Tapping Into the ‘Augmentative’ of AAC Who can benefit from augmentative communication and how do you choose a system? Here are some tips. Make It Work
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Make It Work  |   February 01, 2017
Tapping Into the ‘Augmentative’ of AAC
Author Notes
  • Lisa J. Lawrence, MS, CCC-SLP, is area director for Invo HealthCare/Progressus. She provides support, guidance and clinical leadership to schools, early intervention agencies and clinicians in Philadelphia, New Jersey and Washington, D.C. She is an affiliate of ASHA Special Interest Group 12, Augmentative and Alternative Communication. llawrence@invo-progressus.com
    Lisa J. Lawrence, MS, CCC-SLP, is area director for Invo HealthCare/Progressus. She provides support, guidance and clinical leadership to schools, early intervention agencies and clinicians in Philadelphia, New Jersey and Washington, D.C. She is an affiliate of ASHA Special Interest Group 12, Augmentative and Alternative Communication. llawrence@invo-progressus.com×
Article Information
Augmentative & Alternative Communication / Make It Work
Make It Work   |   February 01, 2017
Tapping Into the ‘Augmentative’ of AAC
The ASHA Leader, February 2017, Vol. 22, 38-39. doi:10.1044/leader.MIW.22022017.38
The ASHA Leader, February 2017, Vol. 22, 38-39. doi:10.1044/leader.MIW.22022017.38
Sometimes when seeking an appropriate augmentative and alternative communication (AAC) device for our clients, we may overlook the importance of the “augmentative” side of AAC.
Augmented communication remains an essential tool for clients who functionally communicate through verbal language. However, these clients might not always effectively communicate verbally or may experience communication breakdowns, especially with unfamiliar communication partners.
I have found during my 23 years as a speech-language pathologist specializing in AAC that the addition of augmentative communication can serve these clients during—or even to prevent—communication breakdowns. For these clients, AAC augments their unaided communication as a means of conversational repair.
Some people who benefit from the augmented side of AAC may include:
  • Children with moderate unintelligibility due to apraxia, phonological disorders or articulation delays.

  • People with moderate to severe dysarthria whose speech breaks down as they become increasingly tired and experience increased muscle weakness.

  • People with word-finding difficulties.

The more input the client and family have during the process, the more they will use their AAC system, experience success, and generalize use to everyday conversation.

Getting on board
The evaluation of AAC systems for people who need augmented communication should be a team effort with the SLP, client and the client’s family or caregivers. The first step is to make sure the client and family understand the need for an AAC system. That understanding—and their subsequent buy-in—help ensure successful assessment and implementation.
How do we get buy-in? I show the client and family how AAC gives them power in their everyday communication interactions. This approach increases their acceptance and desire to use an augmented system for conversational repair.
The process should follow the same protocol as any AAC assessment: trials of various levels of AAC systems from low-tech to high-tech, symbol sets, language sets, and sizes of devices, as well as an overall match of needs to device features. Get your clients’ feedback throughout the evaluation. The more input the client and family have during the process, the more they will use their AAC system, experience success and generalize use to everyday conversation.

The system should be flexible and allow them to quickly augment their speech with a word, a category or a conversational topic in order for the communication partner to understand their message.

Choices
The systems available for augmentative communication are the same as those for alternative communication, but the decision-making process may be different. A client’s choice of system may surprise you. For example, they may choose a system that is very large, because they are comfortable with that particular device. Or they may choose a simpler system, because ease of access is most important to them. Allowing clients to guide the choice increases the chance that they will use their AAC system.
In assessing language systems for alternative AAC users, the idea is to provide the most complex language system they can handle to provide them with maximum opportunities to generate language. For augmented users, however, the system may be needed mostly for conversational repair and expansion when communication breaks down. The system should be flexible and allow them to quickly augment their speech with a word, a category or a conversational topic in order for the communication partner to better understand their message.
The client, therefore, may choose a less-complex language system that allows quick access to core and fringe vocabulary. Augmented users may choose a system that has phrase- and category-based capabilities—in addition to a word-based system—to achieve quicker access, especially children who need the system primarily for conversational repair.
I find that many children with apraxia or phonological disorders tend to choose the simpler phrase- and category-based language systems, with great success for the level of conversational repair they need. I have worked with children who were unsuccessful using a higher-level language system, but who experienced almost immediate success when they changed to a lower-level language system that was easier and faster to access.
Many children use core vocabulary because it allows for generative language and increased vocabulary as they develop more complex syntactical knowledge in combination with word- and phrase-prediction ability as well as prestored phrases to increase efficiency. Many systems—both apps and dedicated speech- generating devices—offer these features.
Alternative communication is a vital part of speech-language treatment for those who can’t communicate verbally, and augmented communication is just as important for those who experience frequent breakdowns. SLPs should consider augmented communication devices for people with apraxia of speech, phonological disorders, articulation delays, dysarthria or word-finding difficulties.
1 Comment
February 16, 2017
Margery Blanc
Using the term 'verbal'
Your points about 'alternative communication' are wonderful! But it's time we correct the mistake we make when we refer to speaking as synonymous with 'verbal.' Speaking is a modality, and all the other modalities of expression are equally valid ways of verbal expression.This (innocent) mistake has become commonplace, but it's a mistake — and results in tremendous misunderstanding. Expressing language through speech is simply expressing language through speech — but the other ways of communicating 'verbally' are writing, typing, various language-based AAC, and sign language. When kids do not communicate effectively through speech, we often apply the term 'non-verbal' — incorrectly — and the ramifications are wide-spread. The autism community commonly refers to kids whose speech is absent or unintelligible or lacking some level of intelligibility as 'non-verbal,' which literally means 'without words,' or 'without language.' This presumption turns out to be false when kids start typing, or using some other modality to express their 'verbal skills.' It is an innocent mistake we all make, but we need to correct ourselves!
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February 2017
Volume 22, Issue 2