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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. lburkhart.com/handouts/stepping_stones_chart_10_12. 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 http://aackids.psu.edu/index.php/ 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: http://community.fpg. unc.edu/connect-modules/learners/module-1 for further information).

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JCPSLP Volume 17, Number 3 2015

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