Communication is a dynamic and transactional process, in which conversation partners influence each other through the course of exchange. Yet, as speech-language pathologists, we design interventions directly targeting the communication competence skills of children who use augmentative and alternative communication (AAC) and often overlook the fact that research suggests optimum communication exchanges depend both on the communication skills of children who use AAC and on those of their communication partners. Even if we inform communication partners of what they should do when interacting with a child using AAC, we may not provide interventions to effectively target the communication skills of communication partners.

Common Interaction Patterns

For example, in the early stages of language and literacy development, adult communication partners (e.g., parents, educators) typically control children's opportunities to participate in early literacy activities such as storybook reading and thus play critical roles in introducing children to books and creating supportive language and literacy-learning environments. During these activities, children's emergent literacy skills, which are widely accepted as critical precursors to the development of language and more sophisticated literacy, become evident.

However, recent literature (e.g., Light, Binger & Kelford-Smith, 1994) indicates that adult communication partners often do not naturally provide supportive opportunities for children using AAC to participate in such activities. Instead, adult communication partners frequently dominate interactions with children using AAC by: (a) asking a high number of closed-ended questions; (b) taking the large majority of conversational turns; (c) providing few opportunities for children to initiate or respond in conversation; (d) controlling the direction and topic of conversation; (e) frequently interrupting the utterances of children; and (f) focusing on the AAC system during interactions.

In turn, children who use AAC have been reported (e.g., Bedrosian, 1999) to: (a) be passive communicators; (b) initiate few interactions; (c) respond infrequently; (d) produce a limited number of communicative functions; and (e) use restricted linguistic forms. Such quantitatively and qualitatively different storybook-reading experiences from those of their peers who do not have a communication disorder, put these children at risk for developing poor language and literacy skills.

Given the above findings and the undisputed importance of learning to read and write in today's information-driven society, it is critical that clinicians implement evidence-based communication partner interventions to maximize the development of emergent literacy skills in children who use AAC through storybook reading.

Culturally and Linguistically Diverse Clients

It is imperative that such interventions be sensitive to the needs reflective of cultural and linguistic diversity, in accordance with best practice guidelines. This is particularly true when implementing parallel interventions in the school and home environments, since literacy experiences are typically mediated in unique ways influenced by cultural, linguistic, and social background.

Research on cultural differences has documented that cultures vary widely with regard to the uses and meanings of literacy events and the interactional styles employed during literacy activities (e.g., Heath, 1983; van Kleeck, 1994). Therefore, when developing literacy interventions, it is important that clinicians understand the role of literacy in different cultures and communities as well as cultural uses of literacy and book reading styles and keep considerations of an individual family's culture and unique style at the forefront of planning.

For example, many African American, Caucasian, and Latino parents have been documented as placing value on book-reading experiences with children while maintaining communication style differences in the interactions. Such differences must be considered, in conjunction with other common societal and educational approaches to literacy, when developing culturally responsive intervention programs that involve literacy activities.

To achieve this objective, we have completed a series of studies with African American, Caucasian, and Latino families involving focus groups and parent interventions. Our objective has been to instruct parents of children who use AAC in the use of culturally relevant evidence-based storybook reading interaction strategies that are complementary to classroom literacy activities and instruction. These investigations have revealed that although there are unique cultural and linguistic considerations across families, there are also many similar considerations and findings across families of children who use AAC.

An overview of the implications of these findings for clinicians conducting communication-partner instruction with families of varying cultural and linguistic backgrounds follows.

Culturally and Linguistically Mediated Clinical Considerations

It may be necessary to creatively modify storybooks and AAC systems to address cultural and linguistic family identities. For example, it may not be relevant or comfortable for all Spanish-speaking families to use the Mexican Spanish dialect included in available storybooks and AAC systems. Therefore, clinicians may need to collaborate with families to alter text included in storybooks or to add digitized messages with relevant vocabulary and pronunciations to children's AAC systems.

• Even when storybooks that seem culturally or linguistically appropriate on the surface are available, it is important for clinicians to consider whether or not the storybooks are preferred by the children with whom they are working. For example, in our studies, we have seen discrepancies between parent preferences for storybooks with culturally relevant characters (e.g., Little Bill, created by Bill Cosby) and children's preferences for more familiar characters in popular culture (e.g., Clifford the Big Red Dog, created by Norman Bridwell).
• It may be necessary to work with parents and children on language code-switching skills as they navigate through home and classroom activities. For example, although a family may predominantly speak Spanish in the home, they may prefer to use English language books and to discuss the storybooks in both Spanish and English.
• Although cultural norms may place more value on oral storytelling traditions, parents may desire to learn to facilitate storybook reading activities with children because of the relevance of these activities to school contexts and success. For example, many African American and Latino families report that adults traditionally tell oral stories while children listen quietly. However, the same families may also value the opportunity to learn to engage in language and early literacy-learning activities similar to those provided in the school to help ensure their success in the school environment.

Clinical Considerations Transcending Culture and Language

• It is possible to dramatically increase the communicative participation of children who use AAC systems in storybook reading interactions by teaching their parents to implement the following evidence-based skills: (a) use of expectant delay (i.e., increased conversational pause time), (b) open-ended question asking, (c) AAC system modeling, and (d) responsiveness to communicative attempts. All of the families who participated in our investigations indicated that these skills were relevant because of the resulting increases in opportunities for their children to take communication turns, even if these were not skills typically familiar within their cultures.
• It is necessary to provide direct instruction and support in the natural environment for parents to learn how to implement the above skills. Again, each of the parents who participated in our investigations indicated that the strategy instruction protocol (Kent-Walsh & McNaughton, 2005) used with them in the home setting was integral to ensuring that they learned how to implement the targeted interaction skills on a consistent and ongoing basis. They placed value on such activities as role play, video review, and coached practice. These families indicated that it was not enough to tell parents about facilitative interaction strategies, that they needed to be shown how to implement these strategies and to be given the necessary support for implementation. This illustrates that simple facilitative interaction skills may be easy to describe, but it is much more difficult to learn to implement these skills in meaningful contexts, no matter what the cultural or linguistic background of the communication partners. For example, it is never easy for communication partners to learn to add extended conversational pauses when communicating.
• Parents gain much more than the ability to facilitate their children's interactions by participating in communication partner instructional programs. For example, parents may feel they are knowledgeable and connected to their children and their children's aided modes of communication for the first time when they play a key role in the intervention process. Most of the parents who participated in our investigations indicated that they had never before received instruction in how to program their children's AAC systems or how to interact with their children.

Final Thoughts

Culturally and linguistically relevant communication partner instruction is a key component of interventions for children who use AAC. It is important for clinicians to make relevant modifications reflective of diverse backgrounds, but it is also critical for clinicians to remember that most of the families with whom we work have at least one common need: to learn to provide meaningful opportunities and supportive environments for their children to become competent communicators using AAC. Therefore, the addition of carefully designed communication partner interventions can yield a wealth of positive results for parents and their children's communication. Readers are referred to Kent-Walsh and McNaughton (2005) for a more detailed description of a possible communication partner instructional protocol for use with parents of children who use AAC.