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Overview of Augmentative Communication Considerations
by Susan Berkowitz, M.S.,M.Ed., C.C.C.,SLPChildren who have significant communication disabilities are at risk in all aspects of their development. Without access to speech they don’t have an efficient means for learning language. And without language, all areas of cognitive development are impacted. These students are also at risk especially for literacy skills; which rest on the development of language. They are at risk for social isolation; without the ability to communicate, it is difficult to make friends and develop interpersonal relationships.It is important to look at providing children who are nonverbal or minimally verbal with an effective means of communication at an early age. Unfortunately, schools and caregivers are frequently unaware of many aspects of augmenting communication, and children wait too long for appropriate intervention.
One of the myths associated with providing augmentative communication systems is that they will impinge upon speech development. in fact, the opposite is true. In both clinician anecdotes and research studies, it has been shown that students given an opportunity to communicate through alternative means increase their verbal output. Another myth frequently heard is that students are not "ready" for a voice output system; that a Picture Exchange system or picture boards need to be proven successful first. And, when students show reluctance to continue using such systems, they are said to have "failed" with them; proving that they aren't ready for something more sophisticated. Again, the opposite is usually true. Students who have developed communicative intent, and can discriminate and use pictures frequently become bored with static picture displays, or become frustrated with cumbersome exchange books that require them to find a picture among a number of pages of pictures, remove it, and find someone to hand it to. These students usually respond significantly better to a less cumbersome system that provides verbal feedback and immediate response.
Some students are said to be too young to benefit from a technological solution to communication deficits. Yet communication skills begin in infancy. Waiting to provide intervention is never beneficial.
Parents and teachers need to be aware, however, that simply providing a communication system or device to a child is not a "silver bullet." Communication skills need to be taught. We provide speech therapy to children with disordered speech, language intervention to children who have difficulty processing or formulating language. So, too, must we provide training is how to communicate with an alternative "voice." Everyone who interacts with the child needs to be consistent in requiring the same type of response, and consistent in using the components of the system. Teachers and parents need to ensure that children have meaningful opportunities to communicate, and that they have the scaffolding they need to support their communicative attempts.
Everyone involved also needs to be aware that augmentative communication assessment is an ongoing process. A child cannot simply be evaluated once, provided with a system, and sent on his or her way. As a child’s communication skills continue to develop, their needs change and so, too, should changes be made or considered in the basic system.
There are a couple of major types of picture and word based augmentative communication systems. There are static display books and boards that are printed on paper in several different formats; the most functional being a flip-book system. There are also static display voice output devices; which provide a limited number of message buttons on pages or overlays that need to be changed manually. For many students, these systems do not foster independence simply because they lack the fine motor skills needed to change these overlays. If what they want to say isn’t on the current page, they have no way to get their message across without gaining the attention of a listener and indicating somehow which page is desired. The limited number of messages available per page also restricts vocabulary and message availability, as well as syntax development. These static devices range from single message buttons to device with 32 buttons per overlay, and from 1 to 20 possible overlays that can be programmed at once.
A second category of system is dynamic display devices. These devices generally have a touch sensitive screen, and pages are programmed to link to one another automatically. The programming can be as simple as a main page with 2 buttons indicating a desire to eat or play, each of which links to a page of appropriate choices - which again can be only 2 or 3. At the other end of the spectrum are the syntactically complex displays with multiple words or icons per page and many layers of pages. Again, we need to remember that communication development is a developmental process. While all of these devices come with pre developed page sets that can be individually modified, it is not necessary to use these, and it is sometimes more appropriate to completely customize the programming. Some of these devices come with software that allows use of word processing (or text-to-speech) with word prediction, and even phrase prediction.
A third type of device is text-to-speech, where the user types in messages on a keyboard and they are spoken. Some commonly used messages can be preprogrammed, as well as classroom presentations, stories, etc. Some of these devices come with features such as abbreviation expansion, word prediction, and various amounts of storage memory. Finally, it is important to remember that an effective communication system is not always restricted to just one of these. Frequently, a combination of single message buttons and a more complex device is used, or one might use a flip book for certain outdoor or wet environments with a voice output device at other times. Communication needs change with the environment and with time. So should our solutions to communication problems.
Susan Berkowitz, M.S.,M.Ed., C.C.C.,SLP
Speech-Language Pathologist and Educational Consultant
Tel: 619-980-0347
berkowitzs@hotmail.com
www.iser.com/berkowitz-CA.html