Introduction to Communication Disorders: A Lifespan Evidence-Based Perspective 5th Edition

CHAPTER 13: Augmentative and Alternative Communication Introduction to Communication Disorders: A Lifespan Evidence-Based Perspective 5th Edition Owens, Farinella, & Metz Developed by Sarah A. Dachtyl, Ph.D., CCC/SLP Chapter Learning Goals Define augmentative and alternative communication (AAC) Describe various types of aided and unaided AAC systems and ways people access AAC Explain how interactive competence is critical in AAC assessment and intervention practices across the lifespan Outline Types of AAC Access Output Assessment Considerations Intervention Considerations Augmentative and Alternative Communication All forms of communication other than oral speech that are used to express thoughts, needs, wants, and ideas Speech-generating devices Consider both the communication technologies used to support individuals with complex communication needs and the interactive competence of communication partners 4 million people in the U.S. are not able to use natural speech to express wants and needs Types of AAC Unaided AAC: No external equipment Aided AAC: Use of equipment Combinations of systems are possible Symbols are central to the process of classifying AAC systems Unaided AAC: Gestures and Vocalizations Use of gesture, body movement, or an observable signal with a communication partner Types of AAC Unaided AAC: Manual Sign Systems Includes ASL, Signed English, Signing Exact English, Tactile Signing, and Amer-Ind Iconic signs look like what they represent Transparent signs are easily guessable Opaque signs are difficult to interpret Fingerspelling: Manual alphabet Motor impairments make it difficult to use manual sign systems Not all communication partners will understand Types of AAC Aided AAC Range in the representations used, the input and output modes, and the degree to which the symbols are transparent No-tech, low-tech, mid-tech, or high-tech Aided Symbols: Tangible Symbols Visual schedules can use tangible symbols and are organized according to the daily activities that occur in an individual’s life Types of AAC Aided Symbols: Pictorial Symbols May include pictures, various representational systems, and/or line drawings Some symbol systems have been specifically designed for AAC use Symbolic systems are relatively rule-governed and generative, allowing for symbol combination and the creation of new symbols Types of AAC Aided Symbols: Orthography and Orthographic Symbols Includes systems such as Braille, fingerspelling, writing, and other ways a person uses symbols for language Combinations of Aided and Unaided Systems People invariably use multiple methods or modes of communication AAC is no exception Access Might include touching buttons, pointing to symbols, or holding an object Care must be exercised in choosing the appropriate interface between the client and the device Direct selection: Pointing with a finger, hand, head pointer, optical head pointer, activating a joystick, using eye gaze Can be difficult for those with severe motor problems Access Efficiency is the speed with which a person is able to use an AAC system to send a message Effectiveness is the degree to which a person is able to use an AAC system to achieve the communication goal Indirect selection methods include scanning and partner-assisted selection/scanning Scanning involves the individual assembling a message through a series of switch activations in which choices are presented sequentially Access In partner-assisted scanning, the options are presented by another person Auditory scanning: Uses a visual and auditory cue Scanning can be slow and laborious Efficiency can be enhanced by placing symbols so that those that are most frequently used are scanned most frequently or by using different scanning methods Output Voice output communication (VOC) can be recorded or digitized, synthesized, or both Comprehension of synthesized speech requires increased attention by the partner Partners tend to respond more slowly to synthesized speech Intelligibility can be increased through training Assessment Considerations Important to understand cognitive-communicative strengths, the everyday communication routines, and the barriers and/or facilitators to successful communication Linguistic competence: Language ability across all dimensions Operational competence: How a person uses an AAC system Social competence: How well a person manages the social aspects of communication Strategic competence: Ability to solve problems Assessment Considerations Specific Assessment Considerations Ideally multi-contextual observations Observations plus structured or standardized assessments OT or PT can aid in motor assessment Visual and auditory acuity and perception are important for system selection and intervention SLP may need to educate caregivers about benefits SLP should collect a list of client preferences and possible symbols to train Assessment Considerations AAC System Selection or Feature Matching Consider Motor and cognitive abilities Potential vocabulary size Ease in learning new system Whether client and partners accept new system Flexibility Intelligibility Aesthetics of the system Arrangement and size of symbols Placement and organization of the symbols Output of the system Assessment Considerations AAC Symbol Selection Will flow from method of communication chosen Consider gestural or signing system used most in the client’s school or workplace and in the local community, availability of teaching materials, and the ease in using material Selection of aided symbols may be guided by potential user’s cognitive abilities, ease of learning different graphic AAC systems, and willingness of communication partners Assessment Considerations AAC Vocabulary Selection Select vocabulary that Reflects needs, desires, likes, and preferences Is functional Several lists for potential vocabulary are available The order of teaching signs or symbols must be guided by the client’s immediate needs Intervention Considerations Team effort Use of longer grammatical utterances is slow if users are forming them from single symbols Can pre-store potential utterances Modeling can be used to teach production of multi-symbol messages Intervention must include short-range and long-range needs of a client Intervention Considerations Keep in mind the following Establish a positive AAC culture Understand AAC as critical to literacy development Use everyday experiences as teaching context Individualize the content Teach partners to modify their interaction style Consider positioning for those with motor impairments Use meaningful interactions Intervention Considerations Community and parent/family support contribute to positive outcomes Abandonment of AAC is usually related to loss of facilitator/partner support Classroom integration requires collaboration between the teacher and SLP AAC training for the educational team is a key element in success Intervention will be most effective if caregivers also use AAC with speech (augmented input) Intervention Considerations A child may become dependent on one or two skilled interaction partners within the family SLP must identify opportunities for communication, create a need for communication, and maximize the instructional benefit One promising method for children with ASD is aided language modeling (ALM), consisting of engaging children in interactive play and providing models of AAC symbol use during play Intervention Considerations Access to appropriate AAC systems is important in facilitating employment Everyday events and routines provide scripts Optimal use occurs when AAC is used willingly and at every opportunity Community-based training wherein the client uses AAC in public may lead to optimal use The AAC user must be involved in real communication with meaningful outcomes Intervention Considerations Evidence-Based Practice in AAC Conducting clinical research with AAC users is difficult Many studies include only a single subject or a very small number of subjects Little long-term research exists In-context intervention designed to promote generalization and transfer must be considered Scanning as an access method is difficult for young children Intervention Considerations For children with ASD or ID, AAC intervention does not impede speech production For children with ASD, the gains in overall communication from the use of sign are modest Although many individuals who use AAC can comprehend and express a wide range of grammatical structures, they tend to produce shorter utterance when they use graphic symbol-based AAC systems Few studies have investigated the effectiveness of AAC-specific aspects of intervention in a family context Summary AAC may enhance an individual’s speech or may become the primary means of communication Decisions on the appropriate type of AAC may need to change as the user’s abilities or needs change Training of both the user and others in the user’s environment is essential Data from assessment is used to determine appropriate method of communication Must be concerned with linguistic, operational, social, and strategic competencies Online Resources Prentke Romich: http://www.prentrom.com/ Dynavox: http://www.dynavoxtech.com/ Mayer-Johnson: http://www.mayer-johnson.com/ USSAAC: http://www.ussaac.org/ Closing the Gap: www.closingthegap.com Center for Literacy and Disability Studies: www.med.unc.edu Center for Technology and Education: http://cte.jhu.edu ISAAC: www.isaac-online.com Rehabilitation Engineering Research Center: http://aac-rerc.psu.edu Quality Educators for Assistive Technology: www.qiat.org RESNA Technical Assistance Project: www.resna.org/taproject/index.html EDLAW: www.edlaw.net AACIntervention.com: http://aacintervention.com