Increasingly, service provision occurs well before 2 years of age. For individuals with the most significant disabilities, the need for some type of communication services is usually evident before the child's second birthday. Those involved in care for these individuals should conduct a comprehensive, interdisciplinary assessment of the child's receptive and expressive communication skills, as well as related areas of cognitive and social development, use valid and reliable assessment instruments—including those designed for general use with infants and toddlers or for specific use with children with severe disabilities, and provide information that can be used to design an appropriate, individualized intervention plan for the child and family.
Current research clearly documents the efficacy of communication services and supports provided to infants, toddlers, and preschoolers with a variety of severe disabilities. Some of the communication services that are appropriate for very young infants and their families include developmentally appropriate assessments of prelinguistic and sociocommunication interactions, including neurodevelopmental assessments, referrals to other professionals as appropriate, specific interventions to prevent impairment or facilitate social, interactive communication when impairment exists, culturally appropriate family and other caregiver education (American Speech-Language-Hearing Association [ASHA], 2004, 2008), and augmentative and alternative communication (AAC) systems.
Communication services should be started as soon as a communication delay or disorder is diagnosed. A professional evaluation can determine if a child is developing appropriately. If not, an intervention program can be designed to help the child develop age-appropriate or functional skills.
For some systems, the challenge is securing enough personnel to provide appropriate communication services and supports rather than an issue with funding. Whatever the cause, systems cannot justify their failure to provide needed communication services and supports to the individuals they serve by citing a shortage of funding or other resources.
The only way that a student can truly have equal access to the curriculum and the ability to participate and progress in that curriculum is if that student has an adequate means of spoken and/or written communication. Communication services can be represented in the individualized education program (IEP) as special education, related services, or supplementary aids and services. Because assistive technology is one of the "special factors" that IEP teams must consider for all children, IEP teams are obliged to discuss communication devices and services when a child's communication limitations are so significant that they impact the child's access to, and ability to benefit from, the general curriculum.
The Individuals with Disabilities Education Act specifies that special education services should enable students to access, participate in, and demonstrate progress with respect to the general education curriculum. A lack of funds and resources cannot be used as a legal basis for denying services required by federal statute.
Transitions to new work and living environments in adulthood are likely to create a need for communication services to support development of communication forms and functions appropriate to new settings as well as to educate new communication partners about the individual's communication forms and support needs. Even if records indicate an adult "did not benefit" from services in earlier years, he/she may be able to benefit from services in adulthood; research has documented the continued development of communication/language skills through young adult years, and new approaches to intervention and advances in AAC technology offer greater chance of success.
Research has shown that many individuals with severe disabilities continue to develop communication and language skills in their adult years. Some individuals may experience particularly positive communication outcomes in adulthood due to factors such as improved assessment and intervention options, new communication technologies, or improved health and stamina.
A number of research studies have shown that adolescents and adults with a variety of severe disabilities made measurable gains when provided with appropriate communication services. For example, the Picture Exchange Communication strategy has been used successfully to elicit the expression of requests in adults with severe disabilities (Conklin & Mayer, 2001; Rehfeldt & Root, 2005).
Gains in communication may support an individual to be more self-determined, which means having influence over what happens to your life (Olney, 2001; Wehmeyer, 2005). Communication intervention may address a variety of self-determination components, including choice making and problem solving.
Many adults with severe disabilities continue to express themselves through challenging behaviors. Oftentimes, improved communication yields a collateral improvement in behavior. So, through Functional Communication Training (FCT), we teach a communicative replacement behavior that allows the person to meet his or her needs without acting out (Durand, 1990; Durand & Merges, 2001; Mancil & Boman, 2010). For example, if someone is throwing materials on the floor as a form of refusal (resulting in breakage or potential injury to others), this person might be taught a gesture (such as gently pushing unwanted materials away or shaking his/her head).
Communication services are likely to be particularly important for adults as they leave home and school and move into new living or working environments. Adults with severe disabilities often need communication services to adapt their communication systems to the demands of new settings. For example, they may need new words added to their communication devices, or they may need to learn how to communicate new functions or meanings. They may need new daily schedule systems to relieve anxiety about new expectations and to provide a context for conversations about their new daily routines.
Communication services provided to adults should include professional development supports to communication partners, such as coworkers, job coaches, and support personnel. Adults with severe disabilities continue to need communication partners who understand their highly individualized and often nonconventional means of communicating. They continue to require highly responsive communication partners—including partners who recognize emergent intentional communication and create opportunities for communication to occur (Ogletree, Bartholomew, Wagaman, Genz, & Reinzinger, 2012).
Thus, communication intervention remains a need in adulthood, and we should expect that, with appropriate programming, gains in communication are likely.
Communication is a lifelong activity of value to people of all ages; intervention to facilitate effective communication is warranted for all ages.
Read the NJC position statement on access to communication services for individuals with severe disabilities, including those over age 22 years.