JCPSLP Vol 17 No 3 2015

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JCPSLP Volume 17, Number 3 2015 137
4. Start early and consider a range of
communication options including high-
tech AAC.
Children’s neurological development particularly between 0
and 3 years of age is primed for language development
making it imperative to start early and aim high with
intervention (Beukelman & Mirenda, 2013; Light & Drager,
2007; Porter, 2012). A review of studies between 1982 and
2007 found seven conclusive studies (totalling 135
participants) on the use of AAC with children under 3 years
of age (Branson & Demchak, 2009). These included five
single-subject studies and two group designs. They found
that unaided and aided AAC systems could be used
effectively with children under 3 years old. Only two of the
studies compared the effectiveness of different types of
AAC systems, with data indicating that aided AAC systems
may be more effective than unaided systems (Branson &
Demchak, 2009).
Janice Light and Kathy Drager carried out longitudinal
research examining the effects of AAC intervention with nine
children under the age of 5 (Light, 2005). Their intervention
strategy involved weekly hour-long sessions that involved:
1) identifying suitable communication contexts; 2)
developing suitable AAC tools that appealed to the child; 3)
coaching the parent to act as the communication facilitator;
4) ensuring communication occurred across all activities,
and 5) monitoring and evaluating their results. Their findings
indicated that all children had improved rates of turn-
taking; they were able to sustain interactions longer; AAC
systems were used for play and learning, and to facilitate
peer interactions; and the participants acquired a range
of semantic concepts (Light, 2005). All participants were
able to start using visual scene displays (whereby words
and phrases were embedded within a picture of a specific
context, e.g., mum and child talking on a toy phone), before
progressing onto hybrid setups (a combination of a visual
scene display and grid buttons containing words and/or
phrases), and eventually onto traditional grid displays (Light,
2005).
5. Work on skill development
concurrently.
Basic interaction skills, alongside interventions targeting all
areas of communicative competence are imperative for
long-term success (Blackstone, 1999; Campbell et al.,
2006; Light & McNaughton, 2014). Research has
demonstrated that it is possible for children under 1 year of
age to develop switching skills (Campbell et al., 2006).
Linda Burkhart has discussed how to approach skill
development in this area which she terms the “juggling act”
(for more detailed information, please see: http://www.
pdf). Burkhart points out the importance of balancing
increasing demands in one area (such as the physical
movement required to activate a switch) with reduced
demands in another area (such as using the switch in a
highly familiar activity that demands less focused attention
of the child). The approach enables a child to work on skill
development across a number of areas concurrently
(Burkhart, 2008).
6. Model, model, model.
As identified above, receptive language input is vital before
expression can take place. AAC systems are no different. In
order for a child to learn to use an AAC system effectively,
their communication partners must also use the same
system (Porter, 2012; Van Tatenhove, 1987). This use is
Cress & Marvin, 2003; Drager et al., 2010; Judge et al.,
2010; Van Tatenhove, 1987). The ability to exert control and
influence others is a motivating driver for most people.
Through the use of personalised core and fringe vocabulary,
an AAC user can realise the power that these words have
over others, and over their environment. For example the
use of the word more enables continuation of a preferred
activity (e.g., more tickles, more blocks to build a tower
before knocking it down), the use of the word stop
facilitates cessation of something undesired (e.g., to stop
another person’s turn with a toy so the child can play with
it). Robust vocabulary selection and motivational contexts
facilitate the development of a wider range of
communicative functions. It is critical for team members,
including the child’s family, to work collaboratively to ensure
appropriate vocabulary selection for motivating and
meaningful interactions (Horn & Kang, 2012; Trembath et
al., 2007). Please see
page/show/id/4 for further suggestions of how to identify
motivating and powerful communication opportunities (Light
& Drager, 2012).
3. Ensure key communication partners
receive robust coaching on AAC use
and how to support communication
interactions.
The role of communication partners is essential for
successful interactions. A skilled communication partner
has the ability to recognise communication attempts, to
scaffold these attempts, to role model language use, and to
shape behaviours towards more appropriate forms of
communication (Olive et al., 2008). In the initial stage of
AAC intervention, the main focus for clinicians could be to
coach communication partners on the continuum of AAC
methods (e.g., unaided and aided), the use of different
interaction strategies, and general information about
language development (Blackstone, 1999; Cress & Marvin,
2003; Judge et al., 2010; Romski & Sevcik, 2005; Van
Tatenhove, 1987). The training could also include
consideration of environmental modifications required in
order to facilitate successful interactions (Judge et al.,
2010), for example, the positioning of AAC systems in
relation to light sources or objects that may cause
distraction.
A number of studies have shown that communication
partners can implement highly successful AAC interventions
following training (McConkey et al., 2010; Olive et al.,
2008; Romski et al., 2010; Stahmer & Ingersoll, 2004).
Furthermore, communication partner training has produced
positive results in terms of parents’ perceptions of their
child’s abilities and overall parental well-being (McConkey
et al., 2010; Romski et al., 2011). Parents obviously have
a very important role as primary communication partners
for young children with CCN. It is imperative, however,
that clinicans acknowledge the demands facing parents
of children with disabilities. They must consider and
regularly re-evaluate the goals and capabilities of families
when planning and implementing AAC with young children
(Marshall & Goldbart, 2008).
The CONNECT website contains useful resources for
team training regarding environmental adaptations and
the importance of embedding interventions within naturally
occurring routines (please see:
for further
information).