participants had met with an SLP to discuss speech and communication, but varied in both timing of the initial intervention and frequency of ongoing intervention. Fewer than half reported that their family members or other important people had received education or support related to communication for PALS. Participants also shared their use of and experiences with telephone and video calls, access methods, mounting systems, word prediction and stored phrases, and message and voice banking. Conclusions Results highlight the importance of early referral for AAC intervention, ongoing re-evaluation and treatment, involvement of communication partners and support for multimodal communication and adaptation to changing needs.

Frequency and correlates of augmentative and alternative communication use in an autistic inpatient sample.

Although augmentative and alternative communication (AAC) strategies are often used by autistic youth, little is known about the use of AAC in inpatient psychiatric settings. This study evaluated how demographic and clinical factors (e.g., language level, IQ) related to AAC use in a well-characterized sample of 527 autistic youth (78.7% male, mean age 12.94) who participated in the Autism Inpatient Collection. AAC use was common, with 42.5% of caregivers reporting at least one form of AAC. White children were more likely to use AAC than non-white children at the bivariate level. In regression analyses, young children were more likely to use AAC than older children. These results suggest the importance of provider training and improved equitable access to AAC.

Physical functionality of alternative communication resources in people with cerebral palsy: A systematic review

BACKGROUND: Augmentative and Alternative Communication (AAC) systems are used by people with motor disabilities, such as those with cerebral palsy (CP). The assessment of physical functional skills is crucial for appropriately choosing the computer access tool. OBJECTIVE: This study aimed to do a systematic literature review addressing the importance of the analysis of physical functional performance for the construction of specific tools to support communication. METHODS: The review followed PRISMA guidelines. We searched articles from 2009 to 2021 using three databases (PubMed, Lilacs in Portuguese, and SciELO). Three reviewers extracted the data. Registration was made to PROSPERO. The risk of bias was assessed using the Cochrane Collaboration tool. RESULTS: We found 132 articles in the databases. First, we excluded 31 articles because they did not provide evidence for the use of alternative communication in people with CP and did not use high technology resources. We also excluded 57 duplicated articles. At the end of this first step, 44 articles were left, 38 of them were excluded because they are not clinical trials. We selected 6 articles for the final analysis. CONCLUSIONS: The systematic review had a positive impact on the precise dissemination of knowledge ensuring comparisons of interventions and articles such as assistive technology programs.

PROJETO DE COMUNICAÇÃO ALTERNATIVA ESTUDO SOBRE OS PROTOCOLOS DE AVALIAÇÃO

With the need to guarantee rights and opportunities for people with complex communication needs, APAE Barueri, in 2021, expanded its range of activities with the implementation of the Alternative Communication Project, aimed for people with intellectual disabilities, ages from 03 to 17 years old and 11 months, who attend the Organization. In the present study, the process of choosing evaluation and application protocols is described, carried out with interdisciplinary team of reference of the user in the Organization; family members and/or legal guardians and the person assisted. The descriptors that guided the search were: alternative communication, protocols and evaluation. With the lack of research materials, such as articles, books, protocols and evaluations, the need for materials and databases to identify the communicative skills of the person with complex communication needs is justified, in order to develop a care plan and initiate the intervention process and the effective use of Alternative Communication. The study begins by presenting the concept of disability and the person with complex communication needs, and then presents the protocols and materials intended for the evaluation process to ratify the user’s eligibility for the Alternative Communication Project. Considerations are made about the facilities and difficulties of each protocol, and considerations about the importance of using alternative communication resources that favor communication and interactions of the person with complex communication needs in all the spaces they are inserted

The Effects of Telepractice to Support Family Members in Modeling a Speech-Generating Device in the Home.

Purpose Family members are an integral support for children with complex communication needs (CCN). However, there is limited research exploring "whole family" intervention to support children with CCN, including evidence-based approaches such as aided language modeling and innovative delivery options such as telepractice. The purpose of this study was to explore whether the use of telepractice-based training and coaching is a valid means of delivering intervention to the whole family unit to implement aided language modeling. Method A 4-year-old child with CCN who uses a speech-generating device and her four family members participated in the study. A single-case multiple-probe design across the four dyads was used to determine the effect of the memory aid, namely, Prepare, Show, Wait, and Respond, via telepractice intervention to teach family members to provide aided language modeling with fidelity during natural routines. Results We found that telepractice-based training and coaching increased family members' high-fidelity models and rate of modeling. The target child also showed an increase in independent communication and rate of augmentative and alternative communication use. Social validity interviews indicated that the participants found the intervention to be socially valid. Conclusions Given the findings of this study, speech-language pathologists should encourage the involvement of the whole family in augmentative and alternative communication interventions. Future research should examine the impact of training and coaching all family members together in their natural environment, explore specific adaptations for participants, and investigate the effects of intervention delivered by speech-language pathologists who work directly with families and utilize family-centered practices.

Exploring augmentative and alternative communication use through collaborative planning and peer modelling: a descriptive case-study

ABSTRACT A descriptive case-study design was used to document the implementation of a four-phase intervention for a child with autism spectrum disorder (ASD) who uses augmentative and alternative communication (AAC) in an inclusive classroom. The focus of the intervention was on enhancing social communication through peer modelling of the child’s speech-generating app during news-sharing, and the intervention was developed and enacted in a collaborative partnership with the classroom teacher. Various sources of data, including interviews, observations, and data from the child’s AAC system, were collated and analysed. From this analysis, three key themes emerged: (a) Enhanced Participation, (b) Optimising AAC Acceptance and Use, and (c) Increased Teacher Agency. These themes suggest positive outcomes for a naturalistic, social-communication intervention, adding to the calls for further research in this area.

Augmentative and Alternative Communication Use by Individuals With Huntington's Disease: Benefits and Challenges of Implementation

Purpose The purpose of this article was to describe the complex symptoms associated with Huntington's disease (HD) and how they influence implementation of augmentative and alternative communication (AAC) services to address communication impairments. Three case studies with varied presentation, AAC recommendations, and overall outcomes are presented followed by a discussion on common challenges of AAC intervention for this population. Conclusion Providing AAC services to individuals with HD can be complicated due to variability in symptoms, access to services, funding, and communication partner support. It is important to understand HD and consider the complex presentation of symptoms that impact appropriate AAC strategies and intervention. Further research is needed to improve guidelines available to clinicians.

High-Technology Augmentative and Alternative Communication in Poststroke Aphasia: A Review of the Factors That Contribute to Successful Augmentative and Alternative Communication Use

Purpose This article aims to explore current knowledge about factors influencing successful use of high-technology augmentative and alternative communication (AAC) in poststroke aphasia through a l...

The Relationship Between Operational Competency, Buy-In, and Augmentative and Alternative Communication Use in School-Age Children With Autism.

Purpose The objective of this study was to investigate the relationship between 2 variables that influence augmentative and alternative communication (AAC) use, caregiver operational competency (i.e., the ability to navigate, customize, and program the device), and AAC system buy-in (i.e., understanding that the device acts as the child's voice and should be treated as an extension of his or her physical body), to determine if there was a relationship between these variables and device use at home and at school in school-age children with autism who use AAC. Method The device use of 29 school-age children ( M age = 7.82 years) with an educational diagnosis of autism who use AAC was tracked using the logging feature on the participants' AAC devices. Participants' parents ( n = 29) and teachers ( n = 14, some teachers reported on multiple students) completed a questionnaire assessing caregiver operational competency and AAC system buy-in. Minutes of data use were extracted from each participant's AAC device ( Cross & Segalman, 2016 ) and averaged across three randomly selected dates. Results The parents and teachers reported high rates of operational competency and buy-in. However, only 10 of the children used their devices at home during the weekends. Despite high rates of parent- and teacher-reported operational competency, participants did not use their devices at high rates. Conclusion Speech-language pathologists may also need to focus on other aspects of parent and teacher training, such as creating communication opportunities for students who use AAC to increase device use at home and at school.

Exploring Experiences of Expressive Aphasia in Brain Injury Patients: A Qualitative Study

Background: Aphasia affects 0.37% of South Africans. Expressive aphasic patients’ ability to react appropriately to the environment contributes to their hospital experience, and ultimately their mental health and recovery. The challenge of communication for these patients makes it important to anticipate their experiences. Objectives: The purpose of the present study was to explore the patterns of patient experiences in relation to expressive aphasia following brain injuries in order to identify helpful recommendations for alternative communication and for promoting mental health and well-being.Methods: A qualitative case series study was completed with the participation of seven adults who had recovered from expressive aphasia. Participants had received their acute care at Worcester Provincial Hospital, South Africa and at the time of the study were able to communicate effectively concerning their experiences and perspectives. Interviews were transcribed and transcripts analysed by two independent researchers. A thematic analysis method, within a constructionist framework, and at a latent level, was applied.Results: Participants were generally satisfied with the services of health professionals. All participants described their families as being supportive. However, even though most participants had attempted to initiate alternative forms of communication, their families had not reciprocated this. Participants experienced sadness, frustration and anger following the onset of expressive aphasia. They reported gaining insight into the way their lives might change in the near future, such as their roles within the community, as well as into their experiences of introspection and self-reflection. Conclusions: Persons with new onset expressive aphasia during acute care at a large South African hospital experience negative emotions (such as feelings of frustration, entrapment and sadness) as well as inadequate responses to their desire to use alternative forms of communication. Anticipation of such negative experiences may substantially help communication. Formal training in this regard is recommended for health care professionals. Also, visitors to patients with expressive aphasia require basic instruction on the use of alternative communication.

Developing the Alphabetic Principle to Aid Text-Based Augmentative and Alternative Communication Use by Adults With Low Speech Intelligibility and Intellectual Disabilities.

We explored alphabet supplementation as an augmentative and alternative communication strategy for adults with minimal literacy. Study 1's goal was to teach onset-letter selection with spoken words and assess generalization to untaught words, demonstrating the alphabetic principle. Study 2 incorporated alphabet supplementation within a naming task and then assessed effects on speech intelligibility. Three men with intellectual disabilities (ID) and low speech intelligibility participated. Study 1 used a multiple-probe design, across three 20-word sets, to show that our computer-based training improved onset-letter selection. We also probed generalization to untrained words. Study 2 taught onset-letter selection for 30 new words chosen for functionality. Five listeners transcribed speech samples of the 30 words in 2 conditions: speech only and speech with alphabet supplementation. Across studies 1 and 2, participants demonstrated onset-letter selection for at least 90 words. Study 1 showed evidence of the alphabetic principle for some but not all word sets. In study 2, participants readily used alphabet supplementation, enabling listeners to understand twice as many words. This is the first demonstration of alphabet supplementation in individuals with ID and minimal literacy. The large number of words learned holds promise both for improving communication and providing a foundation for improved literacy.

Cognitive impairment in amyotrophic lateral sclerosis: the hidden challenges

Motor neurone disease (MND) or amyotrophic lateral sclerosis (ALS) is a devastating, neurological condition. It is a progressive disease that attacks the nerves in the brain and spinal cord, leading to progressive weakness and wasting of muscles. This can lead to difficulties in walking, speech, eating, drinking and breathing (MND Association, 2016). MND is a rapidly progressive disease with death usually occurring 2–5 years from onset of first symptom. Diagnosis is usually made around 12 months from first symptom, with the diagnosis typically being made around the midpoint (50% of total disease duration elapsed) of the disease pathway (Mitchell et al, 2010). Although it is progressive, the rate and nature of progression can be unpredictable, with damage to affected areas occurring in no specific order (MND Association, 2016). The incidence of MND in England, Wales and Northern Ireland is approximately 1–2 cases per 100 000 people per year, very similar to multiple sclerosis. However, due to the rapid progression of MND the prevalence is only about 4–5 per 100 000 compared to about 50 per 100 000 for MS. (MND Association, 2015). People with MND are said to have a series of losses, including the: ■Loss of movement ■Loss of speech ■Loss of ability to eat, drink and breathe. They can have many health and social care professionals involved in their care at any one time. Although often grateful for the support and advice, it can be overwhelming and patients are often confused about roles (Oliver and Webb, 2000). The management of MND is usually provided by a multidisciplinary team based in the hospital and community. There is no cure for MND, with treatment limited to one drug, Riluzole, known to extend survival by only 2–3 months, and has been recommended by the National Institute of Health and Care Excellence (NICE, 2001). The main areas of intervention, are therefore symptom management, and supportive, including interventions to improve quality of life. These may include enteral feeding (Miller et al, 2012; Stavroulakis et al, 2014) and ventilation (Baxter et al, 2013). The physical manifestations of MND/ALS are well known and widely researched. In comparison cognitive impairment in MND is less well recognised.