Children’s Ideas for the Design of AAC Assistive Technologies for

Young Children with Complex Communication Needs

Janice Light, Rebecca Page, Jennifer Curran, and Laura Pitkin

(USA)

I had just come back from visiting the home of a young child who had significant disabilities and required augmentative and alternative communication (AAC). The home, like the homes of many children, had lots of toys – brightly colored, engaging, and fun. I walked into our AAC lab at Penn State University, past the display cabinets filled with our current AAC technologies. I stopped dead in my tracks, shocked by the contrast. Our AAC technologies clearly reflected our preferences and priorities as adults, not those of children. I wondered how children would design AAC technologies for young children. This was the beginning of a fascinating research project that has significant implications for how we design and use AAC technologies with young children. We invited a group of children to design inventions to meet the needs of young children with speech and motor impairments. The resulting inventions looked nothing like our current AAC technologies. They suggested very different priorities and preferences. The paper describes the children’s inventions and discusses their priorities and preferences. Re-designing AAC systems to incorporate the types of functions and features valued by children, may increase their appeal, ensure that they are fun to use, and make them easier for young children to learn and use. 

Prediction and Selection of Vocabulary for Two Leisure Activities

Leigha Dark and Susan Balandin

(Australia)

One of the most important components of successful communication is having access to the correct vocabulary. Vocabulary may be represented as spoken or written words, signs or gestures, line drawings, coloured pictures or graphic symbols. Regardless of the type of representation, a communication system will only be effective if the vocabulary chosen meets the communication needs of the person using it. Predicting and selecting the exact vocabulary needed for people who use Augmentative and Alternative Communication (AAC) to communicate in a range of situations is very difficult. Often many people are involved in the process and a variety of methods used. Prior to this research project being conducted it was not known whether it was easier for informants to predict vocabulary for specific communication situations than for broad, general situations. The researchers in this project looked at people’s ability to predict the vocabulary needed to communicate in two leisure activities popular in Australia: sailing and visiting an internet cafe. They then compared the predicted vocabulary with the vocabulary actually used by people with and without disabilities as they participated in each of the activities. The important findings were as follows:

- Participants were able to predict a lot of vocabulary relevant to the specific leisure situations however much of the vocabulary predicted was never used during the activities.

- During the activities there were some words identified that were used with high frequency and that were specific to the leisure activity being performed. These words were important to know because they enabled the participants to participate effectively in the activity.

- When selecting vocabulary and designing AAC systems it is important to include not only the ‘core’ words that are used all the time, but to also explore the vocabulary used in a range of activities to find the most relevant and important specific vocabulary items used.

Further research of this nature will help improve the process of predicting and selecting vocabulary for people who use AAC systems, thus ensuring that individual’s communication needs are met.

Intentional Communication Acts Expressed by Children with Severe Disabilities

in High-Rate Contexts

Susan Bruce and Claudia Vargas

(USA)

Children with severe disabilities have lower rates of intentional communication acts (ICAs). This results in fewer opportunities for adults to respond to and shape their communication. This study: (1) examined the characteristics of intentional communication acts expressed by 17 children with severe disabilities and (2) identified the activities that evoked the two highest rates of ICAs for each child. This study is unique because researchers coded both visual and non-visual means of establishing joint attention and the study differentiated persistence, repetition, and repairs in ICAs. Sixteen of the 17 participants expressed both their highest and second highest rate of ICAs in the context of preferred activities. Thirteen of the 17 children expressed their highest rate of ICAs during regularly scheduled lessons. Familiarity with the activity supported the children in this study to produce high rates of ICAs. AAC devices with voice output were used in 16/34 high rate contexts. Twenty-five of the 34 high rate activities were 1:1 lessons. Adult proximity supported higher rates of ICAs in both individual and group lessons. Adult proximity is in itself a cue to communicate for children who have severe disabilities and is of particular importance to children who have vision loss. Children with severe disabilities rely on responsive adults who recognize and reinforce their communicative efforts. The first author continues to perform research on how children with severe disabilities achieve mental representation and the ability to communicate through symbols.

The Swedish Speech Interpretation Service: An Exploratory Study of a New Communication Support Provided to People with Aphasia.

Inger Larsson and Anna-Lisa Thorén-Jönsson

(Sweden).

A technical AAC device may not always be sufficient, and sometimes there is a need for another person to support the communication. This person is often a family member or a care provider, which might cause problems with autonomy and privacy.

In Sweden people with complex communication needs now have access to a new kind of communication support. Instead of – or as a complement to – a technical device, they can book an interpreter. The service, called the Swedish Speech interpretation Service (SSIS), is quite similar to the interpretation service for deaf persons, but the SSIS can provide support not only in a conversation, but also in reading and writing. It is possible to book an interpreter for things like reading and writing e-mail, letters, and also simultaneously support the speech and write memos at a meeting with the doctor, authority persons etc.

In this study, twelve persons with aphasia express their views on using an interpreter. They had used an interpreter in many different situations, such as meetings with or telephone calls to public officials, visiting a dentist, shopping or making a will. Results show that the SSIS provided opportunities to control when and how to communicate, and hence become more equal communication partners. The professional role of the interpreter was also regarded as a guarantee for quality, and that confidential matters were not spread.

The study also points out that it is possible and important to interview people with complex communication needs, a group that too often is excluded from studies. 

Long-Term Outcomes For Individuals Who Use Augmentative and Alternative Communication:  Part III – Contributing Factors

Shelley Lund and Janice Light

(USA)

It is important to describe outcomes for individuals who use augmentative and alternative communication (AAC); but even more important to determine what contributes to those outcomes.  In an effort to address this question, we interviewed seven young men who had used AAC systems for at least 15 years, their families, and professionals who had worked with them.  The transcripts of the interviews were analyzed and the following themes emerged that influenced the participants’ outcomes.

Barriers to positive outcomes

- Attitude barriers: negative attitudes of professionals, low expectations of family members, negative attitudes of non-disabled peers, and negative attitudes of society

- Cultural differences: difficulties developing communication systems for multiple languages and professionals’ lack of understanding of cultural issues

- Technological barriers: limitations of technology, difficulty accessing technology, and technical breakdowns

- Service delivery limitations: lack of availability of services, limited knowledge of professionals, lack of collaboration between professionals, and limited focus of goals

Supports to positive outcomes

- Social support: supportive, inclusive communities; strong parental advocacy; expectations of success; and family involvement in intervention

- Personal characteristics: patience, persistence and determination, high expectations of self, and a social nature

- Services: competent and knowledgeable professionals; training for families, communication partners, and teachers; and effective communication between professionals, family, and school.

The comments of the participants and the themes identified remind us how important it is that professionals do not become complacent, and that we continue to strive to provide consumer-driven services so that the best outcomes can be achieved for individuals with complex communication needs.

Interaction Between Children and Their Peers 1: Organizing

and Understanding VOCA Use

Michael Clarke and Ray Wilkinson

(UK)

This paper is the first in a series of two that examines aspects of interaction between children with cerebral palsy who use voice output communication aids (VOCAs) and their peers. It seems that while we have learned much about difficulties that children using communication aids can experience in communicating with adults, relatively little research has focused how children that use VOCAs to interact with other children, especially those who do not have communication difficulties. The research presented in these papers makes a contribution to filling that gap in our knowledge.

This first paper focuses on interactions between two pairs of children: Jamal and Colin, and Martin and David. Jamal and Martin use VOCAs and Colin and David do not have communication difficulties. The interaction is analysed using a method called Conversation Analysis (CA). In brief, CA is a method for determining how people in conversation go about organising their interaction.

In these children’s interactions it was normally the ‘naturally’ speaking child who set up opportunities for the aided speaker to use his VOCA, and they typically did so by asking questions or specifically prompting VOCA use. In setting up an expectation that the aided speaker would use their VOCA in their next contribution, (such as an answer to a question), the ‘naturally’ speaking children had a better chance of understanding what the aided speaker wanted to say, and aided speakers could take turns that could be readily understood by their communication partners. Interestingly, the ‘naturally’ speaking children were seen to take on a responsibility for incorporating VOCA use into their interactions, and in so doing they were seen to treat the VOCA as a resource for the conversation as a whole.  In the second paper of this series (forthcoming) the analysis considers what happens when aided speakers used their VOCAs to initiate new lines of talk rather than following natural speakers’ questions or prompts.

The World Health Organization’s International Classification of Functioning, Disability and Health: Implications for Clinical and Research Practice in the field of Augmentative and Alternative Communication

Parimala Raghavendra , Juan Bornman, Mats Granlund and Eva Björck-Åkesson

(Australia, South Africa, Sweden)

In 2001, the World Health Organization (WHO) published a new classification system, known as the International Classification of Functioning, Disability and Health (ICF). ICF is a multi-purpose classification of health and health related issues and is for all people. ICF has two parts: 1) Functioning and Disability (describes Body functions and Structures & Activities and Participation-tasks and actions) and 2) Contextual factors (Environmental and Personal factors). These interact to show a complex relationship between health condition and the background of a person’s life and living.

The key feature of the model is also the underlying premise of AAC clinical practice; the interaction between individuals who use AAC and their environmental (technology, attitudes of and supports provided by people in the environment) and personal factors (individual’s motivation, personality) that can facilitate or reduce participation. 

This paper is the first paper to explicitly present the relevance and implications of the model to AAC. There is an opportunity for people who use AAC, their families, practitioners and researchers to utilise a universal model to: 1) establish a common language to describe health and heath related aspects of people who use AAC, in order to improve communication and quality of life, 2) develop a subset of ICF codes to describe issues relevant to AAC, and 3) to advocate for services incorporating the social and cultural environments.