negative attitudes toward persons with disabilities and the stigma associated with AAC. Iconicity is the association made between a symbol and the item for which it stands (referent; Schlosser, 2003). the capability to be modified to allow for changes in communication abilities and needs, the ability to motivate use by an individual, and. An SLP may consider AAC systems with the ability to switch between messages in different languages. Augmentative and alternative communication is not appropriate for everyone (2006). lack of support for device use on the part of caregivers or belief that they can communicate effectively without the device, lack of motivation by the user and family members or caregivers, and. Clinicians should consider the amount of support that the child will need to use their AAC system within the school (classroom, lunchroom, hallways, play and leisure activities, etc.) https://doi.org/10.1080/07434610212331281271, Tuthill, J. For more information about the AT Act, go to National Assistive Technology Act Technical Assistance and Training (AT3) Center - AT Act Information. Aspect Research Insights, 6, 14. done with a generated movement or signal (e.g., via joystick, eye gaze, trackball, traditional or head mouse, braincomputer interface technology, light indicator). (2021). Augmentative and alternative communication (AAC) advances: A review of configurations for individuals with a speech disability. AAC intervention requires ongoing collaborative decision making and training to promote communicative competence and language and literacy development, as well as modifications to AAC systems to support changes in communication needs over time. If the person does not initiate, an expectant look and a time delay might be sufficient to prompt language use. Consider the students need for AT, including AAC. Perspectives on Augmentative and Alternative Communication, 21(3), 7481. The clinician reinforces the individuals attempts to communicate as these attempts get closer to the desired communication behavior (McGee et al., 1999). Wilkinson, K., & McIlvane, W. (2002). The Assistive Technology Act (AT Act) of 2004 provides every state and territory with federal funding to support efforts to increase access to, and acquisition of, AT devices and services (Assistive Technology Act, 2004). An SLP should evaluate expressive and receptive skills, including. ), Exemplary practices for beginning communicators: Implications for AAC (pp. https://doi.org/10.1044/aac21.3.74, Wong, V., & Wong, S. N. (1991). Advocacy and/or counseling efforts are critical to informing these potential AAC users, as well as professionals key to AAC implementation (e.g., SLPs, teachers, applied behavior analysis therapists). Journal of Autism and Developmental Disorders, 21(3), 329340. According to ASHAs position statement, Rapid Prompting Method, It is the position of the American Speech-Language-Hearing Association (ASHA) that use of the Rapid Prompting Method (RPM) is not recommended because of prompt dependency and the lack of scientific validity. Disability and Rehabilitation, 24(13), 520. as the official journal of the international society for augmentative and alternative communication (isaac) , augmentative and alternative communication (aac) publishes scientific articles related to the field of augmentative and alternative communication (aac) that report research concerning assessment, treatment, Beukelman, D. R., McGinnis, J., & Morrow, D. (1991). the ability and willingness to use AAC systems. American Journal of Speech-Language Pathology, 13(2), 155167. Organization strategies may change over time based on changes in skills and contexts. Perspectives of the ASHA Special Interest Groups, 5(6), 16831686. https://doi.org/10.1080/13603110701284656, Carr, E., & Durand, M. (1985). https://doi.org/10.1080/07434610600924499, Light, J. C., Stoltz, B., & McNaughton, D. (1996). SLPs collaborate with the individual and their family members with consideration of their beliefs and views of how to incorporate AAC into their lives. The SLP must justify that the device being ordered is medically necessary in order to receive third-party funding. Visual schedules use objects, photographs, drawings, written words, or other symbols to cue or prompt individuals to complete a sequence of tasks or activities. WebAugmentative and alternative communication (AAC) is an area of clinical practice that Provide transition support and documentation if AAC is deemed necessary for the student as they exit the school system. Different encoding options (e.g., alphanumeric, numeric, iconic, alphabetic, and color) are sometimes used to organize displays. Perspectives of the ASHA Special Interest Groups, 5(6), 15861592. https://doi.org/10.1080/21678421.2019.1672748, Elsahar, Y., Hu, S., Bouazza-Marouf, K., Kerr, D., & Mansor, A. 8 Michelle Ferketic, Roseanne Clausen, and Susan Karr (ex officios) provided additional support. For individuals who are deaf-blind, the federally funded I Can Connect program provides eligible individuals with devices necessary for distance-related communication (including computers and software), as well as evaluation and training on the equipment. SGD vendors may be able to assist with funding questions and may have templates for meeting payer standards; however, this does not take the place of a comprehensive AAC evaluation. Information obtained through the use of FC should not be considered as the communication of the person with a disability (ASHA, 2018a). Perspectives of the ASHA Special Interest Groups, 1(12), 125138. cerebrovascular accidents (i.e., stroke); disability following surgeries (e.g., glossectomy, laryngectomy); and, patients in critical care settings (e.g., intubated patients) and, communication apps, such as AAC software that enables dynamic symbol/language representation, single-message devices and recordable/digitized devices, Hearing Assistive Technology Systems (HATS), voice amplifiers and artificial phonation devices, speech valves (for individuals with tracheostomies or ventilators), orthography (i.e., alphabet-based symbols). Facilitated communication [Position statement]. Kent-Walsh, J., & Binger, C. (2009). operating electronic equipment and/or navigating pages in a low-tech system. The purpose of this study was to examine the effects of Augmentative and Augmentative and Alternative Communication, 7(3), 215220. https://doi.org/10.1080/09638280412331280334. 265286). TC has also been used with populations such as individuals with ASD (e.g., Nunes, 2008; Wong & Wong, 1991). And to the right, there are B., Angell, M. E., & Carroll, K. (2006). (2004). Light, J. C., Beukelman, D. R., & Reichle, J. Communicative competence for AAC users consists of the following five individual competencies (Light et al., 2003; Light & McNaughton, 2014). Symbols are not universal across cultures. Augmentative and Alternative Communication, 23(4), 288299. Augmentative And Alternative Communication Systems - Pros and Cons ), The efficacy of augmentative and alternative communication: Toward evidence-based practice (pp. See the Assessment section of Written Language Disorders. https://pubs.asha.org/doi/10.1044/aac22.2.79. Views of disability vary widely and may influence all areas of AAC service delivery, including the decision to use AAC, the choice of AAC hardware, and the selection of vocabulary and symbol systems. https://doi.org/10.1080/07434618.2017.1347960. Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach, 3(4), 303310. Developing cultural competence from a Funds of Knowledge framework: Ethnographic interviewing revisited. failure to consider cultural differences in AAC system design. Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. Below are brief descriptions of both general and specific treatment approaches and instructional strategies for AAC intervention. (2016) estimated that 0.5% of the population requires the use of AAC based on the prevalence of conditions associated with the use of AAC in the United Kingdom. Behavioral methods involve examining antecedents that elicit a behavior and the consequences that follow that behavior. Please see ASHAs Practice Portal page on Cultural Responsiveness for more information. Individuals with Disabilities Education Act of 2004, 20 U.S.C. https://www.jstor.org/stable/23879621, Millar, D. C., Light, J. C., & McNaughton, D. B. Acquisition of grammar (both morphology and syntax) can be especially challenging for AAC users who are simultaneously acquiring language, because morphological markers (e.g., tense and plural markers) are difficult to represent via symbols or may be excluded due to space constraints (Sutton et al., 2002). WebHowever, when this process is interrupted learning becomes very difficult, and things such https://doi.org/10.3109/17483107.2014.913715, McGee, G. G., Morrier, M. J., & Daly, T. (1999). the individuals comfort level with technology; the individuals literacy skills prior to and after the injury or progression of the disease; if the individual is using AAC for the first time; and. Delmar. Members were Stephen Calculator (chair, document revisions committee, 2001), Doreen Blischak, Amy Finch, Tracy Kovach, Lyle Lloyd, Susan McCloskey, Anne McGann, Cassie Sementelli, Ralf Schlosser, and Rose Sevcik. Users may be able to navigate independently from one activity display to another, or they may rely on a facilitator or communication partner to provide the appropriate activity display for a given situation. AAC is typically divided into two broad categories. Varied types of devices are used to help speakers get their messages across. Share. Among adults with amyotrophic lateral sclerosis (ALS) in Scotland, Elliott et al. SLPs are involved in transition planning and may be involved in other support services beyond high school. How to Communicateexchanging single pictures for desired items/activities, Distance and Persistencegeneralizing picture exchange to different situations and communication partners, Picture Discriminationselecting from two or more pictures (typically stored in a communication book) to request items/activities, Sentence Structureconstructing simple sentences by adding a picture of the desired item to a sentence strip that begins with an I want carrier phrase, Answering Questionsusing a picture to request an item/activity in response to the question, What do you want?, Responsive and Spontaneous Commentingusing pictures to respond to a variety of questions (e.g., What do you see? What do you have? What is this?) to introduce commenting behavior. Presentation of items in the selection set can be auditory, tactile, or visual. Discrete trial training (DTT) is a one-to-one instructional approach that uses behavioral methods to teach skills in small systematic steps. Brookes. A person who uses AAC may use a single LRM or a combination of LRMs, depending on preference and the functionality of the system. print awareness activities using adapted books and modeling behaviors, such as indicating. https://doi.org/10.3109/07434618.2012.704523. The school-based SLP works as part of a team that may include an AAC or AT specialist who facilitates or completes the AAC evaluation. The following factors may serve as barriers to AAC use (Johnson et al., 2006; Light et al., 1996; Moorcroft et al., 2019; Pape et al., 2002): There are many misconceptions about AAC that may deter an individual or a family member from AAC use. Webcommunication at some point in life, there must be an alternative means to express using word/phrase prediction to enhance efficiency, using an introductory (pre-stored) statement to explain AAC to unfamiliar communication partners, and. Augmentative and Alternative Communication, 33(3), 181187. Typically developing children begin to find this type of grouping helpful at around the age of 67 years, so this strategy may not be appropriate for individuals at earlier stages of language development (Beukelman & Light, 2020). Nunes, D. R. P. (2008). In fact, this approach can be effective for participants of many differing ages/disabilities/language skills (ONeill et al., 2018). Solving social-behavioral problems through the use of visually supported communication. Rehabilitation engineers or AT professionals help SLPs and AAC users with programming, accessibility, and efficient use of the AAC device. These include additional augmentative supports and hearing AT systems. The most frequently used words: Comparing child-directed speech and young childrens speech to inform vocabulary selection for aided input. As with SGDs, an SLP should document medical necessity for accessories. https://doi.org/10.3233/PRM-2010-0141, Drager, K. D. R., Light, J., Speltz, J., Fallon, K., & Jeffries, L. (2003). The SLP is also responsible for IEP documentation. A comparison of standard and user vocabulary lists. https://doi.org/10.1044/1092-4388(2003/024), Drager, K. D. R., Postal, V. J., Carroulus, L., Castellano, M., Gagliano, C., & Glynn, J. Effects of interventions that include aided augmentative and alternative communication input on the communication of individuals with complex communication needs: A meta-analysis. Use evidence-based practice to evaluate functional outcomes of AAC intervention. Visual scenes may be easier to learn and use than grid displays for beginning communicators (e.g., young children or older individuals who are at early-functioning communication stages). the need for trial periods with devices or extended dynamic assessment across multiple sessions to ensure the clinicians confidence in system recommendations. Involve individuals and family members in decision making to the greatest extent possible throughout the assessment and intervention process. Other conditions https://doi.org/10.1901/jaba.1985.18-111, Costello, J. M. (2011/2016). When Should Your Child Start Using AAC? Accessories that may support an AAC user include the following: This list of resources is not exhaustive and the inclusion of any specific resource does not imply endorsement from ASHA. Provide training for medical and allied health professionals, educators, family members, and community members about AAC use and the impact of AAC on quality of life. Educate other professionals and caregivers on the needs of persons using AAC and the role of SLPs in meeting the needs of individuals who use AAC. Porter, G., & Cafiero, J. M. (2009). https://doi.org/10.1044/1092-4388(2006/021), Mindel, M. (2020). This can be accomplished by providing core and fringe vocabulary supports in the home and day environment (e.g., classroom) and by introducing visually represented language using a variety of communication display forms and sizes prior to the formal assessment process. capacity for use in varying environments and with different partners. Erickson, K. A., Koppenhaver, D. A., & Cunningham, J. W. (2006). Augmentative and Alternative Communication evidence map, Augmentative and Alternative Communication (AAC) Evidence Map, Assessment Tools, Techniques, and Data Sources, Collaborating With Interpreters, Transliterators, and Translators, Speech Sound Disorders: Articulation and Phonology, Evaluating and Treating Communication and Cognitive Disorders: Approaches to Referral and Collaboration for Speech-Language Pathology and Clinical Neuropsychology, Interprofessional Education/Interprofessional Practice (IPE/IPP), National Joint Committee for the Communication Needs of Persons With Severe Disabilities (NJC), End-of-Life Issues in Speech-Language Pathology, National Assistive Technology Act Technical Assistance and Training (AT3) Center - Program Directory, National Assistive Technology Act Technical Assistance and Training (AT3) Center - AT Act Information, Local Coverage Determinations by State Index, Medicare Coverage Policy on Speech-Generating Devices, TEDPA Telecommunications Equipment Distribution Program Association, Health Care Common Procedure Coding System (HCPCS) Level II Codes: AAC and Other Speech-Language Pathology Related Devices, An Overview of the AAC Assessment Process, International Society for Augmentative and Alternative Communication, National Parent Center on Transition and Employment, Association of Assistive Technology Act Programs, Communication Supports InventoryChildren & Youth (CSI-CY), Family Impact of Assistive Technology Scale for Augmentative and Alternative Communication Systems (FIATS-AAC), Dynamic Learning Maps Professional Development, Pennsylvania Training and Technical Assistance Network (PaTTAN), American Association on Intellectual and Developmental Disabilities (AAIDD), Assistive Technology Industry Association (ATIA), Rehabilitation Engineering and Assistive Technology Society of America (RESNA), Rehabilitation Engineering Research Center on AAC, Boston Childrens Hospital Augmentative Communication Program Handouts and Resources. WebAugmentative and Alternative Communication (AAC) Children who have significant limitations in communicating verbally may be evaluated by a speech-language pathologist, occupational therapist, rehabilitation professional, physical therapist or medical professional. These can be the result of congenital disabilities, acquired disabilities, or neurological differences such as autism. If the IEP team determines that AAC is required in order for a student to be provided free appropriate public education (FAPE; U.S. Department of Education Office for Civil Rights, 1996; U.S. Department of Education Office of Special Education Programs, 2006), the technology must be provided to implement the IEP. This helps ensure carryover and functional use of the system in everyday life. In G. Soto & C. Zangari (Eds. It may be difficult to generalize learning via DTT beyond the setting in which a skill is learned. See End-of-Life Issues in Speech-Language Pathology for more information. used in a core vocabulary approach allows the individual to complete various communicative functions, such as asking questions, requesting, rejecting, protesting, commenting, and describing. Message banking, voice banking and legacy messages [Message banking examples from people with ALS]. There are advantages and disadvantages to different AAC systems. Augmentative & alternative communication: Supporting children and adults with complex communication needs (5th ed.). Augmentative and Alternative Communication, 31(1), 7784. People of all ages can use AAC if they have trouble with speech or language skills. (2003). Evaluation of the Language Acquisition through Motor Planning (LAMP) program with children with autism spectrum disorders (ASD). These devices use synthesized speech output, digitized speech output, or both. WebWhat is alternative communication in health and social care? Intervention principles and procedures. Prediction and selection of vocabulary for two leisure activities. The challenges associated with AAC use can present added barriers to success in postsecondary educational or vocational training programs, employment settings, and independent or semi-independent living situations. https://doi.org/10.1044/2019_AJSLP-19-00041, Drager, K. D. R., Light, J., & McNaughton, D. (2010). Provision of assistive technology devices among people with ALS in Germany: A platform-case management approach. A review of medical records at the University of Iowa Hospitals & Clinics found that 33% of intensive care unit (ICU) patients met the AAC candidacy criterion, whereas 3% of non-ICU patients met the AAC candidacy criterion (Zubow & Hurtig, 2013). (2000). Vocabulary is often divided into two categories: core and fringe (or extended). https://doi.org/10.1080/07434610310001598233. Symbol selection is also based on the persons ability to access, recognize, and learn each symbols meaning. https://doi.org/10.1080/07434619712331278048, National Joint Committee for the Communication Needs of Persons With Severe Disabilities. Many components of the comprehensive assessment may already be documented in an individuals records (i.e., medical or school records). Abandonment occurs in approximately one third of cases (Zangari & Kangas, 1997), even if the system is well designed and functional (Johnson et al., 2006). Partial or complete abandonment of AAC can occur when partner input is not considered during AAC intervention (Angelo et al., 1995; H. P. Parette et al., 2000; P. Parette et al., 2000). Visual prompts can be general (e.g., gesturing toward the communication system) or specific (e.g., pointing to a specific display location). The organization of vocabulary, symbol size, and number of symbols on the grid is individualized and determined by the type of display; the type of symbol; and the visual acuity, communication and cognitive skills, integrated sensory system, and motor control of the individual. A persons spoken vocabulary will change based on their age, communication partner, language development, environment, mood, and context. The use of signs among children with Down syndrome [Poster presentation]. Environmental modifications should be made to accommodate vision or hearing deficits and any other physical difficulties. If the individual (and/or communication partner) wears hearing aids or prescription eyeglasses, these should be worn during the assessment. Semanticsyntactic displays are useful for adults with relatively intact language (e.g., individuals with ALS) or language learners, and they can facilitate efficient production of grammatically complex messages. Ability to use various symbol features to meet current and future communication needs, including, Based on individual skills and needs, determine appropriate AAC system features, including. In addition to helping the individual identify goals and objectives for treatment, they often have input into the type of AAC system used, daily communication needs, and vocabulary incorporated into the system. ease transitions from one activity to the next, provide opportunities to make choices, and. Family-centered decision making in assistive technology. A thorough assessment includes gathering information about lifestyle, the desire to communicate, and expectations regarding AAC use that are unique to each individual and their communication environments. https://doi.org/10.3109/07434618.2015.1064163. 1997- American Speech-Language-Hearing Association. Patel et al. Rapid prompting method [Position statement]. Consumers and professionals may think that young children are not ready for AAC until they reach school age. Augmentative and Alternative Communication (Practice Portal). Family, friends, and caregivers bring an important and unique understanding of the strengths, challenges, and needs of the individual who uses AAC. Many literacy activities can be adapted to meet the needs of AAC users, for example. having a positive attitude toward the use of AAC, having confidence in ones ability to communicate effectively in a given situation, and. Perspectives of speech-language pathologists regarding success versus abandonment of AAC. International Journal of Language & Communication Disorders, e51(6), 639653. https://doi.org/10.1080/07434610400006646, Kristoffersson, E., Sandber, A. G., & Holck, P. (2020). WebWith respect to advantages and disadvantages, three main areas of concern emerged: the The Cleft PalateCraniofacial Journal, 58(3), 324331. Interventions should incorporate use of the AAC system into a naturalistic environment and address using the system to target broader communication goals such as language and literacy development and social interaction. AAC assessments may be time consuming, and if all questions are unanswered, continued assessment may progress alongside treatment. (2004). Beukelman and Light (2020) estimated that approximately 5 million Americans and 97 million people in the world may benefit from AAC. (2000). Memory, attention, problem-solving, and executive skills in the context of functional AAC use. https://doi.org/10.1080/07434610600807470, Blockberger, S., & Johnston, J. https://doi.org/10.1044/0161-1461(2006/006), Barker, R. M., Saunders, K. J., & Brady, N. C. (2012). Language Acquisition Through Motor Planning (LAMP) is a therapeutic approach based on neurological and motor learning principles that uses a high-tech AAC system to provide the child with opportunities to initiate activity, engage in communication around activities of their choice, and access consistent motor plans to locate vocabulary (Potts & Satterfield, 2013). (1995). There is significant variability in funding of AAC devices between different plans and companies. Inadequate training of communication partners has been identified as a barrier to device use in addition to limitations of the AAC device itself and insufficient involvement in device selection (Bailey et al., 2006). Considerations in teaching graphic symbols to beginning communicators. Assistive technology devices among people with ALS in Germany: a platform-case management approach for trial periods with devices extended! 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( 2009 ) for the communication needs: a platform-case management approach 2010 ) Light ( 2020.! Made to accommodate vision or hearing deficits and any other physical difficulties,! Records ( i.e., medical or school records ) a team that may include an AAC AT. Additional support ) estimated that approximately 5 million Americans and 97 million people in the context of functional AAC.. Children are not ready for AAC ( pp AAC use learn each symbols meaning. ) or skills... Include an AAC or AT professionals help slps and AAC users, for example people! ( 2010 disadvantages of augmentative and alternative communication and context stigma associated with AAC W. ( 2002 ) professionals may that! Include additional augmentative supports and hearing AT systems continued assessment may already be in. A given situation, and needs: a meta-analysis webwhat is alternative communication ( AAC ) advances: a management... 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