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JCPSLP
Volume 17, Number 3 2015
Journal of Clinical Practice in Speech-Language Pathology
It is also understood and accepted that typically
developing children experiment and play with language
in order to refine their language use (Cress & Marvin,
2003). Therefore, children with CCN must have access
to comprehensive AAC systems in order to have the
same opportunities for language play and exploration
(Burkhart, 2008; Porter, 2012). Without AAC systems
in place, children with CCN have limited capacity to
demonstrate their ability and understanding (Romski &
Sevcik, 2005). A person’s ability to communicate is strongly
linked to cognitive development and also to their ability to
demonstrate knowledge (Romski & Sevcik, 2005), making
it essential for children with CCN to have access to AAC
systems early on so they can experience these language
learning opportunities.
It is necessary to point out that while prerequisite skills
do not exist
before
AAC systems can be implemented,
foundation interaction skills do need to be addressed
during EI. These skills support all communication
interactions, including the use of AAC. They include the
development of cause and effect, joint attention, intentional
behaviours, shared enjoyment, and receptive language
skills (Blackstone, 1999). Experts interviewed on this topic
reported placing particular emphasis on making interactions
engaging for children, using a range of AAC tools
concurrently, and focusing their interventions on the use of
core vocabulary (Blackstone, 1999).
For some children, concurrent operational skill
development also needs to take place in order to enable
functional and independent long-term use of AAC
systems. For example, those with motor impairments
may need exposure to switch skill development in order
to compensate for their physical disabilities. A review of
studies focusing on technology use with infants and young
children between 1980 and 2004 revealed 12 studies
that demonstrated strong evidence for teaching switch
activation successfully to children under 1 year of age with
a variety of diagnoses and cognitive abilities (Campbell,
Milbourne, Dugan, & Wilcox, 2006).
Guidelines for AAC intervention
The following section provides suggestions for where to
start with AAC intervention for children under 5 of age.
1. Follow language progression models
of typically developing children by
targeting appropriate language levels
within intervention.
As discussed above, the language development of typically
developing children is supported by a significant amount of
receptive language input, accompanied by adult support
within the child’s zone of proximal development.
Opportunities to use, explore and play with language are
reinforced by communication partners attributing meaning
to children’s communication attempts. For children requiring
AAC, it is essential that these same foundations and
opportunities are provided, and that we use models of
typical language progression to guide intervention
(Burkhart, 2008; Cress & Marvin, 2003; Light & Drager,
2007; Porter, 2012; Van Tatenhove, 1987).
2. Focus on highly motivating
interactions to teach the power of
communication.
Implementing AAC in the context of highly motivating
interactions is critical (Blackstone, 1999; Burkhart, 2008;
demands relating to their children’s disabilities, as well
as feelings relating to grief and loss (Marshell & Goldbart,
2008). These pressures may influence their capacity to
engage with their child’s AAC intervention. Marshall and
Goldbart (2008, p. 95) explained that:
parents vary in how much and at what point(s) they
prioritize communication over other issues, how
involved and how ‘expert’ they want to be. They
experience the insufficiency of time which makes it
difficult to achieve all that they would like to and they
may feel frustrated and guilty about their children’s
difficulties and what they are able to offer them .
Professionals must acknowledge these factors and tailor
their expectations and approaches to align with individual
families’ priorities and needs (Marshall & Goldbart, 2008).
Communicative functions
All too often caregivers and teams become focused on the
communication of basic wants and needs such as
mealtimes and toileting. While these types of messages are
highly important, it is critical for children with CCN to be
introduced to a wide range of communicative functions
(Cress & Marvin, 2003; Light & McNaughton, 2014; Van
Tatenhove, 1987), for example, commenting, arguing,
requesting, protesting, greeting, asking questions, initiating,
and many more. Intervention focusing on core vocabulary
development not only provides the user with
communicative power, but also ensures the modelling and
use of a range of communicative functions.
Prerequisites for AAC use
An important myth to dispel is the presumption that a set of
prerequisites must be met before AAC intervention can
commence. For example, it was previously thought that
children needed to demonstrate understanding through a
hierarchy of symbol representation methods from real
objects to photos before moving onto line drawings.
However, Romski and Sevcik (2005) argued that no such
hierarchy exists. Their assertion was backed up by research
with typically developing children across three
developmental stages (6, 9 and 12 months) which found no
significant differences between or across participant
responses to photos versus PCS symbols for choice
making (Da Fonte & Taber-Doughty, 2010).
Another misconception is that the child must
demonstrate a certain level of cognitive skill before AAC is
introduced. This assumption is dangerous as we do not
approach language acquisition with typically developing
children in this manner. Rather, we understand that we
must speak to them for at least 12 months before they
are likely to speak their first word back to us. Furthermore,
we speak to them using many more words than they can
say to us at any given time, while concurrently reducing
the complexity of our language, enabling us to operate
within their zone of proximal development (what the child
is able to achieve and learn with the support of an adult;
Vygotsky, 1978). This process of feeding language in before
expecting output highlights the two key components of
language acquisition and use, which are, receptive (what
one understands) and expressive (what one is able to
communicate). For all people learning language at any
stage of life, language must be absorbed receptively before
it will be expressed. For users of AAC, this process can
be replicated through the use of their AAC system by their
communication partners (Goossens, 1989; Porter, 2012).