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Augmentative and Alternative Communication to Support

Meaningful ParticipationJanice Light, Ph.D.

Penn State UniversityPresentation at PA Everyday Lives Conference

Hershey, PA; January 9, 2020

Individuals with complex communication needs

• Approximately 5 million Americans are unable to rely on speech to communicate• As a result, they are severely restricted in their

participation in education, employment, healthcare, family, & community

Augmentative & Alternative Communication (AAC)

• AAC provides a means to support communication & participation for individuals with limited or no speech• Unaided AAC–Requires only the individual’s body–E.g., gestures, pantomime, signs (Beukelman &

Mirenda, 2013)

Aided AAC

• Aided AAC–Requires some form of external support• Low tech communication boards or books• Picture Exchange Communication Symbols PECS• Visual schedules• Assistive technologies with speech, text, & electronic

output • (Beukelman & Mirenda, 2013)

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Benefits of AAC

• Research demonstrates that AAC –Enhances communication–Supports language development– Increases participation–Reduces challenging behaviors–At no risk to speech development – (Light, McNaughton,& Caron, 2019)

Benefits of AAC

• Benefits of AAC extend–Across ages• Infants, toddlers, preschoolers, school-aged children,

adolescents, & adults–Across individuals with• Autism spectrum disorder, cerebral palsy, Down

syndrome, intellectual developmental disabilities, multiple disabilities, etc.

How can we best support individuals with complex communication needs

who require AAC?Start as early as possible

AAC supports communication, language development, & learning

AAC does not inhibit speech development

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AAC supports early learning

Gina is 10 months old. She has Down syndrome, and lives at home with her parents and her older sisters. She does not talk. She loves looking at books and loves animals, especially the family dog, Blue.

AAC supports early learning• Introduce AAC as early as possible• Snap photos of meaningful & motivating activities using AAC apps• Add vocabulary in response to the child’s interests– Touch the picture to speak the word

• Model signs & gestures• Wait – Allow child time to communicate

• Respond immediately to all attempts to communicate

Research shows AAC supports language development

• Research shows that AAC results in significant increases in the frequency of communication turns & number of unique concepts expressed by– Infants, toddlers, & preschoolers with ASD, IDD, & CP

– Adolescents & adults with severe disabilities who are beginning communicators

– E.g., Drager et al., 2019; Holyfield et al., 2019; Light et al., 2012; 2016; Light & Drager, 2017; Light, McNaughton, & Caron, 2019

Support participation in social interactions

Don’t just focus on requests for food & activitiesUse AAC to foster social interaction

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AAC supports social interaction

Charlie is 8 years old and has ASD. He lives at home with his parents and his younger brother. He uses some sign approximations and he exchanges picture symbols (PECS) to make requests for preferred activities. He likes to look at books and watch videos. He struggles to interact socially with his peers.

AAC supports communication for many purposes

• Too often intervention focuses only on teaching requests

• “There is more to life than cookies”

• Use AAC as a means to support social interactions with peers –Social interactions form

the foundation for friendships–Essential to quality of life

AAC supports social interaction

• Choose motivating shared activities– E.g., preferred books or videos

• Add photos of book pages or preferred videos to AAC apps• Add fun, motivating vocabulary with relevant speech output &

sound effects to support communication• Encourage participants to take turns– Wait and allow partner to communicate– Respond to partner

Research shows AAC supports social interaction

• Research shows that AAC supports social interactions–Preschoolers with ASD & IDD demonstrate increased

turn taking & engagement with peers (Therrien & Light, 2016, 2018)–Adolescents with ASD, Down syndrome, IDD, & CP

demonstrate increased turn taking & engagement with peers (Babb, 2020)

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Ensure appropriately high expectations

Develop skills to fulfill meaningful rolesUse AAC to teach literacy skills

AAC can support literacy learning

• Literacy skills are critical to all aspects of life– Literacy allows individuals to communicate any message

• More than 90% of individuals with complex communication needs enter adulthood without literacy skills

• As a result, they are severely restricted in their access to education, employment, healthcare, & community living

• But it doesn’t have to be this way

AAC supports literacy learning

Sandra is 14 years old and has cerebral palsy. She uses speech but unfamiliar partners have difficulty understanding her. She uses picture-based AAC technology to clarify. She attends a life skills program at school; she has not received literacy instruction. She wants to get a job at the SPCA and volunteer at her church but is limited by her lack of literacy skills.

Provide adapted evidence-based literacy instruction

• Utilize meaningful & motivating materials• Target appropriate skills• Teach letter sound knowledge, sound blending, decoding, phoneme

segmentation, encoding, reading comprehension• Use evidence-based instructional procedures– Model, guided practice, independent practice

• Adapt instruction – Support alternative response modes

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AAC technologies support literacy learning

• Tiffany is 22 years old. • She has Down syndrome and a history of seizures. • She lives at home with her parents and two sisters. • She loves bowling and wrestling. • She attends a post-secondary program for adults with IDD. • She did not receive literacy instruction at school. • She uses an AAC app with pictures to clarify her speech.

Use AAC to support literacy learning

• Utilize AAC apps with the transition to literacy (T2L) feature• Individual selects picture symbol• Text appears dynamically• Movement attracts individual’s attention to the written word

• Word is spoken out • Links text to speech

• Text is also linked to picture symbol to promote understanding of meaning

Research shows AAC technologies can support literacy learning

• Research shows that AAC apps with T2L support literacy learning – Research with more than 50 individuals with ASD, CP, Down

syndrome, IDD• Ages 3-50+

– 91% increased their reading skills using AAC to support the transition to literacy

– Learned to read words with only 1-17 minutes of exposure to dynamic text

– E.g., Boyle et al., 2017; Caron et al., 2018; Holyfield et al., 2018; Light, McNaughton, & Caron, 2019; Mandak et al., 2018

Focus on increasing participation in meaningful real world contexts

Target motivating goals

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AAC supports participation in the community

James is 21-years old and has severe ASD. He has no functional speech. He is currently participating in a vocational training program at the school library. His responsibilities include checking books in and sorting books. He is very dependent on his job coach to assist him in completing his work tasks; he rarely communicates.

AAC supports participation• Introduce AAC technologies with video visual scene displays (VSDs)• Combine benefits of – Video modeling– AAC supports

• AAC video VSD technology– Capture video of each step of the activity– Individual watches video of each step – Video pauses at end of each step– Automatically provides VSD with relevant vocabulary – Individual completes step / required communication

AAC supports community participation

• Research shows that AAC apps with video VSDs support successful participation in employment, volunteer, & community activities

• All participants demonstrated significant increases –# of steps completed successfully –# of communication opportunities fulfilled successfully >90% successful independent participation – (O’Neill et al., 2017; Babb, Gormley, et al., 2018; Babb et al.,

in press)

Impact of AAC to support participation• “I think it's very powerful to see them go from

where they started and then, in a matter of a couple of weeks, to be able to work independently. That was just absolutely incredible. You could just see the pride - the students were feeling very successful. ”

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Effects of AAC supports

• AAC offers the potential to enhance• Communication• Language learning• Social interaction with peers• Literacy learning• Participation in education, employment, healthcare, &

community living

Take away messages

• Start as early as possible– AAC supports learning

• Support a wide range of communication goals– Use AAC to foster social interactions

• Ensure appropriately high expectations– Build skills to fulfill meaningful roles

• Focus on increasing participation in real world contexts– Target meaningful and motivating goals

Conclusion

• It is necessary, but not sufficient, to provide evidence-based AAC technologies & interventions• Also required is a deep commitment to the fundamental

right of all individuals to have the opportunity to attain their full potential.

https://aac-learning-center.psu.edu/2018/10/14/the-folly-of-fortune-telling/

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Further resources on AAC

• For further information and videos on AAC interventions, please visit

• https://aac-learning-center.psu.edu/• https://aackids.psu.edu• https://aacliteracy.psu.edu• https://aac.psu.edu• https://rerc-aac.psu.edu

Handouts and references are available at https://aac.psu.edu

References• Babb, S., McNaughton, D., Light, J., Caron, J., Wydner, K., & Jung, S. (2020). Using AAC video visual scene displays

to increase participation and communication within a volunteer activity for adolescents with complex

communication needs. Augmentative and Alternative Communication.

• Babb, S., Gormley, J., McNaughton, D., & Light, J. (2019). Enhancing independent participation within vocational

activities for an adolescent with ASD using AAC video visual scene displays. Special Education Technology, 34,120-132. doi: 10.1177/0162643418795842

• Boyle, S., McCoy, A., McNaughton, D. & Light, J. (2017). Using digital texts in interactive reading activities for

children with language delays and disorders: A review of the research literature and pilot study. Seminars in Speech and Language, 38,263-275. doi: 10.1055/s-0037-1604274

• Beukelman, D. & Light, J. (2020). Augmentative and Alternative Communication. Baltimore MD: Paul H. Brookes

Publishing Co.

• Caron, J., Holyfield, C., Light, J., & McNaughton, D. (2018). “What have you been doing?”: Supporting displaced

talk through AAC video VSD technology. Perspectives on Augmentative and Alternative Communication, 3, 123-

135. doi: 10.1044/persp3.SIG12.123

• Caron, J. G., Light, J., Holyfield, C., & McNaughton, D. (2018). Effects of dynamic text in an AAC app on sight word

reading for individuals with autism spectrum disorder. Augmentative and Alternative Communication, 34, 143-

154. doi: 10.1080/07434618.2018.1457715

References• Drager, K., Light, J., Currall, J., Muttiah, N., Smith, V., Kreis, D., Nilam-Hall, A., Parratt, D., Schuessler, K.,

Shermetta, K., & Wiscount, J. (2019). AAC technologies with visual scene displays and “just in time” programming and symbolic communication turns expressed by students with severe disability. Journal of Intellectual & Developmental Disability, 44, 321-336. doi: 10.3109/13668250.2017.1326585

• Holyfield, C., Caron, J.G., Drager, K., & Light, J. (2019). Effect of mobile technology featuring visual scene displays and “just-in-time” programming on the frequency, content, and function of communication turns by pre-adolescent and adolescent beginning communicators. International Journal of Speech Language Pathology, 21,201-211. doi: 10.1080/17549507.2018.144144Communication Displays in Individuals with and without NeurodevelopmentalDisorders

• Holyfield, C., Caron, J., Light, J., & McNaughton, D. (2019, advance online). Effect of video embedded with hotspots with dynamic text on single word recognition by children with multiple disabilities. Journal of Developmental and Physical Disabilities. doi: 10.1007/s10882-019-09673-5

• Holyfield, C., Caron, J., & Light, J. (2019, advance online). Programming AAC just-in-time for beginning communicators: The process. Augmentative and Alternative Communication doi: 10.1080/07434618.2019.1686538

• Holyfield, C., Light, J., McNaughton, D., Caron, J., Drager, K., & Pope, L. (2019, advance online). Effect of AAC technology with dynamic text on the single word recognition of adults with intellectual and developmental disabilities. International Journal of Speech Language Pathology. doi: 10.1080/17549507.2019.1619836

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References

• Light, J. & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication. Augmentative and Alternative Communication, 30, 1-18.

• Light, J. & McNaughton, D. (2012). Supporting the communication, language, and literacy development of children with complex communication needs: State of the science and future research priorities. Assistive Technology, 24, 34-44.

• Light, J., McNaughton, D., & Caron, J.G. (2019). New and emerging AAC technology supports for children with complex communication needs and their partners: State of the science and future research. Augmentative and Alternative Communication, 35, 26-41. doi: 10.1080/07434618.2018.1557251

• Mandak, K., Light, J., & Boyle, S. (2018). The effects of instruction on single-word reading for individuals who use aided AAC: A systematic review. Augmentative and Alternative Communication, 34, 206-218. doi: 10.1080/07434618.2018.1470668

• Mandak, K., Light, J., & McNaughton, D. (2019). Digital books with dynamic text and speech output: Effects on sight word reading for preschoolers with autism spectrum disorder. Journal of Autism and Developmental Disabilities, 49, 1193-1204 . doi: 10.1007/s10803-018-3817-1

References• O’Neill, T., Light, J., & McNaughton, D. (2017). Videos with integrated AAC visual scene

displays to enhance participation in community and vocational activities: Pilot case study of an adolescent with autism spectrum disorder. Perspectives on Augmentative and Alternative Communication, 2(12), 55-69. doi:10.1044/persp2.sig12.55

• Therrien, M. & Light, J. (2018). Promoting peer interaction for preschool children with complex communication needs and autism spectrum disorders. American Journal of Speech Language Pathology, 27, 201-221. doi:10.1044/2017_AJSLP-17-0104

• Therrien, M. & Light, J. (2016). Teaching communicative turn-taking using the iPad to support social interaction for children who use AAC. Augmentative and Alternative Communication, 32, 163-174. doi: 10.1080/07434618.2016.1205133.

• Therrien, M., Light, J., & Pope, L. (2016). Systematic review of the effects of interventions to promote peer interactions for children who use aided AAC. Augmentative and Alternative Communication, 32, 81-93. doi: 10.3109/07434618.2016.1146331

RERC-AAC.ORG• We are very grateful to all of the individuals who use AAC and families who

have participated in our research. • The contents of this presentation were developed under a grant from the

National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number #90RE5017) to the Rehabilitation Engineering Research Center on Augmentative and Alternative Communication (RERC on AAC).

• NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this presentation do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.