The Use of Augmentative and Alternative Communication Methods with Infants and Toddlers with Disabilities: A Research Review

A comparison of two approaches for representing AAC vocabulary for young children

PURPOSE

Young children with complex communication needs often experience difficulty in using currently available graphic symbol systems as a method of augmentative and alternative communication (AAC). Information on young children's performance with graphic representations based on this population's conceptualizations of these vocabulary items may assist in the development of more effective AAC systems.

METHOD

This study developed Developmentally Appropriate Symbols (DAS) for 10 early emerging vocabulary concepts using procedures designed to address both conceptual and appeal issues for graphic representations for young children. Using a post-test only, between-subjects comparison group design, 40 typically-developing 2.5-3.5-year-old children were randomly assigned to receive a brief training in either of two different types of graphic symbol sets: (a) DAS or (b) Picture Communication Symbols (PCS), a, commercially available graphic symbol system.

RESULT

Results of a two sample independent t-test provide evidence that children in the DAS condition correctly identified more symbols than children trained with the PCS symbols. There was no evidence of a preference between the symbol sets.

CONCLUSION

The results provide support for careful consideration of children's use and understanding of language in developing AAC systems for young children.

Teaching Active Listening Skills to Pre-Service Speech-Language Pathologists: A First Step in Supporting Collaboration With Parents of Young Children Who Require AAC

Purpose

This study examined the effect of instruction in an active listening strategy on the communication skills of pre-service speech-language pathologists (SLPs).

Method

Twenty-three pre-service SLPs in their 2nd year of graduate study received a brief strategy instruction in active listening skills. Participants were videotaped during a simulated parent meeting before and after the strategy instruction. Simulated parent meetings addressed issues that parents of children who use augmentative and alternative communication (AAC) may face. Social validity measures were gathered from the participants and from parents of children who use AAC.

Results

Pre- and postinstruction use of the active listening strategy was scored and compared using a Wilcoxon signed-ranks test, with statistically significant results. Postinstruction scores were significantly higher than preinstruction scores, providing evidence of the effectiveness of the instruction. Furthermore, participants and parents of children who use AAC described the postinstruction interactions more positively than the preinstruction interactions, suggesting that the pre-service SLPs benefited from the instruction.

Conclusion

The current study provides evidence of the effectiveness of strategy instruction in active listening skills that may be incorporated into SLP preparation programs.

Communication intervention in Rett syndrome: a survey of speech language pathologists in Swedish health services

PURPOSE

To investigate communication intervention that speech language pathologists (SLPs) provide to people with Rett syndrome.

METHODS

A web-based survey targeting all Swedish SLPs working with people currently receiving support from habilitation services.

RESULTS

The SLPs reportedly followed recommended practice in the following aspects: (1) Information on communicative function was collected from several sources, including observation in well-known settings and reports from the client s social network, (2) Multimodal communication was promoted and, (3) Responsive partner strategies were largely targeted in the intervention. However, few instruments or standard procedures were used and partner instruction was given informally. Most SLPs used communication aids in the intervention and their general impression of using communication aids was positive. Further, augmentative and alternative communication (AAC) was estimated to increase and clarify communicative contributions from the person.

CONCLUSIONS

Communication aids were reported to have a positive influence on communicative functions. Swedish SLP services followed best practice in several aspects, but there are areas with potential for development. Tools and best practice guidelines are needed to support SLPs in the AAC process for clients with Rett syndrome. [Box: see text].

Reliability and validity of the C-BiLLT: a new instrument to assess comprehension of spoken language in young children with cerebral palsy and complex communication needs

In clinical practice, a variety of diagnostic tests are available to assess a child's comprehension of spoken language. However, none of these tests have been designed specifically for use with children who have severe motor impairments and who experience severe difficulty when using speech to communicate. This article describes the process of investigating the reliability and validity of the Computer-Based Instrument for Low Motor Language Testing (C-BiLLT), which was specifically developed to assess spoken Dutch language comprehension in children with cerebral palsy and complex communication needs. The study included 806 children with typical development, and 87 nonspeaking children with cerebral palsy and complex communication needs, and was designed to provide information on the psychometric qualities of the C-BiLLT. The potential utility of the C-BiLLT as a measure of spoken Dutch language comprehension abilities for children with cerebral palsy and complex communication needs is discussed.

Natural Speech and AAC Intervention in Childhood Motor Speech Disorders: Not an Either/Or Situation

The future of natural speech development is uncertain for children with motor speech disorders (MSD). There is a strong desire to put plans in place as early as possible to anticipate long-term needs. Simultaneously, the knowledge that natural speech development may take time and effort and the idea that augmentative and alternative communication (AAC) can help to fill in the gap while such progress is being made makes sense on a foundational level. However, practical questions remain about the balance of natural speech intervention along with AAC use, particularly when both skills may require intervention and practice before functional benefits are realized. Although AAC stands for augmentative and alternative communication, what the acronym does not provide is an indication of how balance between augmenting natural speech and seeking more of an alternative is to be obtained. In this article, we review impairments in natural speech in children with MSDs. Through this lens, we navigate a path to understanding how, on a practical level, AAC and natural speech strategies can be implemented simultaneously and in a complementary fashion. Following an overview of literature, we move to a discussion of the dual paradigm approach. Finally, we conclude with practical applications of principles through a case study.

Communicative Competence for Individuals who require Augmentative and Alternative Communication: A New Definition for a New Era of Communication?

In 1989, Light defined communicative competence for individuals with complex communication needs who require augmentative and alternative communication (AAC) as a dynamic interpersonal construct based on functionality of communication; adequacy of communication; and sufficiency of knowledge, judgment, and skills. Specifically, Light argued that, in order to demonstrate communicative competence, individuals who required AAC had to develop and integrate knowledge, judgment, and skills in four interrelated domains: linguistic, operational, social, and strategic. In 2003, Light expanded this definition and argued that the attainment of communicative competence is influenced by not just linguistic, operational, social, and strategic competencies but also a variety of psychosocial factors (e.g., motivation, attitude, confidence, resilience) as well as barriers and supports in the environment. In the 25 years since this definition of communicative competence for individuals who use AAC was originally proposed, there have been significant changes in the AAC field. In this paper, we review the preliminary definition of communicative competence, consider the changes in the field, and then revisit the proposed definition to determine if it is still relevant and valid for this new era of communication.

The iPad and mobile technology revolution: benefits and challenges for individuals who require augmentative and alternative communication

The iPad and other mobile technologies provide powerful new tools to potentially enhance communication for individuals with developmental disabilities, acquired neurogenic disorders, and degenerative neurological conditions. These mobile technologies offer a number of potential benefits, including: (a) increased awareness and social acceptance of augmentative and alternative communication (AAC), (b) greater consumer empowerment in accessing AAC solutions, (c) increased adoption of AAC technologies, (d) greater functionality and interconnectivity, and (e) greater diffusion of AAC research and development. However, there remain a number of significant challenges that must be addressed if these benefits are to be fully realized: (a) to ensure the focus is on communication, not just technology, (b) to develop innovative models of AAC service delivery to ensure successful outcomes, (c) to ensure ease of access for all individuals who require AAC, and, (d) to maximize AAC solutions to support a wide variety of communication functions. There is an urgent need for effective collaboration among key stakeholders to support research and development activities, and to ensure the successful implementation of mobile technologies to enhance communication outcomes for individuals who require AAC and their families.

A systematic review of interventions for children with cerebral palsy: state of the evidence

AIM

The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP).

METHOD

This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health.

RESULTS

Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded 'do it' (green go); 58% (76 out of 131) 'probably do it' (yellow measure); 20% (26 out of 131) 'probably do not do it' (yellow measure); and 6% (8 out of 131) 'do not do it' (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red).

INTERPRETATION

Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.

AAC Use by Young Children at Home

This study describes AAC availability and use in 55 young children in the United States.

The children, aged 15 to 75 months, had not yet started kindergarten, had used their latest AAC system for 6 to 24 months, and had a variety of developmental disorders resulting in a severe communication disorder. The primary caregivers, all mothers, completed an 81-question case history about demographics, child's age at diagnosis and AAC receipt, and current AAC availability and use at home. They reported that the children waited an average of 6 months between a diagnosis and acquisition of their first AAC system. Forty children (73%) had received a different AAC system since acquiring their first AAC system. Most had multimodal AAC systems, which included both aided and unaided components, although 11 had used only the unaided AAC system of sign language. More than half of the AAC systems included voice output components. Sign language was the most frequently used AAC within the children's homes. The primary caregivers reported satisfaction with their children's AAC systems. Additional research is needed to describe current AAC practices with young children. These practices should then be evaluated for their effectiveness on both short- and long-term outcomes.