And Alternative Communication Use Research Articles

Malaysian teachers’ experience using augmentative and alternative communication with students

Teachers play an important role in the successful implementation of augmentative and alternative communication (AAC) for students with complex communication needs. The goal of this two-phase, mixed-methods study was to explore Malaysian teachers’ use of, experience with, and perceptions about AAC. Phase 1 involved 252 teachers who completed a questionnaire that was aimed at collecting nationwide data about their use and overall perceptions of AAC. Phase 2 involved semi-structured interviews with 13 teachers who had experience supporting students who used AAC. Approximately half of the participants who completed the questionnaire knew about AAC and had used AAC with their students. Almost all of the participants had positive views of AAC though some misconceptions were reported. Most participants had limited knowledge about AAC that led them to experience difficulties supporting their students. Teachers were motivated to receive AAC-related training to enable them to use AAC more successfully with their students given the small number of SLPs in the country.

Perceived importance of AAC messages to support communication in rehabilitation settings

Purpose Permanent or temporary speech loss can occur due to a variety of medical conditions and often requires individuals to use augmentative and alternative communication (AAC) strategies and technologies to support communication. The use of AAC in medical and rehabilitation settings is critical to ensure the health, safety and psychological well-being of communicatively vulnerable individuals. Method This study surveyed the perceived importance of communication messages within five categories (Basic Needs, Patient-Provider Specific Communication, Social, Feelings, and Messages for Young Children) by individuals with disability who have undergone recent medical care as well as by rehabilitation care providers. Results Results indicated that, with only a few exceptions, participants with disability more frequently selected all of the messages listed under the Patient-Provider Specific, Social, and Feelings categories compared to rehabilitation care providers’ responses. Additionally, the individuals with disabilities selected messages that were more personalised to their specific care needs under Basic Needs. Both participant groups were asked to also suggest other messages that they perceived as important under each category. The other suggested messages demonstrated the potential need to provide personalisation to AAC displays to best meet the communication needs of individuals with disability. Implications for Rehabilitation There is a critical need for individuals who find themselves in medical settings (ICU, acute care hospital, rehabilitation hospital, etc.) to be able to communicate. This study provides preliminary information on the breadth of communication content that is perceived as relevant by individuals with disability and rehabilitation care providers. The need to provide personalized as well as a wide range of communication content options was of particular importance to individuals with disability. This information may provide specific guidance on how to best develop augmentative and alternative communication options for individuals in medical settings.

Revisiting the Role of Augmentative and Alternative Communication in Aphasia Rehabilitation.

Purpose The purpose of this article is to revisit the role of augmentative and alternative communication (AAC) in poststroke aphasia rehabilitation. The authors' intent is to provide a viewpoint that expands the use of AAC in poststroke aphasia rehabilitation. Specifically, we seek to clarify the role of AAC in restorative and participation approaches to aphasia rehabilitation while also considering the role of AAC in a comprehensive treatment plan. The authors support their viewpoint with citations from both the historic and contemporary literature on aphasia rehabilitation. Conclusions A thought-provoking viewpoint on the role of AAC in poststroke aphasia rehabilitation is proposed. More specifically, the versatility of AAC strategies is reviewed, with an emphasis on how AAC can be used to empower people with aphasia to fully participate and engage in life activities with increased independence. Moreover, we argue that AAC can be viewed as a dual-purpose tool that can simultaneously serve to drive intersystemic reorganization resulting in some improved language performance-and perhaps restoration of language function-while offering a communication alternative during inevitable anomic events.

Augmentative and Alternative Communication Intervention for People With Angelman Syndrome: a Systematic Review

Angelman syndrome is often associated with severe communication impairment indicating the need for augmentative and alternative communication (AAC) intervention. The present review sought to identify and summarize intervention studies on the use of augmentative and alternative communication for people with Angelman syndrome. Recently, a specific communicative profile has been suggested for people with Angelman syndrome. To identify the usefulness of AAC to augment this profile, we conducted a systematic search of the literature. Nine studies were identified and summarized with respect to (a) participants, (b) communication mode, (c) design, (d) intervention procedures, (e) outcome measures, and main findings. Overall, results from these studies suggest that AAC intervention is a viable approach for enhancing the communication skills of people with Angelman syndrome. However, additional research with larger samples is required to extend the evidence base supporting the use of AAC with people with Angelman syndrome.

Collaborer avec l'entourage pour mieux implémenter une CAA

Communication partner instruction of indi viduals using augmentative and alternative communication (AAC) is a huge challenge for speech and language therapists. The purpose of this article was to identify the active ingredients of AAC communication partner interventions based on available data. In a first step, we identified targets and implementation strategies that have been sh own as effective in parent implemented communication interventions with young child ren. In a second step, these data were supplemented by studies on the training of communication partners in the context of the use of AAC. Taken together, these studies point out that the most effective targets to improve the interaction style of partners consist in training their responsiveness and use of language models. Pragmatic outcomes (e.g., tu rn-taking), the access to spontaneous communication and a support for understanding have to be added for AAC interventions. To achieve this, the instructional methods employed with communication partners should include various combinations of implementation modalities (e.g., information sharing, modeling, guided practice, verbal rehearsal and feedback). Verbal rehearsal was shown to have a key role for the efficacy of the implementation. Finally, the communication partner's proficiency level with the AAC device should also be considered.

Communication Partner Training to Increase Interactive Communication Using Augmentative and Alternative Communication: A Case Study

Purpose The purpose of this clinical focus article was to assess the communication partner's (CP) perception regarding the effectiveness of a CP training model to support augmentative and alternative communication (AAC) use within a parent–adolescent dyad. Method This case study implements an adaptation of an 8-stage strategy instruction protocol for teaching aided language modeling across functional activities. Procedures for designing CP training to meet the specific needs of a particular CP and an individual using AAC (IUA) are offered. Pre- and posttraining questionnaires surveyed the CP's feelings and knowledge about using the AAC strategies and the IUA's AAC skill level. Results Quantitative and qualitative analyses of the CP's responses on the pre- and posttraining questionnaires revealed more confidence in supporting her son when using his device, increased knowledge of strategies to support AAC use, and increased understanding of the device operation. She also perceived that her son used his device more confidently and effectively in a variety of ways. Conclusion CP training that includes strategy instruction, along with practice and feedback, helps to increase the CP's and the IUA's understanding of the specific device and how to use it in more naturalistic, functional settings and situations. Since the CP's needs are similar across developmental and neurogenic groups, the direct strategy instruction described in this clinical focus article can be used by practicing clinicians working with pediatric or neurogenic populations to teach communication and operational skills. The results suggest that CP training should be included in treatment planning for speech-language pathologists working with individuals with complex communication needs who use AAC.

Am I the curriculum?

When we consider disability and the curriculum, we usually mean preparing professionals to work with people with disabilities or including students with disabilities. Here, I provide a personal description of these ideas colliding. It's Fall 2017, and I'm taking a course on Augmentative and Alternative Communication (AAC). That means it's about disability, or really, about certain services for people with disabilities. My classmates are studying to be speech language pathologists. I'm Autistic, and I use AAC part time because I can sometimes, but not always, speak. I'm the first AAC user to take this class. As we go through, the professor keeps saying how much they're learning from me, as an AAC user. So: am I the curriculum or the student? Am I both? Could I be a teacher? As I work on and eventually publish my class project, an overview of AAC use by speaking autistic adults, am I the object of research or the researcher? Am I both?

Augmentative and Alternative Communication for Speaking Autistic Adults: Overview and Recommendations.

What is augmentative and alternative communication?: Augmentative and alternative communication (AAC) describes the ways people communicate without, or in addition to, speech.What do we know about AAC for autistic adults who can speak?: Research on AAC and autism has focused on nonspeaking children. However, autistic adults who use AAC sometimes tell each other about AAC. This community knowledge includes reasons AAC is important, useful AAC strategies, and barriers to AAC use. This article talks about autistic community knowledge about AAC and then makes suggestions.Why is AAC important for autistic adults who can speak?: Autistic adults, including those who talk, may not always be able to meet all their communication needs with speech alone. Autistic people who use speech may experience intermittent, unreliable, and/or insufficient speech.What AAC strategies do speaking autistic adults use?: The three main ways that autistic adults report on using AAC include: (1)Free or low-cost tools that are not specific to AAC (e.g., online chat rooms, text messaging applications, or handwriting).(2)Mobile applications designed for communication support.(3)Signed languages such as American Sign Language.What are some common barriers to AAC use for speaking autistic adults?: Several barriers may prevent AAC use. These include the following: Knowledge of AAC optionsAttitudes about who AAC is useful forBeliefs that the use of AAC should be decreased if a person can speakCost of AAC devices and applications.What are our recommendations to autistic adults who might use AAC and their supporters?: Support autistics in defining their own communication needs, regardless of speech.Evaluate communication goals and match them with system features when making decisions about AAC.Prioritize all communication, not just speech.Explore a variety of options to support communication.Explore low- and no-cost options to support communication. What are some research questions that still need to be answered?: What communication strategies do autistic adults see as effective?What AAC strategies are being used, in what environments, and by whom?What prevents effective AAC use?How can AAC specialists and autistic adults best collaborate to promote and evaluate AAC use?How can communication supports be designed to better meet the needs of autistic adults?

Characteristics of Secondary Age Students With Intellectual Disability Who Participate in School-Sponsored Extracurricular Activities

This study investigated the relation between grade level, support needs, and use of augmentative and alternative communication (AAC) and the participation of secondary age students with intellectual disability in school-sponsored extracurricular activities. Participants were special education teachers with at least one student with an intellectual disability on their caseload who participated in a school-sponsored extracurricular activity ( N = 498). Data were collected using an online questionnaire sent to members of a national listserv for transition professionals. Teachers reported students participated in a variety of extracurricular activities within the categories of sports/fitness, school clubs, special events, and performing arts. The majority of students participated in activities for less than 3 hr per week and did not participate in activities that only included students with disabilities. Support needs and use of AAC were related to the type of extracurricular activities in which students participated, the amount of time students spent in extracurricular activities each week, and the extent to which students participated in extracurricular activities that only included students with disabilities. Grade-level differences were nonsignificant, except in relation to activities that only included students with disabilities.

Augmentative and alternative communication in the Philippines: a survey of speech-language pathologist competence, training, and practice

A cross-sectional survey study was undertaken to describe the perceived competence, pre- and post-professional training, and practice of Filipino speech-language pathologists (SLPs) in augmentative and alternative communication (AAC). Printed and electronic questionnaires were distributed to all SLPs in the Philippines with at least 1 year of practice experience. A total of 152 (47%) questionnaires were returned. Based on these data, 108 respondents (71%) practiced AAC, but most (range = 59–89%) did not perceive themselves to be competent in working with various client populations with complex communication needs. A majority (range = 70–93%) of the respondents reported limited pre-professional training in all AAC content areas, and at least 82% strongly desired continuing education in almost all areas of AAC. Almost 90% of respondents only occasionally (53%) or rarely (36%) recommended AAC, and 82% considered it as a last resort. Major practice challenges reported were families’ negative attitudes toward AAC and lack of AAC-specific interdisciplinary collaboration. Infrequent use of high-tech AAC was also reported. The findings suggest various ways through which AAC education and services in the Philippines may be enhanced. They also imply the need for further research on alternative service delivery models, as well as additional members of the AAC team.

A comunicação aumentativa e alternativa em crianças com perturbações graves da comunicação: cinco mitos

A capacidade de comunicar permite criar oportunidades de interação, influenciar o comportamento de outros e através disso exercer controlo sobre o meio ambiente da pessoa. Proporcionar uma forma aumentativa ou alternativa de comunicar potencia a autonomia e uma melhor qualidade de vida das crianças com perturbações da comunicação. Este facto, requere da parte dos profissionais um conjunto de competências para intervir junto destas crianças.
 A implementação da Comunicação Aumentativa e Alternativa (CAA) pode ser dificultada por preconceitos sobre a necessidade de uso, período mais adequado para iniciar a aprendizagem e competências precisas para o desenvolvimento da comunicação através destes recursos. Nesse sentido, este texto tem como finalidade contribuir para uma compreensão acerca dos mitos e realidades em relação ao uso da CAA. Foram analisadas as produções científicas nacionais e internacionais acerca do uso da CAA em populações com problemas graves na comunicação. Para isso, foi realizada uma busca em bases de dados de artigos, teses e dissertações, utilizando a combinação dos descritores “Comunicação Alternativa”, “Comunicação Aumentativa” e “Perturbações da Comunicação”.
 Os cinco mitos apresentados, caso não sejam adequadamente esclarecidos, podem levar a problemas na adesão à CAA por parte das famílias e de alguns profissionais. Assim, surge a necessidade de desmistificar estas questões de forma a promover o apoio adequado a crianças que podem beneficiar de CAA.

A pilot community-based randomized comparison of speech generating devices and the picture exchange communication system for children diagnosed with autism spectrum disorder.

A pilot community-based randomized controlled trial was conducted to compare the effects of the Picture Exchange Communication System (PECS) to a teaching sequence using a high-tech Speech Generating Device (SGD) to teach social communication behaviors. The two approaches were compared to evaluate the effectiveness of the newer, more high-tech intervention using technology to improve social and communicative behavior of children diagnosed with Autism Spectrum Disorder. A total of 35 school-age children were randomized to either a high-tech (SGD device) or low-tech (PECS cards) form of Augmentative and Alternative Communication (AAC). Study participants received 4 months of communication training delivered in their classrooms, and the primary outcome measures of the trial were several functional communication skills emphasized in the PECS teaching sequence. Results indicated that both high-tech and low-tech AAC approaches resulted in significant improvements in communication, and that these improvements did not differ significantly between the two approaches. These findings support the use of high-tech AAC, and highlight the need for evidence-based guidelines for its use as well as evaluation with individuals with a range impairments and disabilities. Autism Research 2018, 11: 1701-1711. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study compared the effectiveness of a free and open-source app for teaching social and communicative behavior to children with autism spectrum disorder (ASD) to traditional picture card approaches. Thirty-five children with ASD were randomized to a picture card or app-based intervention and both treatment approaches resulted in significant improvements in social and communicative behavior. These data indicated that both "high-tech" and "low-tech" interventions were effective for improving behavior and that there was not a significant difference between the two approaches.

A modified multimodal communication treatment for individuals with traumatic brain injury

People living with the effects of traumatic brain injury (TBI) might use augmentative and alternative communication (AAC) due to cognitive-communication disabilities and/or co-occurring motor speech disorders. However, the most effective method for teaching people with TBI to use AAC strategies and resolve communication breakdowns is unknown. Prior research conducted with people with aphasia suggests an integrated multimodal treatment improved the use of AAC to resolve communication breakdowns. In this study, the researchers measured the effectiveness of a modified Multimodal Communication Treatment designed to increase communication breakdown resolution and use of AAC strategies by two individuals with TBI. A multiple baseline, single-case design was used to measure outcomes for the two participants who had motor speech disorders and cognitive-communication impairments. They completed four pre-treatment sessions, 20 treatment sessions, and three post-treatment sessions. Dependent variables included the number of AAC strategies produced during a modality probe task and two measures of communication breakdown resolution during a structured, functional task. Both participants increased use of AAC strategies during modality probes, but demonstrated minimal changes in communication breakdown resolution variables, potentially due to their impairments in executive function and memory. Results indicate that modifications to MCT may improve the use of AAC strategies for communication breakdown resolution for some people with TBI.

AAC and Autism in Brazil: A Descriptive Review

ABSTRACTThe effectiveness of using Augmentative and Alternative Communication (AAC) with individuals with Autism spectrum disorder (ASD) is well documented in descriptive reviews and meta-analytic investigations published in international journals in the last decade. Most of these analyses include researches conducted in North-American or European countries, where AAC has become an evidence-based practice. Little is known, however, about the use of AAC for individuals with ASD in developing countries. The purpose of this descriptive review was to elucidate how AAC has been used with individuals with ASD in Brazil. Nineteen studies, including dissertations, theses and journal articles, published in the last five years, were analysed. Results revealed the prevalence of low-technology AAC, with a significant portion using picture-exchange communication methods. The use of higher-technology devices was limited and none of the investigations used manual signs. Most were intervention studies that used primarily quasi-experimental designs to evaluate the effectiveness of intervention packages on school-aged children in natural settings. Strengths/weaknesses of the studies, overall limitations, and recommendations for future research are discussed.

Teachers’ Attitudes Towards Children Who Use AAC in Italian Primary Schools

ABSTRACTEarly Augmentative and Alternative Communication (AAC) interventions in school environments aim to support the development of the communication skills of children with complex communication needs. Goals of this study were to analyse the teachers’ attitudes towards children using AAC in primary schools in Italy and their perceptions of the barriers and the benefits of using AAC. Two groups of teachers, those with and without AAC experience, responded to an online survey. The five scales of the Teacher Attitude Scale (TAS) questionnaire and two open-ended questions were used to compare the attitudes and the perceptions between the groups of teachers. Results showed that there was a significant difference among the two groups for two of the five scales of the TAS questionnaire. Both groups reported similar barriers and benefits and indicated the use of AAC as being the main barrier. In conclusion, having experience with children who use AAC in class impacts the teachers’ perceptions of their own abilities and the teachers’ perceptions of the abilities of the children.

Implementation and Intervention Practices to Facilitate Communication Skills for a Child With Complex Communication Needs

For children with complex communication needs (CCN), augmentative and alternative communication (AAC) devices offer a means to communicate and participate in daily activities. Effective implementation and intervention practices are needed for supporting teaching teams working with children with CCN to improve child use of AAC. The purpose of this article is to describe two studies examining these issues. Study 1 examined the effects of a behavior skills training (BST) approach to professional development to support a classroom teaching team in the implementation of a behavior support plan for a child with CCN; Study 2 evaluated the effects of a single behavior (adult modeling) on AAC use. Results indicated teachers increased their fidelity with training and coaching, but not with training alone. Further, unprompted use of the AAC device occurred more frequently when an adult modeled use of the device.

A systematic review of Functional Communication Training (FCT) interventions involving augmentative and alternative communication in school settings

The purpose of this meta-analysis was to summarize single-case intervention studies in which Functional Communication Training (FCT) involving augmentative and alternative communication (AAC) was implemented in school settings. Overall, the findings suggest that FCT involving AAC was effective in reducing challenging behaviour and promoting aided or unaided AAC use among participants with disability. FCT was more effective for the participants who engaged in less severe forms of challenging behaviour prior to intervention. Additionally, FCT was more effective when informed by a descriptive functional behaviour assessment and delivered within inclusive school settings. Implications for practice and directions for future research related to FCT for students who use AAC are addressed.

A systematic quality review of high-tech AAC interventions as an evidence-based practice

Although high-tech augmentative and alternative communication (AAC) is commonly used to teach social-communication skills to people with autism spectrum disorder or intellectual disabilities who have complex communication needs, there is a critical need to evaluate the efficacy of this approach. The aim of this systematic review was to evaluate the quality of single-case experimental design research on the use of high-tech AAC to teach social-communication skills to individuals with autism spectrum disorder or intellectual disabilities who have complex communication needs, to determine if this intervention approach meets the criteria for evidence-based practices as outlined by the What Works Clearinghouse. Additionally, information on the following extended methodological standards is reported on all included studies: participant description, description of setting and materials, interventionist description, baseline and intervention description, maintenance, generalization, procedural integrity, and social validity. The results from 18 multiple-baseline or multiple-probe experiments across 17 studies indicate that using high-tech AAC to teach social-communication skills to individuals with autism spectrum disorder or intellectual disabilities and complex communication needs can be considered an evidence-based practice, although the review of comparison (i.e., alternating treatment) design studies did not indicate that high-tech AAC is significantly better than low-tech AAC.

Assessing cognitive functioning in females with Rett syndrome by eye-tracking methodology.

While many individuals with severe developmental impairments learn to communicate with augmentative and alternative communication (AAC) devices, a significant number of individuals show major difficulties in the effective use of AAC. Recent technological innovations, i.e., eye-tracking technology (ETT), aim to improve the transparency of communication and may also enable a more valid cognitive assessment. To investigate whether ETT in forced-choice tasks can enable children with very severe motor and speech impairments to respond consistently, allowing a more reliable evaluation of their language comprehension. Participants were 17 girls with Rett syndrome (M=6:06 years). Their ability to respond by eye gaze was first practiced with computer games using ETT. Afterwards, their receptive vocabulary was assessed using the Peabody Picture Vocabulary Test-4 (PPVT-4). Target words were orally presented and participants responded by focusing their eyes on the preferred picture. Remarkable differences between the participants in receptive vocabulary were demonstrated using ETT. The verbal comprehension abilities of 32% of the participants ranged from low-average to mild cognitive impairment, and the other 68% of the participants showed moderate to severe impairment. Young age at the time of assessment was positively correlated with higher receptive vocabulary. The use of ETT seems to make the communicational signals of children with severe motor and communication impairments more easily understood. Early practice of ETT may improve the quality of communication and enable more reliable conclusions in learning and assessment sessions.

High-technology augmentative and alternative communication for individuals with intellectual and developmental disabilities and complex communication needs: a meta-analysis

The use of mobile technology is ubiquitous in modern society and is rapidly increasing in novel use. The use of mobile devices and software applications (“apps”) as augmentative and alternative communication (AAC) is rapidly expanding in the community, and this is also reflected in the research literature. This article reports the social-communication outcome results of a meta-analysis of single-case experimental research on the use of high-tech AAC, including mobile devices, by individuals with intellectual and developmental disabilities, including autism spectrum disorder. Following inclusion determination, and excluding studies with poor design quality, raw data from 24 publications were extracted and included 89 A-B phase contrasts. Tau-U nonparametric, non-overlap effect size was used to aggregate the results across all studies for an omnibus and moderator analyses. Kendall’s S was calculated for confidence intervals, p-values, and standard error. The omnibus analysis indicated overall low to moderate positive effects on social-communication outcomes for high-tech AAC use by individuals with intellectual and developmental disabilities.