Communication Benefits of AAC

Blog #19 in the Phonology Means Nothing and Other Astounding and Very Practical Facts about Speech Sound Disorders Blog Series

For more information about this series, see the Phonology Means Nothing Series welcome page.

AAC offers many benefits to a child’s development of communication (Romski et al., 2015).  This blog explores three questions that families ask about AAC, especially when their child is younger.  These frequently encountered, heartfelt questions include:  Will AAC interfere with my child’s speech development?  What are possible communication benefits of AAC for my child?  When should I begin AAC?

Will AAC Interfere with Natural Speech?

Families who are considering AAC for their children often ask, “Will AAC interfere with natural speech?”  The question reflects the fear that AAC will become a communication crutch that a child will use instead of speech.  A family may picture a child, using AAC to communicate, the development of speech withering before it has a chance to develop.

The short answer to this concern:  no, AAC does not interfere with the development of natural speech.  Instead, a child can use AAC tools while they work on improving their speech production and a child’s natural speech can be incorporated into the AAC system (ASHA, 2018; Millar, Light, & Schlosser, 2006).

A number of studies have indicated that the use of AAC does not reduce speech production (Baumann Leech & Cress 2011; King, Hengst, & DeThrone, 2013; Millar, Light, & Schlosser, 2006; Oommen & McCarthy, 2015; Romski et al., 2010; Schlosser & Wendt, 2008). For instance, two studies, one a meta-analysis and the other a systematic review investigated the effect of AAC on speech production (Millar et al., 2006; Schlosser & Wendt 2008). The meta-analysis focused on individuals with developmental delays and the latter review narrowed the scope to children with a diagnosis of autism spectrum disorder. The findings concluded:

1. Speech did not decrease when AAC is part of the intervention.
2. Some children who use AAC improve in speech (Millar et al., 2006; Schlosser & Wendt, 2008).

Oommen and McCarthy, (2015) observed that for some there was more willingness to practice speech with AAC as anxiety was then reduced. AAC assists with conveying a message and does not interfere with the use of speech.

What are Possible Communication Benefits of AAC for My Child?

In addition to promoting speech, additional communication benefits of AAC include: 

• Reduce frustration (Baumann Leech & Cress, 2011) and anxiety when communicating (Binger & Light, 2007, Cumley & Swanson, 1999; Oommen & McCarthy, 2015),
• Promote language development through increasing a child’s ability to express himself/herself  when the student is not able to use their natural speech (ASHA, 2018; Cress & Marvin, 2003; Oommen & McCarthy, 2015; Romski et al., 2015);
• Assist with the ability to say more complex sentence structures that couldn’t be produced with natural speech (Binger et al., 2011; Binger et al. 2017);
• Provide a window into expressive words and language skills not verbalized or verbalized clearly (Cress & Marvin, 2003; Romski et al., 2015); and
• Assist comprehension of language by providing multi-model input when the adult is modeling the use of AAC (Drager et al., 2010).

When Should I Introduce AAC?

You should consider AAC when speech and/or language difficulties are observed (Romski et al., 2015). Don’t wait until all other ideas have been tried (Cress & Marvin, 2003; Romski & Sevick, 2005). For some, like a child at risk for communication challenges such as with diagnosis of Down syndrome or cerebral palsy, AAC tools should be considered earlier via early childhood intervention services (Cress & Marvin, 2003; Light & Drager, 2012; Romski & Sevick, 2005). Early interventions that include AAC tools support the development of communication skills (Branson & Demchak, 2009; Light & Drager, 2012; Romski & Sevick, 2005; Romski et al., 2015).   Even children who are very young can use and benefit from AAC. For instance, Romski et al. (2015) and Branson and Demchak, (2009) completed systematic reviews. The studies included a range of AAC tools such as gestures, signs, pictures, and/or high tech devices. The low tech (also called no tech) options were noted more frequently in the younger age groups. Both articles concluded that with intervention young children could learn to use AAC and that these tools supported the development of expressive communication skills.  More specific information about both article is as follows:

• Romski et al. (2015) reviewed articles spanning a 30-year time frame, 1985 to 2014. The studies collected included children from a mean age range of 15 months to 6 years 8 months. Twenty-six studies targeted individuals 3 and under and 44 targeted children 4 to 6 years of age. The research design of the studies varied. 
• Branson and Demchak (2009) completed a systematic review of studies that included children from 16 months to 36 months who had a variety of diagnoses that presented with a risk for communication difficulties. The review included 12 studies (seven that showed “conclusive evidence”). Four of the studies (two with conclusive evidence) were also included in the Romski et al. (2015) review.

In addition, displays on devices can vary. Sometimes grids (pictures in rows and columns) are used, sometimes visuals scenes, and sometimes both. Visual scenes (pictures of events or places and including objects important to the individual) have been used with younger children and others emerging in their AAC use (Light & Drager, 2007).  Holyfield et al., (2017), explored technology pairing just-in-time programming with visual scenes. The target population for the study was 10 toddlers 10 to 22 months old. At the conclusion of the study, all participants were reported to be able to complete at least some elements of the just-in-time programming such as taking a picture to create the visual scene or drawing a “hot spot” (a transparent button to access a recording).  The children were able to increase their knowledge about the use of the technology. It will be exciting to see what the future holds as technology advances and research continues in the field of AAC.

References

American Speech-Language-Hearing Association (ASHA). (2018). Augmentative and alternative communication key issues. Retrieved from https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942773§ion=Key_Issues#AAC_Myths_and_Realities

Baumann Leech, E. R., & Cress, C. J. (2011). Indirect facilitation of speech in a late talking child by prompted production of picture symbols or signs. Augmentative and Alternative Communication, 27, 40–52. doi:10.3109/07434618.2010.550062

Binger, C., & Light, J. (2007). The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication, 23(1), 30–43.

Binger, C., Maguire-Marshall, M., & Kent-Walsh, J. (2011). Using aided AAC models, recasts, and contrastive targets to teach grammatical morphemes to children who use AAC. Journal of Speech, Language, and Hearing Research, 54, 160–176.

Binger, C., Kent-Walsh, J., King, M., & Mansfield, L. (2017, July). Sentence productions of 3- and 4-year-old children who use augmentative and alternative communication. Journal of Speech, Language, and Hearing Research, 60, 1930–1945.

Branson, D., & Demchak, M. (2009). The use of augmentative and alternative communication methods with infants and toddlers with disabilities: A research review. Augmentative and Alternative Communication, 25(4), 274–286. doi: 10.3109/07434610903384529

Cress, C. J., & Marvin, C. A. (2003). Common questions about AAC services in early intervention. Augmentative and Alternative Communication, 19(4), 254–272, doi:10.1080/07434610310001598242

Cumley, C., & Swanson, S. (1999). Augmentative and alternative communication options for children with developmental apraxia of speech: Three case studies. Augmentative and Alternative Communication, 15(2), 110–125. doi:10.1080/07434619912331278615

Drager, K., Light, J., & McNaughton, D. (2010). Effects of AAC interventions on communication and language for your children with complex communication needs. Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach 3, 303–310. doi: 10.3233/PRM-2010-0141

Holyfield, C., Drager, K., Light, J., & Gosnell Caron, J. (2017, August). Typical toddlers’ participation in “Just-in-Time” programming of vocabulary for visual scene display augmentative and alternative communication apps on mobile technology: A descriptive study. American Journal of Speech-Language Pathology, 26, 737–749.

King, A. M., Hengst, J. A., & DeThrone, L. S. (2013). Severe speech sound disorders: An integrated multimodal intervention. Language, Speech, and Hearing Services in the Schools, 44, 195–210.

Light, J., & Drager, K. (2007). AAC technologies for young children with complex communication needs: State of the science and future research directions. Augmentative and Alternative Communication. 23(3), 204–216.

Light, J.C., & Drager, K. (2012). Early intervention for children with autism, cerebral palsy, Down syndrome, and other disabilities. Penn State. Retrieved from https://aackids.psu.edu/index.php/page/show/id/8/index.html

Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49(2), 248–264.

Oommen, E. R., & McCarthy, J. W. (2015). Simultaneous natural speech and AAC interventions for children with childhood apraxia speech: Lessons form a speech-language pathologist focus group. Augmentative and Alternative Communication, 31(1), 63–76. doi:10:3109/07434618.2014.1001520

Romski, M., & Sevcik, R. A. (2005). Augmentative communication and early intervention. Infants and Young Children, 18 (3), 174-185.

Romski, M., Sevcik, R. A., Adamson, L. B., Cheslock, M., Smith, A., Barker, R. M., & Bakeman, R. (2010). Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents. Journal of Speech, Language and Hearing Research, 53, 350–365.

Romski, M., Sevick, R. A., Barton-Hulsey, A., & Whitmore, A. S. (2015). Early intervention and AAC: What a difference 30 years makes. Augmentative and Alternative Communication, 31(3), 181–202. doi:10.3109/07434618.2015.1064163

Schlosser, R. W., & Wendt, O. (2008). Effects of augmentative and alternative communication intervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology, 17, 212–230. doi:1058-0360/08/1703-0212