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Facilitated communication (FC) has been a heavily debated and documented topic across multiple disciplines, including sociology, education, psychology, pediatrics, speech-language pathology, and disability studies. Although many professionals from various disciplines and advocates have offered opinions, suggestions, and research on the topic, there has been minimal input from the occupational therapy (OT) profession. The lack of OT input is noteworthy as OTs are experts in enabling upper extremity performance and independence through a variety of training, adaptation and modification strategies, and use of external supports. Because of their professional code of ethics and a specific knowledge base, OTs are uniquely positioned to provide a host of ethical and evidence-based strategies that enable independent access to communication technology. The consideration of multiple access options is contrary to the typical facilitated encounter where facilitators exclusively choose to manipulate an upper extremity in order for letters to be selected on a display or keyboard. The purpose of this paper is threefold: (a) To offer insight into the standard of care by OTs including their ethical standards; (b) to identify varied accommodations that enable access using a feature-matching standard of care that eliminates the need for a facilitator; and (c) to highlight how to increase independent assistive technology/augmentative and alternative communication access, thus dissuading the need or use of facilitated access to letters. [ABSTRACT FROM AUTHOR]

Augmentative and alternative communication (AAC) approaches offer expressive and receptive supports for the segment of the population of individuals with autism spectrum disorder (ASD) who have little or no functional speech. The National Center for Autism Evidence and Practice (NCAEP) declared augmentative and alternative communication (AAC) interventions for individuals with autism an "evidence-based practice." Following a brief analysis of the breakdown of studies included in NCAEP by dependent variable, we introduce each of the four papers published as part of this special issue on Advances in Augmentative and Alternative Communication Research for Individuals with Autism Spectrum Disorder. In addition to elucidating the contributions and advances of each paper to the research base, including the NCAEP report, we provide a critical commentary as applicable in the hopes of stimulating and guiding further research. [ABSTRACT FROM AUTHOR]

This study's goal was to inform the selection of the most frequently used words to serve as a reference for core vocabulary selection for Hebrew-speaking children who require AAC. The paper describes the vocabulary used by 12 Hebrew-speaking preschool children with typical development in two different conditions: peer talk, and peer talk with adult mediation. Language samples were audio-recorded, transcribed, and analyzed using the CHILDES (Child Language Data Exchange System) tools to identify the most frequently used words. The top 200 lexemes (all variations of a single word) in the peer talk and adult-mediated peer talk conditions accounted for 87.15% (n = 5008 tokens) and 86.4% (n = 5331 tokens) of the total tokens produced in each language sample (n = 5746, n = 6168), respectively. A substantially overlapping vocabulary of 337 lexemes accounted for up to 87% (n = 10411) of the tokens produced in the composite list (n = 11914). The results indicate that a relatively small set of words represent a large proportion of the words used by the preschoolers across two different conditions. General versus language-specific implications for core vocabulary selection for children in need of AAC devices are discussed. [ABSTRACT FROM AUTHOR]

Multilingual individuals who use augmentative and alternative communication (AAC) often shift between language environments and speakers of different languages; thus, code-switching (or alternating between languages or dialects within or across contexts) becomes necessary for effective communication. Recently, AAC product developers have responded to this need by building multilingual AAC systems; however, research in multilingualism and AAC is lacking. In this paper, we discuss theoretical and practical implications for research related to code-switching using aided AAC. We use available literature investigating the sociolinguistic, psycholinguistic, and usage-based aspects of code-switching in spoken or signed modalities as a starting point for considering code-switching using aided AAC. We present examples illustrating the varied expression of codeswitching across aided AAC modalities and discuss directions for future research. [ABSTRACT FROM AUTHOR]

Conversational repair has been found to play a fundamental role in the acquisition of language. This paper describes existing research on conversational repair and its relationship to language learning, whether a first language or a second language, as well as its relevance to augmentative and alternative communication (AAC). A case is made for incorporating prompts to repair in conversation-based language interventions with children learning to use AAC. We argue that interventions targeting linguistic complexity should encourage self-repair in conversation in order to develop linguistic and operational competency as well as increase automaticity when using AAC. Clinical implications and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Significant advances have been made in interventions to maintain communication and personhood for individuals with neurodegenerative conditions. One innovation is Message Banking, a clinical approach first developed at Boston Children's Hospital (BCH). This paper outlines the Message Banking process as implemented at BCH, which includes the option of "Double Dipping," where banked messages are mined to develop personalized synthesized voices. More than a decade of experience has led to the evolution of six core principles underpinning the BCH process, resulting in a structured introduction of the associated concepts and practices with people with amyotrophic lateral sclerosis (ALS) and their families. These principles highlight the importance of assigning ownership and control of the process to individuals with ALS and their families, ensuring that as a tool it is empowering and offers hope. Changes have been driven by feedback from individuals who have participated in the BCH process over many years. The success of the process has recently been extended through partnerships that allow the recorded messages to be used to develop individual personalized synthetic voices to complement banked messages. While the process of banking messages is technically relatively simple, the full value of the process should be underpinned by the values and principles outlined in this tutorial. [ABSTRACT FROM AUTHOR]

The field of augmentative and alternative communication (AAC) has witnessed significant changes since its inception. AAC services are now considered for a much greater number of individuals with complex communication needs and there are many more AAC options available as communication supports, including a proliferation of technologies. The scope and options for communication within society have increased substantially to include a wide array of digital and social media. Individuals with complex communication needs have increased expectations for participation and engagement across a full range of environments—education, employment, family, healthcare, and community living. Despite these advances, there remain critical challenges that must be addressed. This paper discusses key advances in the AAC field, delineates challenges, and discusses future directions to address these challenges, specifically as they relate to research and development to enhance AAC interventions and technologies for individuals with complex communication needs and their families. [ABSTRACT FROM AUTHOR]

For children with typical development, language is learned through everyday discursive interaction. Adults mediate child participation in such interactions through the deployment of a range of co-constructive strategies, including repeating, questioning, prompting, expanding, and reformulating the child’s utterances. Adult reformulations of child utterances, also known as recasts, have also been shown to relate to the acquisition of linguistic structures in children with language and learning disabilities and children and adults learning a foreign language. In this paper we discuss the theoretical basis and empirical evidence for the use of different types of recasts as a major language learning catalyst, and what may account for their facilitative effects. We consider the occurrence of different types of recasts in AAC-mediated interactions and their potential for language facilitation, within the typical operational and linguistic constraints of such interactions. We also consider the benefit of explicit and corrective forms of recasts for language facilitation in conversations with children who rely on AAC. We conclude by outlining future research directions. [ABSTRACT FROM PUBLISHER]

Augmentative and alternative communication (AAC) social media research is relatively new, and is built on a foundation of research on use of the Internet and social media by people with communication disabilities. Although the field is expanding to include a range of people who use AAC, there are limitations and gaps in research that will need to be addressed in order to keep pace with the rapid evolution of social media connectivity in assistive communication technologies. In this paper, we consider the aims, scope, and methodologies of AAC social media research, with a focus on social network sites. Lack of detailed attention to specific social network sites and little use of social media data limits the extent to which findings can be confirmed. Increased use of social media data across a range of platforms, including Instagram and YouTube, would provide important insights into the lives of people who use AAC and the ways in which they and their supporters use social media. New directions for AAC social media research are presented in line with those discussed at the social media research symposium at the International Society for Augmentative and Alternative Communication in Toronto, Canada, on August 12, 2016. [ABSTRACT FROM PUBLISHER]

Research about the effectiveness of communicative supports and advances in photographic technology has prompted changes in the way speech-language pathologists design and implement interventions for people with aphasia. The purpose of this paper is to describe the use of photographic images as a basis for developing communication supports for people with chronic aphasia secondary to sudden-onset events due to cerebrovascular accidents (strokes). Topics include the evolution of AAC-based supports as they relate to people with aphasia, the development and key features of visual scene displays (VSDs), and future directions concerning the incorporation of photographs into communication supports for people with chronic and severe aphasia. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM AUTHOR]

The vocabulary needs of individuals who are unable to spell their messages continue to be of concern in the field of augmentative and alternative communication (AAC). Social validation of vocabulary selection has been suggested as one way to improve the effectiveness and relevance of service delivery in AAC. Despite increased emphasis on stakeholder accountability, social validation is not frequently used in AAC research. This paper describes an investigation of the social validity of a vocabulary set identified in earlier research. A previous study used stakeholder focus groups to identify vocabulary that could be used by South African adults who use AAC to disclose their experiences as victims of crime or abuse. Another study used this vocabulary to create communication boards for use by adults with complex communication needs. In this current project, 12 South African adults with complex communication needs who use AAC systems used a 5-point Likert scale to score the importance of each of the previously identified 57 vocabulary items. This two-step process of first using stakeholder focus groups to identify vocabulary, and then having literate persons who use AAC provide information on social validity of the vocabulary on behalf of their peers who are illiterate, appears to hold promise as a culturally relevant vocabulary selection approach for sensitive topics such as crime and abuse. [ABSTRACT FROM AUTHOR]

The child's interactions with persons in the proximal environment constitute the context for development of communication. Within early close relationships, the child acquires communication skills; developmental outcomes are defined by the continuous dynamic interactions of the child, the experiences provided by the family and close environment, and the use of different means of augmentative and alternative communication (AAC). Communication problems manifest in a variety of ways and at different levels of severity. The nature of problems differs as a function of the child's age and diagnosed condition, the communication skills of interaction partners, and the availability of communication aids. The focus for assessment and intervention may be the child, the family, the close environment and/or the interactions between them. Clarifying these varied functions and environmental factors is crucial for appropriate assessment and provision of augmentative and alternative communication (AAC) interventions. This paper reviews issues in assessment and intervention for children in need of AAC and presents the World Health Organizations' (WHO) International Classification of Functioning, Disability and Health version for Children and Youth (ICF-CY) as a tool to enhance assessment and intervention in the AAC field. [ABSTRACT FROM AUTHOR]

Augmentative and alternative communication (AAC) technologies offer the potential to provide children who have complex communication needs with access to the magic and power of communication. This paper is intended to (a) summarize the research related to AAC technologies for young children who have complex communication needs; and (b) define priorities for future research to improve AAC technologies and interventions for children with complex communication needs. With the realization of improved AAC technologies, young children with complex communication needs will have better tools to maximize their development of communication, language, and literacy skills, and attain their full potential. [ABSTRACT FROM AUTHOR]

A recognized challenge in the field of augmentative and alternative communication (AAC) is the assessment of the individual skills and preferences of potential users of AAC. Particularly in cognitive assessment, many traditional methods are inappropriate because they require the participant to produce a verbal response and/or involve complex verbal instructions. For individuals with limited verbal forms of language, failure at such tasks is relatively uninstructive, either for revealing their functional intellectual status or for developing effective interventions. This paper presents a demonstration of a method developed to evaluate category structure and, thus, semantic organization in individuals with limited verbal skills concomitant to autism spectrum disorder. This method offers a promising tool for assessing clients for AAC. Further potential uses of this method, both clinically and in research, are discussed. [ABSTRACT FROM AUTHOR]

To date little attention has been focused on the sexual abuse experiences of people who use augmentative and alternative communication (AAC) and on addressing ways to reduce their risk for this type of abuse. This paper describes the results of a 3-year project that aimed to: (a) learn about the sexual abuse experiences of people who use AAC; (b) provide educational forums and resources on topics relating to sexual abuse for adults who use AAC; (c) define implications in risk reduction for various community service workers who support people who use AAC (e.g., attendant service providers, abuse counselors, sexual health educators, police, victim assistance services, legal professionals, and health care professionals); and (d) make recommendations to parents, educators, service providers, and consumer advocacy organizations about their roles in reducing the risk of abuse for youth and adults who use AAC. The findings suggest that the majority of participants in this project have experienced a range of abuses including sexual abuse, lack information about healthy and abusive relationships, have no way of communicating about sexuality and abuse, and lack supports in their personal lives and from within the community-at-large that are necessary to cope with relationship difficulties and specifically problems associated with abuse and justice system services. These findings and implications are shared with the intent of highlighting the need for more research and attention to the issue of abuse prevention for people who use AAC. [ABSTRACT FROM AUTHOR]

Although augmentative and alternative communication (AAC) has become a widely accepted means of supporting children who have complex communication needs, demographic data indicate that AAC instruction lags behind service delivery needs. In this paper, information is presented about a web-based AAC course for special education teachers, which was delivered primarily via distance learning. Also presented are data about (a) how the course participants responded to material presented in the online format and (b) their level of satisfaction with the learning environment. As an investigation of what might be considered current best practice, both successes and difficulties that characterized the course are highlighted. A number of suggestions are made for improvements and recommendations for the delivery of media-enhanced web-based courses in AAC. [ABSTRACT FROM AUTHOR]

Over the last two decades it has been recognized that spoken language and communication skills continue to develop during adolescence. It seems likely that, for people who use aided AAC, language learning similarly continues into adolescence. Despite its importance, this developmental period has been largely ignored in research. In this paper, the significance assigned to adolescence as a developmental period is reviewed. The language and communication changes that typify adolescence and the consequences of difficulties in these areas are considered. Potential challenges to aided communication systems and the implications of the linguistic and socio-communicative attributes of such systems are explored. Finally, an agenda for research is proposed in order to further the understanding among AAC professionals of this important developmental period. [ABSTRACT FROM AUTHOR]

In this paper, an analysis of augmentative and alternative communication (AAC) system use by two adults with acquired dysarthria in conversation with their partners at home is presented. The qualitative methodology of Conversation Analysis (CA) is used to describe a particular type of AAC activity that was utilized during conversations by speakers with dysarthria for whom natural speech was still the primary modality. The two main findings were (a) that AAC was regularly used by speakers with dysarthria to attempt self-repairs of communication problems identified by their non-dysarthric partners; and (b) that AAC turns during self-repair activities were typically treated as intelligible but not fully understandable. It is suggested that CA can serve as a useful tool in dysarthria/AAC assessment and for the tailoring of AAC interventions to everyday conversational practices between people with dysarthria and their conversation partners. [ABSTRACT FROM AUTHOR]

In this paper are the findings of a 3-year research project into communication between 15 people with Motor Neurone Disease (MND) and their closest communication partners, as the disease progressed. Data were collected through video recordings, narratives, and field notes. The purpose of the communication and the use of augmentative and alternative communication (AAC) according to the perceptions of people with MND and their partners were examined. For the people in this study, it appeared that AAC was less successful than anticipated. The participants gave a number of reasons, which were interpreted by the researcher to include (a) the need for social closeness, which may not be possible when using a device; and (b) the complexity of learning how to use a high technology device combined with inadequate training. Both theoretical and practical issues are raised for professionals who work with and provide services to families with MND. [ABSTRACT FROM AUTHOR]

Many adults with cerebral palsy and complex communication needs rely upon the support of their unpaid carers when they are in hospital. In this paper, the authors present some of the findings of a larger qualitative study of the experiences of unpaid carers of hospitalized adults with cerebral palsy and complex communication needs who did not have access to their usual augmentative and alternative communication (AAC) systems. Drawing upon the stories of unpaid carers, communication issues associated with cerebral palsy and complex communication needs and the absence of AAC are discussed. Such information can be used to assist AAC specialists, hospital staff, and hospital policy developers to improve care provided to not only people with cerebral palsy and complex communication needs, but also to other people who are unable to speak in hospital. [ABSTRACT FROM AUTHOR]

In this paper, the results of two studies designed to investigate the learning demands of four different approaches to the layout and organization of language in electronic augmentative and alternative communication (AAC) systems are presented: taxonomic grid, schematic grid, schematic scene, and iconic encoding techniques. A total of 80 typically developing children participated in the two studies: 40 four-year-olds (Study 1) and 40 five-year-olds (Study 2). Ten children in each study were randomly assigned to each of the four system organization conditions. The children were introduced to target vocabulary items (24 items for the 4-year-olds and 30 for the 5-year-olds) in a series of four learning and testing sessions. Half of the vocabulary items were concrete concepts and half were abstract concepts. Results of the studies indicated that the 4-year-old and 5-year-old children were more accurate locating target vocabulary in the three dynamic display conditions (taxonomic grid, schematic grid, schematic scene) than in the iconic encoding condition. On initial exposure to the systems, the iconic encoding technique was not at all transparent to the children; the other three systems were only moderately transparent. All but one of the 4-year-old children and all of the 5-year-old children demonstrated gains in accuracy across the learning sessions; gains were significantly greater for the three dynamic display conditions than for the iconic encoding condition. The children were more accurate with the concrete vocabulary items than the abstract ones. There was some, albeit limited, evidence that the children generalized to facilitate learning of novel vocabulary items. Results are discussed with reference to the literature. Implications for practice and directions for future research are also discussed. [ABSTRACT FROM AUTHOR]

An evidence-based practice (EBP) approach to clinical and educational practice emphasizes the importance of integrating sound research evidence into the decision-making process. This paper provides a discussion of the relevance of EBP to the field of augmentative and alternative communication (AAC). Included is an examination of what is currently known about decision-making in AAC, as well as a brief history of EBP and its application in other fields. A definition of EBP in AAC is proposed and a schematic of the EBP process is described, including proposed design hierarchies of evidence. This process is then illustrated with a case example. Finally, key factors for the adoption of EBP in AAC are discussed. [ABSTRACT FROM AUTHOR]

One of the most frequently cited concerns from parents, teachers, and other caregivers, upon hearing a recommendation for the use of augmentative and alternative communication (AAC) is, 'Will its use interfere with natural speech?' Reports of positive effects of AAC use, particularly that of speech output, are increasingly available, whereas evidence to support negative consequences of AAC use has not been widely reported. In this paper, possible explanations for increases in natural speech production associated with AAC use are explored, along with a discussion of clinical implications and future research. [ABSTRACT FROM AUTHOR]

Speech output from speech-generating devices (SGD) and SGD software, such as talking word processors, has changed the landscape of options for aided communication. The purpose of this paper is to review and critique research into the roles of speech output for communication partners, learners, and learner-partner dyads. Research on partner oriented roles is reviewed in terms of attitudes and perceived communicative competence, and communicative behavior. Learner-oriented roles of speech output are summarized in terms of graphic symbol learning, communicative functions and social regulation, learner preference, challenging behaviors, natural speech production, comprehension, and literacy. Roles for the learner partner dyad include changes to interaction patterns. Methodological issues are discussed and practical implications are drawn where appropriate. Finally, directions for future research are proposed. [ABSTRACT FROM AUTHOR]