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Purpose Many, but not all, children with autism spectrum disorder (ASD) have a difficult time communicating in conventional ways to express their decisions, preferences, and ideas. Augmentative and alternative communication (AAC) can fulfill many purposes of communication and support a child to achieve maximal self-determination and agency. The goal of assessment is not to fit the child to a particular device or communication strategy—but rather to identify the strategies that enhance the child's strengths to maximize their independent communication and ultimately their ability to exert control over their world. Method Our method was to combine results from our scoping review of the research literature, observations of videos of AAC assessments being conducted by specialists, and interviews with AAC experts (Lund, Quach, Weissling, McKelvey, & Dietz, 2017) and use these combined sources to extract overlapping themes. Finally, we completed an expert review of the results to verify their validity. Results There are 11 areas, which we found through our research, that should be included when assessing the communication and language skills of children with ASD who are minimally verbal. They are communication needs, current communication skills, language, cognition, symbol representation, sensory perceptual skills, motor skills, literacy, behavior, preferences, and system features. Conclusions It is important to embrace agency and choice throughout the assessment process. Having access to communication through AAC can give children with ASD a voice not only to express their choices but also to increase their self-determination.

Purpose The present pilot study aimed to provide estimates of the feasibility and efficacy of a remote microphone (RM) system as an augmentative intervention to improve the functional listening performance of preschool children with autism spectrum disorder (ASD) and language disorder. Method Eight children with ASD and language disorder participated. Efficacy of the RM system was determined by evaluating participants' functional listening performance, as measured by an observational measure in RM-off and RM-on conditions. Responses were evaluated at the individual level using an alternating conditions design. Results Adequate feasibility was demonstrated as all participants were able to complete tasks in the RM-on condition. A subset of participants showed significant improvements in their functional listening performance in the RM-on condition, as demonstrated by visual inspection and effect sizes (nonoverlapping data points and percentage of data points exceeding the mean), indicating that there may be important sources of individual differences in responses to RM use in children with ASD. Conclusion The results of this pilot study provide support for future research on RM systems to target functional listening performance in children with ASD and language disorder.

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.

Purpose The purpose of this article was to describe the complex symptoms associated with Huntington's disease (HD) and how they influence implementation of augmentative and alternative communication (AAC) services to address communication impairments. Three case studies with varied presentation, AAC recommendations, and overall outcomes are presented followed by a discussion on common challenges of AAC intervention for this population. Conclusion Providing AAC services to individuals with HD can be complicated due to variability in symptoms, access to services, funding, and communication partner support. It is important to understand HD and consider the complex presentation of symptoms that impact appropriate AAC strategies and intervention. Further research is needed to improve guidelines available to clinicians.

Purpose The purpose of this article was to share perspectives and experiences as a provider of augmentative and alternative communication (AAC) evaluations and trainings with families in Phoenix, A...

Clinicians facilitate successful use of Alternative and Augmentative Communication (AAC). The most clinically competent providers, however, address needs that extend beyond technical AAC use to hel...

Children with complex communication needs (CCN) exhibit multiple needs in a variety of domains, including language, literacy, and speech. Children with CCN often require augmentative/alternative communication (AAC), a mode of communication designed to compensate for the communication and related disability patterns of individuals with CCN (Light, Beukelman, & Reichle, 2003). Given the diverse needs of this population, service provision presents challenges to teachers and therapists alike. Telepractice service provision offers solutions to guide service delivery for children with CCN, who may be located in remote settings with limited access to AAC specialists. The tele-AAC working group of the International Society on Augmentative and Alternative Communication (ISAAC) 2012 Research Symposium highlighted a need for increased information on telepractice service delivery for children with CCN in the area of literacy. To date, evidence-based practices for assessment of literacy skills in children with CCN are limited. In addition, literacy assessment for children with CCN via telepractice presents challenges requiring adaptation for telepractice service delivery. This paper summarizes existing literature examining literacy assessment and intervention, and applies these principles to development and implementation of adapted literacy assessment methods conducted via telepractice for a child with CCN.

Mobile technology provides a solution for individuals who require augmentative and alternative intervention. Principles of augmentative and alternative communication assessment and intervention, such as feature matching and the participation model, developed with dedicated speech-generating devices can be applied to these generic mobile technologies with success. This article presents a clinical review of an adult with aphasia who reached her goals for greater communicative participation through mobile technology. Details presented include device selection, sequence of intervention, and funding issues related to device purchase and intervention costs. Issues related to graduate student clinical education are addressed. The purpose of the article is to encourage clinicians to consider mobile technology when intervening with an individual diagnosed with mild receptive and moderate expressive aphasia featuring word-finding difficulties.

Telepractice is increasingly applied to assessment and intervention for persons with autism spectrum disorders (ASD), and the use of telepractice for delivering augmentative and alternative communication (AAC) services is expanding. To date, no studies have focused on the assessment of communication in children with ASD who are minimally verbal. This case exploration represents a first attempt to apply the clinical assessment approach (also known as Visual Immersion System) developed in the Autism Language Program in the Center for Communication Enhancement (CCE) at Boston Children's Hospital (BCH) through a telepractice service delivery model. In this paper we detail an on-site evaluation, and then describe the application of the various evaluation components to telepractice delivery. Our findings provide preliminary evidence that communication assessment information can be successfully obtained for this population via telepractice. The results demonstrated that the telepractice evaluation took greater time to complete than the on-site evaluation, likely due to both technical and cultural factors. Further study is warranted particularly in the delivery of family instruction materials prior to the evaluation and to quality assurance measures.

Shared storybook reading provides an authentic context for facilitating the literacy, language, and communication skills of children with complex communication needs who use augmentative and alternative communication (AAC). This paper discusses the research surrounding the effectiveness of shared storybook reading and provides suggestions on how to maximize the language and literacy outcomes for children who use AAC. The paper highlights how simple AAC technologies, aided language displays, and picture communication symbols can be used to support communication during shared storybook reading for beginning communicators. In addition, it outlines how systematic strategies can be implemented to extend the communication skills of children with access to comprehensive AAC systems. Finally, the paper discusses the need to select books for shared storybook reading that are appealing, engaging, and age-appropriate, and the importance of providing frequent opportunities for repeated readings.

Family and school collaboration is key for successful implementation of augmentative alternative communication (AAC). The importance of this collaboration as well as specific strategies for including families in all aspects of the AAC process is outlined in this paper. Strategies to improve communication throughout the assessment process are discussed as well as specific interventions that can assist in treatment. Finally, efforts to improve generalization and maintenance of AAC abilities are detailed.

Tele-AAC is a method of service delivery in which professionals provide intervention, assessment, and consultation services through the use of telecommunication technologies to individuals who use augmentative communication systems. In response to the nationwide shortage of highly trained speech-language pathologists, tele-AAC has emerged as a viable way to reach underserved clients. This paper examines the clinical aspects related to tele-AAC, including required and supplementary technology/equipment, resources and personnel needed, training, and quality assurance considerations. In addition, the infrastructure necessary to deliver the range of synchronous and asynchronous tele-AAC services is discussed.

PurposeTo investigate a model of language development for nonverbal preschool-age children learning to communicate with augmentative or alternative communication.MethodNinety-three preschool children with intellectual disabilities were assessed at Time 1, and 82 of these children were assessed 1 year later, at Time 2. The outcome variable was the number of different words the children produced (with speech, sign, or speech-generating devices). Children's intrinsic predictor for language was modeled as a latent variable consisting of cognitive development, comprehension, play, and nonverbal communication complexity. Adult input at school and home, and amount of augmentative or alternative communication instruction, were proposed mediators of vocabulary acquisition.ResultsA confirmatory factor analysis revealed that measures converged as a coherent construct, and a structural equation model indicated that the intrinsic child predictor construct predicted different words children produced. The amount of input received at home, but not at school, was a significant mediator.ConclusionsThe hypothesized model accurately reflects a latent construct of Intrinsic Symbolic Factor (ISF). Children who evidenced higher initial levels of ISF and more adult input at home produced more words 1 year later. The findings support the need to assess multiple child variables and suggest interventions directed to the indicators of ISF and input.

There is a scarcity of research regarding individuals who are members of a linguistic minority and have a disability. A clear example of this is the lack of research of augmentative and alternative...

The purpose of this project was to identify unique vocabulary associated with specific medical procedures. Personnel from six medical facilities with acute care or long-term acute care hospital (LTACH) units participated by proposing vocabulary/messages associated with procedures in which they routinely participated. Speech-language pathologists, respiratory therapists, physicians, nurses, chaplains, and nursing aids participated in the project. The unique vocabulary associated with common medical procedures is available in this article and on our augmentative and alternative communication–related website, http://aac.unl.edu .

As speech-language pathologists enter into the workforce, it is clear that many of them are underprepared in the area of Alternative and Augmentative Communication (AAC). Many times, inexperienced clinicians will not be aware of the resources available to them for further clinical training in AAC. Researchers have investigated and documented how these clinicians prefer to learn about new technology as adults. In this article, we will identify and discuss the need for ongoing clinical training for clinicians with limited experience with AAC specific to the adult population, note ways in which inexperienced clinicians can obtain clinical training, and review literature that examines the various ways adult clinicians learn new and technological information most effectively.

Teaching speech-language pathology (SLP) students about alternative and augmentative communication (AAC) through case studies can provide a more meaningful experience than found in a more traditional didactic approach. Case studies give students a clinical context for the material presented in class. They also enable consideration of a wide range of factors, including family dynamics, school or work contexts, and the participation of other team members (e.g., POT, PT, and teachers). In this course, case studies are the focus, but material is also presented through lecture/discussion, labs (where various AAC devices are used and evaluated by the students), and readings. The focus on case studies presents a number of challenges. For the students, this is one of the first times they are forced to deal with complex clinical problems for which the answers are not readily available in a textbook. They complain that the assignments are vague and that the cases require too much time to complete. For the instructors, the course requires much more time in providing information to the students, answering questions about the cases, and generally supporting the students. In the end, the students manage to “pull it all together” and present thoughtful and thorough implementation plans for their cases. After entering into practice or graduating, students report that the course prepared them for working with a client with AAC needs.

Over the past 20 years, there have been many advances in the computer industry as well as in augmentative and alternative communication (AAC) devices. Computers are becoming more compact and have multiple purposes, such as the iPhone, which is a cell phone, mp3 player, and an Internet browser. AAC devices also have evolved to become multi-purpose devices; the most sophisticated devices have functionality similar to the iPhone and iPod. Recently, the idea of having the iPhone and iPad as a communication device was initiated with the development of language applications specifically for this format. It might be true that this idea could become the future of AAC devices; however, there are major access issues to overcome before the idea is a reality. This article will chronicle advancements in AAC devices, specifically on access methods, throughout the years, towards the transition to handheld devices. The newest technologies hold much promise with both features and affordability factors being highly attractive. Yet, these technologies must be made to incorporate alternate access if they are to meet their fullest potential as AAC tools.

Purpose Study 1 developed the Assessment of Attitudes Toward Augmentative and Alternative Communication—2 (AATAAC–2) to assess adolescents' attitudes toward peers who use AAC. Study 2 used the AATAAC–2 to examine influences of familiarity with people with disabilities; type of AAC device; and various combinations of gender of rater, AAC user, and communication partner on adolescents' attitudes. Method In Study 1, 194 adolescents viewed videotapes depicting adolescents using AAC, then completed AATAAC–2. Study 2 utilized 8 videotapes depicting 4 different gender combinations of AAC user and communication partner as experimental stimuli. Each gender combination was filmed twice: once with a static touch screen device, and once with a dynamic touch screen device. One-hundred thirty-six adolescents were randomly assigned to view 1 of the 8 videos. Participants then completed AATAAC–2. Results Study 1 demonstrated that AATAAC–2 has adequate psychometric properties. Raters' responses in Study 2 indicated no main effect of device type; girls were more positive than boys; and familiarity with peers with disabilities was associated with more positive attitudes. No 2-way interactions were significant; 3-way interaction of level of familiarity, gender, and type of device used was significant. Conclusions Familiarity and gender contribute to adolescents' attitudes; type of AAC device combined with these factors to influence attitudes.

Evidence is accumulating for the language use model in psycholinguistics, the social sciences as well as work in human computer interaction. Recent research in augmentative and alternative communication (AAC) has demonstrated the insufficiency of the sender-receiver model for characterizing augmented interactions. In this paper we will begin to provide a framework for showing how the AAC field may benefit from examining how people perform using language during in-person interaction.

This article presents a reflection on the relationship between language acquisition theories and augmentative and alternative (AAC) intervention, particularly related to grammar. Aspects of the language-learning situation for children needing AAC and of production of language using an AAC system that may pose challenges for acquisition of grammar are discussed. The implications for AAC intervention that can be drawn from several language acquisition theories are explored. It is suggested that establishing clearer or more overt links between theories and intervention is important in order to make underlying assumptions more explicit and to be aware of the theoretical underpinnings of AAC intervention.

LPs Julie Irwin and Phyllis Watson, experts in alternative and augmentative communication, joined an online chat highlighting apps to help private practitioners with electronic record-keeping to save time and run better practices. The Leader was there ...

Research and practice on augmentative communication for persons with moderate or severe mental retardation have primarily targeted the acquisition and use of single symbols. Symbol combinations, however, provide insight into how augmented communicators use individual symbols to build more complex communications. In Study 1, untaught symbol combinations produced during natural communication interactions by 7 subjects with mental retardation were examined for their semantic, ordering, and generalization patterns. The symbol combinations largely resembled those produced by young speaking language learners, suggesting that the augmented communicators were following typical patterns of communication in generating their symbol combinations. In Study 2, we examined the symbol combinations modeled for subjects by their partners. The structure of the modeled combinations did not resemble the children’s productions, indicating that the children could not have relied on simple rote imitation for their combination production. These results suggest that augmented communicators with mental retardation may use their symbols as speaking children use oral words in the development of complex communications.

There is considerable disagreement in the literature and among clinicians about the success of facilitated communication, a new method of augmentative communication being used with people diagnosed autistic. Some claim almost everyone exposed to it achieves success, basing their claims upon their observations and experiences of naturally occurring facilitated interactions. Others claim minimal or no success, basing their claims on their observations of facilitated interactions under controlled experimental conditions. I argue here that both claims can be valid and that FC users with autism are sometimes competent and other times incompetent, depending upon the conditions under which they are evaluated. I support my argument by offering a collaborative view of communication in place of the commonly held view that communication involves passing messages over an invisible conduit. Given the assumption that facilitated communication does allow for the expression of unexpected competence for many with autism, I describe various unusual phenomena being revealed by facilitation and FC users and offer some theoretical approaches for explaining these phenomena. I then propose some research ideas for studying the phenomena associated with FC and offer them as suggestions for how we might proceed in our efforts to develop our understanding of when and how it works for people with autism.

The vocabulary size, vocabulary characteristics, and informant reactions associated with three different methods of vocabulary selection for augmentative communication and three different types of informants were compared. Six school-aged children with severe communication disorders and physical disabilities served as student subjects. For each subject, three adult informants (primary caregiver, teacher, and speech-language pathologist) completed three vocabulary selection tools (blank page, categorical inventory, and vocabulary checklist). Informants also were asked to complete a questionnaire in order to document their reactions to using the various tools. Results indicated that the vocabulary checklist yielded more words than did the blank page or the categorical tools. For half of the subjects, the parents contributed more words than the speech-language pathologist or teacher; for the other half of the subjects, the speech-language pathologist contributed more words than the parent or the teacher. Commonality among the list of words and implications for clinical applications and future research are addressed.

The effects of speech output type, aided message length, and partner reauditorization on naive observers’ perceptions of the communicative competence of an adult augmentative and alternative communication (AAC) system user were examined. Subjects consisted of 48 naive adults with minimal exposure to nonspeaking persons. Eight scripted videotaped conversational conditions involving an AAC user and a normal-speaking partner were employed in the manipulation of the three independent variables. A balanced incomplete block design was used. Following each viewing, subjects completed a questionnaire designed to assess the communicative competence of the AAC user. Results indicated a significant main effect for aided message length only. Ratings of the AAC user were higher in conditions with phrases than in conditions with single-word messages. Of interest was the finding that the use of digitized versus synthesized speech output had no effect on observer ratings. Clinical implications are discussed.

This study investigated the cognitive and linguistic processing demands of message-encoding techniques used to retrieve prestored messages from computer-based augmentative communication systems. Twelve physically disabled adults with severe speech impairments participated in six counterbalanced experimental conditions, consisting of three encoding techniques (salient letter, letter category, and iconic codes), each in a personalized condition in which subjects selected their own codes and in a nonpersonalized condition in which codes were preselected by a clinician. In each of the experimental conditions, the subjects participated in five learning and testing sessions. During these sessions, the subjects learned the codes for lists of 80 messages, half of which involved concrete referents and half abstract concepts. Results indicated that the subjects were more accurate in recalling the codes to retrieve preprogrammed messages when using the two letter encoding techniques than when using the iconic technique. No reliable differences were found between recall performances with personalized codes and with nonpersonalized ones for any of the three encoding techniques. Code recall improved consistently across the series of learning sessions; there were no significant differences in the rates of learning across the encoding techniques. Subjects were found to be more accurate at recalling the codes to retrieve concrete messages than those to retrieve abstract messages.

A single-subject multiple-baseline design, replicated across three dyads, was used to examine the efficacy of instructing facilitators (i.e., significant others) to promote communication with people who use augmentative and alternative communication (AAC) systems. Facilitators were instructed in four 1-hour sessions to decrease their conversational control and provide more opportunities for the participants using AAC systems to communicate. Following instruction, facilitators decreased their rates of turn-taking and initiations and increased the proportion of turns that were responsive. Participants using AAC systems increased the frequency of their initiations. Following intervention, turn-taking and initiation patterns in the dyads were more reciprocal. Generalization occurred to the natural environment. Results suggest that facilitator instruction is an effective and efficient means of promoting greater participation in daily interactions by people who use AAC systems.

Partially speaking students and users of augmentative/alternative communication systems commonly benefit from a method of signalling to initiate or repair their communicative efforts. This article describes a simple way of modifying a common, inexpensive 9-volt portable transistor radio to serve as a durable, cosmetically attractive audio oscillator signalling device that can be operated by a single external switch. The unit can still be used as a radio receiver in the usual fashion. Instructions for modification and use are described, with suggestions for switches and mounting.

The comparative translucency within and across five aided augmentative and alternative symbol systems or sets (Blissymbols, Picsyms, PIC, PCS, and Rebus) for symbols representing three parts of speech (nouns, verbs, and modifiers) was investigated. A sample of 41 items representing an initial lexicon was rated by undergraduate college students on a 7-point scale of iconicity. Results indicate that translucency varies among systems or sets and among parts of speech. Rebus and PCS were the most translucent overall; however, a number of Blissymbolics, Picsyms, and PIC symbols were also rated as highly translucent. Caution is indicated in extrapolating results to young or retarded learners because of the influence of normal adult knowledge and experience on translucency ratings. Care must also be taken in extrapolating to more advanced lexicons containing larger, more developmentally advanced vocabularies.

Last June, autism expert Billy T. Ogletree chatted with participants from an ASHA online conference on partner instruction in alternative and augmentative communication. Here's what they said.

Inexpensive materials are described to assist speech-language pathologists in the evaluation and training of electronic augmentative communication potentials of nonspeaking, physically handicapped persons.

A 13-year-old communicatively and intellectually delayed male was taught to use discriminatively each of two previously acquired augmentative systems that consisted of signing and direct select letter encoding. Procedures used resulted in the use of signs with signers and direct select encoding with nonsigners. The learner's selection of the most appropriate communication modality generalized to new persons and environments.

Criteria for determining candidacy for an augmentative communication system are reviewed. Included is a consideration of cognitive, oral reflex, language, motor, intelligibility, emotional, chronological age, previous therapy, imitative, and environmental factors. The multiple factors are arranged on a branching type decision matrix, which yields a decision to either elect, reject, or delay implementation of an augmentative communication system. Case data demonstrating application of the decision matrix are presented.

Interaction patterns and strategies of communication used by nonspeaking persons are described, pertaining to eight methods of communication frequently utilized by nonspeakers. Although these communication forms are generally recognized and used by the public at large, they have greater value for handicapped communicators. Professional and societal implications of greater exposure to nonspeaking persons in general and augmentative systems in particular are also described.

This study sought to determine how augmentative communication device output modes differentially affected various aspects of interactions between nonspeaking persons (NSPs) and their speaking partners (SPs). It was hypothesized that when an electronic output display (EOD) was added to a communication board, the semipermanent display of information would lessen the dyad's need to adopt specialized turn and message formulation conventions, permitting the NSP to construct more complex messages with fewer communication breakdowns. A series of 10 interactional teaching tasks were recorded for two adult male nonhandicapped dyads performing under the two output conditions (±EOD). Interaction transcripts were analyzed with regard to quantitative differences within and between dyads with respect to turn taking, message formulation, propositional content, and several types of insertion sequences (guessing, confirmation queries, message reformulations). With the exception of message reformulation, changes due to output mode were nonexistent or inconsistent for the variables measured within and across dyads. The addition of the EOD significantly lowered the rate of message reformulation and the total number of reformulation-related turns. Results are discussed with regard to research and clinical implications for augmentative communication.

The potential population for augmentative communication is large, yet no objective assessment criteria exist. This article provides the clinician with a series of matrices designed to facilitate assessment decision making and implementation of augmentative communication. The first matrix addresses the appropriateness of augmentative communication. In the matrix the clinician will find an indepth, systematic decision-making procedure for aiding in the choice of augmentative procedures as primary or complementary methods of communication. The second matrix provides the clinician with information on modes of augmentative communication. These modes include manual systems, communication boards, and electronic devices. The third matrix focuses on code information. Particular attention is given to visual and manual codes. Together, the matrices provide the clinician with an objective procedure for evaluating and organizing available clinical information on nonspeaking clients.

The mealtime setting can be creatively used by the speech-language pathologist to increase the positive interactions between the child and caregiver and to establish the basic prerequisites for the development of communication. Specific program suggestions are provided to enable the speech-language pathologist to utilize the mealtime setting to integrate both vocal and nonvocal communicative objectives. The roots of interaction and communication which underly both vocal and nonvocal systems are described.

Greater numbers of nonspeaking persons are being educated in public schools. Public school speech-language pathologists frequently have minimal training and experience in providing appropriate augmentative communication system training to this population. This paper provides options, based on PL 94-142's mandates and ASHA's Code of Ethics, for service delivery of such systems.