JCPSLP Vol 17 No 3 2015

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JCPSLP Volume 17, Number 3 2015 135
In a final example, Romski and colleagues (2010)
investigated the impact of speech generating devices
(SGDs) during language interventions. They assigned
groups of children, aged 2–3 years old, to three
experimental conditions: speech only; aided input (where
participants were prompted to communicate using a
mid-tech voice output system); and aided output (where
communication partners modelled the use of a mid-tech
voice output system). The children who received the two
aided interventions produced significantly larger amounts of
vocabulary (either via speech or their AAC system) than the
speech only group (Romski et al., 2010).
Timing of AAC implementation
Experts in the field of AAC recommend that AAC is
introduced as early as possible in order to avoid potential
long-term negative outcomes associated with
communication impairment (Cress & Marvin, 2003; Drager
et al., 2010; Light & Drager, 2007; Romski & Sevcik, 2005;
Van Tatenhove, 1987). As Romski and Sevcik stated: “AAC
is not a last resort but rather a first line of intervention that
can provide a firm foundation for the development of
spoken language comprehension and production” (p. 183).
Cress and Marvin (2003) suggested that AAC intervention
should commence if a child’s communication is difficult for
a child’s caregivers or communication partners to decipher.
Often one of the reasons for delaying AAC
implementation with young children is that the majority of
basic wants and needs are generally well interpreted and
adequately met by a child’s primary caregiver. The risk in
this approach however, is that it teaches young children
to become dependent on informed and familiar listeners.
This may lead to the development of learned helplessness
where the child becomes used to not being able to
communicate effectively and ceases to have the motivation
to continue trying (Van Tatenhove, 1987). Suggestions
for preventing learned helplessness involve coaching
communication partners to recognise and support early
communication attempts, and demonstrating the power
of communication through the use of “core vocabulary”
in motivating and functional contexts (Judge et al., 2010;
Olive, Lang, & Davis, 2008; Romski & Sevcik, 2005; Van
Tatenhove, 1987).
Core vocabulary is a set of 400–500 words that feature
in approximately 80% of the speech people produce
(Banajee, Dicarlo, & Stricklin, 2003; Cannon & Edmond,
2009; Clendon & Erickson, 2008; Clendon, Sturm, & Cali,
2013; Trembath, Balandin, & Togher, 2007). They include
words such as: more , again, stop, go, finished, this, that,
etc. These words have the ability to hold power over a
communication partner by directing an interaction. They
also have high utility and thus provide lots of opportunities
for modelling and repeated use (Geist, Hatch, & Erickson,
2014). The remainder of words that make up a person’s
vocabulary (usually many thousands of words) are referred
to as “fringe” or “extended vocabulary”.
A further factor influencing the timing of AAC
implementation is the reality that many children with CCN
have compromised health status. As a consequence,
often therapies which are perceived as additional or
optional are held back until the child’s health is more
stable. This can be a dangerous approach when it comes
to AAC implementation as without a functional means of
communication, these children run the risk of being unable
to express themselves effectively (Cress & Marvin, 2003).
It is critical to acknowledge, however, that parents of
children with CCN are frequently dealing with considerable
discussed the substantial benefits inherent in access to
these technologies but also highlighted the increased
demands they place on linguistic, operational, and social
competence. They stated that:
with the dramatic change in the scope of
communication and the explosion of tools through
which to meet communication needs, individuals with
complex communication needs now have access
potentially to a much wider and more diverse audience
than ever before. (Light & McNaughton, 2014, p. 9)
This means, however, that the communication expectations
for AAC users have changed. They must develop the skills
required to “independently use these new tools, adhere to
their conventions, and communicate with a broader
audience that includes those who may have limited or no
prior experience with AAC” (p. 9).
Challenging myths and
misconceptions
Despite the increased availability and implementation of
AAC within some communities, there continue to be myths
and misconceptions about the appropriateness and timing
of AAC intervention with infants and young children. A
number of highly regarded experts in the field of AAC have
written about these issues (Cress & Marvin, 2003; Judge,
Floyd, & Wood-Fields, 2010; Romski & Sevcik, 2005; Van
Tatenhove, 1987).
AAC and speech development
One common assumption is that AAC use will impede or
prevent speech development (Van Tatenhove, 1987). It is
well documented that these concerns are unwarranted
(Cress & Marvin, 2003; Johnston, McDonnell, Nelson, &
Magnavito, 2003; Romski et al., 2010; Stahmer & Ingersoll,
2004). Research studies have demonstrated that AAC
intervention for children below 5 years of age assists with
the development of speech, language and functional
communication skills (e.g., Drager et al., 2010; Johnston et
al., 2003; Dunst, Trivette, Hamby, & Simkus, 2013; Romski
et al., 2010; Stahmer & Ingersoll, 2004).
Johnston and colleagues (2003), for example, introduced
no-tech (Picture Communication Symbols [PCS]) and low-
tech (single message voice output device) AAC systems
to two children (one aged 3;10 with developmental delay
and the other aged 4;6 with athetoid cerebral palsy
and developmental delay) across an average of four
sessions. Their intervention strategies included (a) creating
appropriate and motivating communication opportunities;
(b) modelling use of the AAC system by peers and
teachers; (c) least to most prompting, and (d) naturally
occurring consequences for communication attempts. The
children demonstrated a 100% increase in the correct use
of unprompted symbolic communication (Johnston et al.,
2003).
In another study, Stahmer and Ingersoll (2014) explored
the effectiveness of an EI service for children with autism
spectrum disorder (ASD). The Picture Exchange
Communication System (PECS) and modified sign language
were implemented simultaneously with students who were
described as nonverbal. Not only did the use of AAC appear
to assist spoken language development (80% exited the
program with spoken language), but by the completion of
the intervention, 90% of participants were able to
independently use a functional communication system
compared to only 50% when the study commenced.