Communication Facts: Special Populations: Augmentative and Alternative Communication - 2008 Edition

An augmentative and alternative communication (AAC) system is an integrated group of components, including the symbols, aids, strategies, and techniques used by individuals with severe speech and language disabilities to enhance communication. The system serves to supplement any gestural, spoken, and/or written communication abilities (1). Augmentative and alternative modes of communication have assumed an increasingly important role in meeting the communicative needs of individuals with severe disabilities (2).

General Demographics of Users

• Persons with severe and profound disabilities may be especially vulnerable to separation from the mainstream of society. Technologies such as AAC systems can help minimize this separation from other people (3).
• Published prevalence estimates of the number of people with severe speech impairments vary widely, depending on the country, age group, and type(s) of disability surveyed (4).
• Several studies suggest that 8 to 12 people per 1,000 experience severe communication impairments that require AAC (5-7).
• Two types of individuals may benefit from the use of AAC systems: those with long-term communication impairments (e.g., dysarthria, aphasia, apraxia) and those with more temporary conditions (e.g., tracheostomy placement, intubation) (8).
• The etiologies for permanent impairment occur in all socioeconomic, racial, ethnic, and age groups. The etiologies resulting in significant communication impairment can be congenital or acquired (8).

Children as Users of AAC

• A significant delay in communication development affects all aspects of a child's development. Children with established disabilities and severe communication impairments may not develop spoken language (9).
• Most individuals who use AAC are first exposed to language through the spoken language of their families and, later, of the broader social community. Despite the trend toward early intervention, many individuals with significant communication impairments are not introduced to AAC until they are 3 or 4 years old or even older. As a result, the spoken language of the family and the community may be their only language during the critical early years of development (7).
• According to one study, several reasons may be attributed to the neglect of adolescents who have not received any systematic intervention to develop AAC. These reasons include continued emphasis on developing cognitive prerequisites before starting direct instruction to teach functional communication, and a lack of AAC awareness and expertise among some clinicians (10).
• Current literature suggests a lack of empirically validated strategies for teaching reading skills to children who use AAC (11).
• In 2006, 50% of speech-language pathologists in schools indicated that they served individuals who are nonverbal and/or required AAC (12).

Adults as Users of AAC

• Researchers in the field of AAC have demonstrated that many people with acquired communication disorders may benefit from the use of AAC technologies to improve communication effectiveness and enhance participation in life activities. However, some adults with acquired disorders may reject AAC options despite the opportunities they offer for improved quality of life (13).
• Data on the use of AAC is not collected in any national census activity. To date, national searches to identify individuals who use AAC and are employed have identified only small numbers (14).
• Recent advances in technology should be expanding employment opportunities for people with disabilities, including those who use AAC. However, this hasn't been the case. A survey of AAC professionals suggests that only 14% of the 5,333 AAC users known to these respondents were employed in some way (14).
• Schools can and must play an important role in preparing the future worker with the human capital or "hard skills" needed for employment. Individuals who use AAC and their employers believe that schools must do more to prepare individuals who use AAC for the workplace (14).

References

1. American Speech-Language-Hearing Association. (2002). Augmentative and alternative communication: knowledge and skills for service delivery. ASHA Supplement 22, 97-106.
2. Johnston, S.S., Reichle, J., & Evans, J. (2004, February). Supporting augmentative and alternative communication use by beginning communicators with severe disabilities. American Journal of Speech Language Pathology, 13 (1): 20-30.
3. Hourcade, J., Pilotte, T.E., West, E., & Parette, P. (2004, Winter). A history of augmentative and alternative communication with severe and profound disabilities. Focus on Autism and Other Developmental Disabilities, 19 (4): 235-244.
4. Beukelman, D.R., & Mirenda, P. (2005). Augmentative and alternative communication: Supporting children and adults with complex communication needs (3rd ed.). Baltimore: Paul H. Brookes Publishing Co.
5. Matas, J., Mathy-Laikko, P., Beukelman, D., & Legresley, K. (1985). Identifying the non-speaking population: A demographic study. Augmentative and Alternative Communication, 1, 17-31.
6. Beukelman, D.R., & Ansel, B. (1995). Research priorities in augmentative and alternative communication. Augmentative and Alternative Communication, 11, 131-134.
7. Light, J.C., Beukelman, D.R., & Reichle, J. (2003). Communicative competence for individuals who use AAC: From research to effective practice. Baltimore: Paul H. Brookes Publishing Co.
8. Downey, D., & Hurtig, R. (2003, July). Augmentative and alternative communication. Pediatric Annals, 32 (7): 467-474.
9. Sevcik, R.A., Romski, M.A., & Adamson, L.B. (2004). Research directions in augmentative and alternative communication in preschool children. Disability and Rehabilitation, 26 (21/22): 1323-1329.
10. Sigafoos, J. et. al. Transferring AAC intervention to the home. Disability and Rehabilitation, 26 (21/22): 1330-1334.
11. Fallon, K.A., Light, J., McNaughton, D., Drager, K., & Hammer, C. (2004, December). The effects of direct instruction on the single-word reading skills of children who require augmentative and alternative communication. Journal of Speech Language Hearing Research, 47 (6): 1424-1439.
12. American Speech-Language-Hearing Association (2006). 2006 Schools Survey Report: Caseload Characteristics. Rockville, MD: ASHA.
13. Lasker, J.P., & Bedrosian, J.L. (2001, September). Promoting acceptance of augmentative and alternative communication by adults with acquired communication disorders. Augmentative and Alternative Communication, 17, 141-153.
14. McNaughton, D., & Nelson Bryen, D. (2002, Summer). Enhancing participation in employment through AAC technologies. Assistive Technologies, 14 (1): 58-70.

Compiled by Andrea Castrogiovanni * American Speech-Language-Hearing Association * 2200 Research Boulevard, Rockville, MD 20850 * acastrogiovanni@asha.org