JCPSLP Vol 17 No 3 2015

Fresh science and pioneering practice

Early intervention and AAC Research and expert recommendations Pariya Behnami and Sally Clendon

This paper explores the appropriateness and benefits of implementing augmentative and alternative communication (AAC) with children under the age of five. It outlines a number of myths related to the use of AAC with young children and examines the existing evidence base in order to identify the modes of AAC that have been shown to be effective. Finally, the paper provides suggestions of where to begin with early intervention involving AAC with reference to key research findings and advice from field experts. These suggestions include following language progression models based on typical language development, focusing on highly motivating interactions to teach the coaching, having high expectations, using a multimodal approach, targeting operational skills alongside communication intervention, and providing extensive aided language input. I t is well researched and widely accepted across education, medical, and allied health communities that early intervention (EI) for children with disabilities results in ongoing, significant positive outcomes. These include improvements in important domains such as cognition, communication, and motor skills (Landa & Kalb, 2012; Miller & Guitar, 2009; Spittle, Orton, Anderson, Boyd, & Doyle, 2012). The benefits also extend beyond children, with positive outcomes for families including enhanced parent–child interactions (Ciccone, Hennessey, & Stokes, 2012) as well as increased parental self-esteem, decreased stress, and greater use of community resources (e.g., Benzies et al., 2014). Furthermore, effective EI allows for more cost-effective service delivery which is critical in the current financial market (Drager, Light, & McNaughton, 2010; Eapen, Crncec, & Walter, 2013). An understanding of the benefits of effective EI provision is important for a range of people and services including: families, clinicians, educators, support staff, management, training services, and fund holders. Alongside the importance of understanding the benefits of EI is the importance of knowing how to implement effective EI. power of communication, providing communication partners with robust

This paper explores the appropriateness and benefits of implementing augmentative and alternative communication (AAC) for children under the age of five. Despite the acceptance of the importance of intervening as early as possible with children with disabilities, and the evidence base supporting the use of AAC with individuals with complex communication needs (CCN), a number of myths have hampered the provison of AAC to young children. These myths will be examined, and existing research will be explored to identify what modes of AAC and supports have been shown to be effective. Finally, the paper will provide suggestions of where to begin with AAC intervention by discussing implications for clinical practice from research findings and advice from field experts. AAC AAC is a term used to describe “the use of non-speech modes as a supplement to, or a substitute for, spoken language” (von Tetzchner & Jensen, 1996, p. 1). AAC systems can be no-tech, low-tech, mid-tech, or high-tech. Examples of no-tech systems include sign language and communication boards or books. These systems are no-tech as they do not require a power source. Low-tech, mid-tech, and high-tech systems do require a power source and vary in terms of their programming complexity and the amount of training required (Assistive Technology Training Online Project, 2000–2005). High-tech systems also differ from low- and mid-tech systems in that they can store large amounts of vocabulary and therefore enable more complex message generation. No-tech systems may also provide access to a large amount of vocabulary. When discussing high-tech AAC systems, it is important to acknowledge the significant role that technology plays in the lives we lead today and the crossovers occurring between mainstream technologies and AAC. The advent of mobile technology such as tablets and smart phones has resulted in technology becoming pervasive, heavily influencing areas such as social communication and access to information. Recent evidence exploring the impact of this for young children suggests that access to technology facilitates the development “of a huge array of skills, knowledge, and understandings about the world in which they live” (Yelland & Gilbert, 2014, p. 2). The increased availability of technology, particularly mobile technology, has resulted in more widespread use and acceptance of AAC. Light and McNaughton (2014) recently re-examined Light’s (1989) model of communicative competence for users of AAC. They

THIS ARTICLE HAS BEEN PEER- REVIEWED KEYWORDS AUGMENTATIVE AND ALTERNATIVE COMMUNI­ CATION EARLY INTERVENTION LANGUAGE

Pariya Behnami (top) and Sally Clendon

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JCPSLP Volume 17, Number 3 2015

Journal of Clinical Practice in Speech-Language Pathology