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Augmentative Communication

Augmentative/alternative communication (AAC) is any device, system or method of communication that can help individuals with communication difficulties to communicate more easily and effectively. AAC is used by individuals who have difficulty speaking, writing, or reading. Augmentative devices are used to enhance learning, participation, and independence for many individuals with disabilities.

Although AAC is often used to refer to formal communication devices and systems such as communication boards, voice output communication aids (VOCAs), or sign language, it can include less sophisticated means of communication, such as facial expressions, non-speech vocalizations, and gestures.

There are many benefits associated with using AAC. Following are some examples of how AAC can help a child who is unable to communicate effectively:

• AAC has been shown to enhance a child’s cognitive, social, and academic abilities.
• AAC can assist the child in learning the early cognitive and social skills on which conventional communication is based, while teaching functional communication at the same time.
• AAC can help care-givers better understand the child to better meet his needs.
• AAC provides the means for the child to make choices and indicate likes and dislikes, preventing him or her from becoming passive due to the inability to communicate.
• AAC prevents undesirable behavior due to the frustration caused by the inability to communicate.
• AAC allows the child to participate in activities he might not otherwise be able to engage in because of his communication difficulties.

AAC should not be thought of as a last resort, or a method to use when all other methods have failed, because it does not typically consist of one mode of communication; sign language or a VOCA may be used in conjunction with gestures, vocalizations or speech. Multiple modes of communication should be used because: it allows the child to continue to work on speech while providing him or her with an alternative method of communicating; it decreases the reliance on any single type of communication method (which is important in the event the device is broken or unavailable); it allows the child to adjust his or her communication method to fit the requirements of different situations (home vs. school); and it is more natural to have several methods of communicating. Individuals without speech difficulties communicate in different ways (speech, gestures, writing); the same should apply to individuals with speech difficulties.

To begin the AAC process, the parent must first make contact with an organization who provides AAC services to children with severe communication disorders. For children who are zero to three years of age, parents should contact their early intervention program, which is responsible for providing a comprehensive assessment, therapy, and various other services. For children ages three and older, the public school system is required by the federal government to develop and provide, at no cost to the family, an AAC program (including services and equipment) that is designed to assist the child in receiving an appropriate education. If your early intervention program or school does not have an AAC specialist, you can visit the Service Providers Network at http://www.augcomm.com/service.html to locate a specialist in your area.

Before any type of system is considered, it is important that an assessment be made by a team of professionals to identify the child’s strengths, abilities, and communication needs. The team should include the child (if appropriate), the parents, an AAC specialist, a speech-language pathologist, an occupational therapist, a physical therapist, a special education and/or regular education teacher, and a psychologist.

Once the assessment is complete and the needs of the child have been identified and agreed upon, the next task is to choose an AAC device or system for the child. Following is a description of the types of systems available:

• Communication Boards/Books - These have no technology involvement; they use pictures, symbols, and drawings instead. The child uses the boards to communicate by pointing, touching, or eye gaze. The downfall to using communication boards is that they deter eye contact, in that the child must be looking at the board rather than the person he or she is communicating with and vice-versa.

• Picture Exchange Communication System (PECS) - This system teaches the child to approach and give a picture to their communicative partner in exchange for that item. With this system, the child initiates a communicative act for a concrete outcome within a social context.

• Voice Output Communication Aids (VOCAs) - These devices are also graphical, but unlike communication boards, are high technology devices that output speech. VOCAs can include those devices that contain a single message to devices that have the ability to store unlimited messages. Vocabulary must be programmed into the VOCA, either by the manufacturer, the purchaser, or both.

• Object Identification - This method uses concrete objects that are used as symbols for other objects or activities. They may be whole, partial, or miniature objects and can be indicated by being pointed to, reached for, touched, or held.

• Sign Language - This form of communication consists of finger and hand movements that may involve American Sign Language or sign language developed by the child.

• Vocalizations - These are sounds produced by the throat and mouth that are not words, but are able to be used for communication reliably and consistently.

For information on specific communication devices and systems, please visit the Communication Aid Manufacturers Association web site at http://www.aacproducts.org/members.

In deciding which system or device is most appropriate for your child, the following guidelines should be considered:

• Eliminate systems that are inappropriate and have the child try out a few different systems for several weeks before a final decision is made.

• Always choose the quickest and most efficient system that does not cause negative side effects such as fatigue.

• In selecting an AAC program, it is easy to become distracted by the equipment and systems, forgetting that people teach communication, not technology. Therefore, keep the child’s goals in mind and think about teaching methods to be used.

If a VOCA is being considered, there are several issues to keep in mind:

• Devices need batteries - a child is unable to use the communicate device if the batteries die. Extra batteries should be kept on hand.

• Devices break down and need service.

• Some devices require programming and can result in a tremendous amount of work.

• Devices need to be portable, as children need to communicate all the time, even while walking or riding in a car.

• The device should be sturdy, as children tend to be hard on equipment.

• VOCAs can be very expensive, costing thousands of dollars.

• Some devices may be too difficult or complicated for the child to operate.

Once the method of AAC has been decided upon and the child is ready to begin using AAC, the next difficult task is teaching the child how to communicate with it. Determining how to teach AAC to a child must be highly individualized, however, the following are general teaching tips:

• Both parents and teachers should work together in teaching the child to provide consistency and the opportunity to use AAC in different environments.

• Siblings and peers should use the same system while communicating with the child so that the use of AAC feels more natural.

• Formal instruction should occur frequently and for short periods of time.

• Teaching should occur in natural settings - places where the child feels at ease - and focus on communication skills that fit into the activities that take place within that environment.

• Respect the child and teach with compassion and humor. Children enjoy playing, so to keep their interest and attention, teaching sessions should be fun.

• Allow the child to experiment in non-communicative ways with his or her AAC. This is how children learn about and feel comfortable with their AAC.

• Begin using AAC around areas of interest to the child (food or toys).

• Children need control. Incorporate messages that allow the child to make a decision over what happens to him (i.e., selecting a video, where to go on an outing).

In the past, some children with moderate to severe disabilities were considered too cognitively impaired to learn how to communicate effectively. These individuals were not even considered candidates for AAC. However, studies have since shown that any child, from those with severe and multiple disabilities to those with temporary impairments, can benefit from an AAC program that is appropriate and individualized.

For more information on AAC, please visit AAC Connecting Young Kids at http://www.mauigateway.com/~duffy/yaack.

 

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