Infants & Young ChitdrenVol. 18, No. 3, pp. 174-185© 2005 Lippincott Williams & Wilkins, Inc.

Augmentative Communicationand Early InterventionMyths and Realities

MaryAnn Romski, PhD, CCC-SLP; Rose A. Sevcik, PhD

The use of augmentative and alternative communication (AAC) services and supports with infantsand young children has been limited, owing to a number of myths about the appropriateness ofAAC use with this population. This article will provide an overview of some of the myths thathave hampered the inclusion of AAC into early intervention service delivery and refutes them. Itwill then examine some of the realities that must be considered when delivering AAC servicesand supports to young children. Key words: augmentative communication, severe disabilities,speech and language intervention

FOR more than 3 decades now, the fieldknown as augmentative and alternative

communication (AAC) has addressed the com-munication needs of children and adults whocannot consistently rely on speech for func-tional communication (e.g., Beukelman &Mirenda, 2005). Numerous developments inthe hardware and software options availableto an individual using AAC, including speechoutput capabilities, have occurred from the1980s to the present. The capacities ofthe de-,vices and the intelligibility of the voices haveimproved substantially. (See the Communica-tion Aids Manufacturers' Association Web site,http://www.aacproducts.org, for the range oftechnology available.) Simultaneously, therealso have been important developments in theempirical knowledge base to support decisionmaking for successful clinical assessment andintervention.

from the Georgia State University, Atlanta, Georgia.

The preparation of this article was funded in partby grant DC03799 from Che National Institutes ofHealth and a Research Program Enhancement Grantfrom Georgia State University. The authors contributedequally to the preparation of this article.

Corresponding author: MaryAnn Romski, PhD,CCC-SLP, Department of Communication, Georgia StateUniversity, PO Box 4000, Atlanta, GA 30302 (e-mail:mromski@gsu. edu).

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Despite these advances, the inclusion ofAAC services and supports into early interven-tion service delivery for young children hasbeen hampered primarily by myths about thespecific types of roles AAC plays. The pur-pose of this article is to examine these myths,in light of the current literature on the earlylanguage development period, and to providearguments and data to refute them. To meetthis goal, we "will provide an overview of howlanguage and communication skills emerge inyoung typically developing children and theroles AAC may play in facilitating the develop-ment of young children with significant com-munication disabilities. Next, we will exam-ine some of the myths and then discuss theissues that contribute to the successful deliv-ery of AAC services and supports for youngchildren.

TYPICAL PATTERNS OF EARLYLANGUAGE DEVELOPMENT

Young children use language for manypurposes, including to meet their wants andneeds, to gain knowledge about the worldaround them, to develop and maintain socialrelationships, and to exchange informationwith others. In order for young children todevelop functional language and communica-tion skills, they must be able to comprehend

Augmentative Communication and Earty Intervention 175

and produce language so that they can takeon the reciprocal roles of both listener andspeaker in conversational exchanges (Sevcik& Romski, 2002). Sevcik and Romski (2002)defined language comprehension as theability to understand what is said to us so thatwe can function as a listener in communi-cative exchanges. Conversely, they char-acterized language production as the abil-ity to express oneself so that one canfunction as a speaker in conversationalexchanges.

Language comprehension

Spoken language comprehension skills as-sume an extremely important role in the earlycommunication development of typically de-veloping children (Adamson, 1996). Frombirth on, young, typically developing, chil-dren hear spoken language during rich social-communicative interactions that include reoc-curring familiar situations or events (Bruner,1983; Nelson, 1985). WeU-estabUshed rou-tines draw the young child's attention toword forms and their referents in the environ-ment. Word input from the caregiver to thechild also permits the caregiver to create newlearning opportunities by capitalizing on well-established routines and the child's under-standing of them (Oviatt, 1985). These socialand environmental contexts converge withthe available linguistic information to produceunderstandings (Huttenlocher, 1974). Con-textual, or situational, speech comprehensionbegins to emerge as early as 9 months ofage and by 12-15 months the child under-stands, on average, about 50 words withoutcontextual supports (Benedict, 1979; Miller,Chapman, Branston, & Reichle, 1980; Snyder,Bates, & Bretherton, 1981). This type of com-prehension means that children first learnto respond to words in highly contextual-ized routines that include situational supports(Platt & Coggins, 1990). For example, a childtouches the blocks after her mother says"go get the blocks" and simultaneously pointsto them. The understanding of these wordsprogress developmentally from person and

object names to actions and from present toabsent person and object names. The mostcommon compositions of the first 50 recep-tive words include people, games and rou-tines, familiar objects, animals, body parts,and actions (Fenson et al., 1994). Recently re-ported methodologies suggest that from theoutset the young child relies on comprehen-sion to build a foundation for later productiveword use (Hollich, Hirsh Pasek, & Golinkoff,2000).

As children move through their secondyear of life, the character of their under-standing of words changes. By 24 months,they rely more on social cues than on per-ceptual cues (Hollich et al., 2000). Theyalso quickly expand their understanding fromsingle words to relational commands, suchas "Give daddy a kiss," and can carry outsuch instructions (Goldin-Meadow, Seligman,& Gelman, 1976; Hirsh-Pasek & Golinkoff,1996; Roberts, 1983). Golinkoff, Hirsh-Pasek,Cauley, and Gordon (1987) reported thattypically developing children as young as17 months of age, who were characterizedas productively one-word communicators andnot producing word order, actually compre-hended word order (e.g., "Big bird tickleErnie." "Ernie tickle big bird.") when a video-based preferential looking paradigm was em-ployed to assess their skills.

Interestingly, Fenson and his colleagues(1994) reported overlap between the wordsyoung children comprehended and pro-duced, although comprehension was shownto have a developmental advantage in the ma-jority ofthe children they studied. Young typ-ically developing children quickly move onto word production, and the child's ability tocomprehend words, and even sentences, isassumed by the adults in the child's environ-ments. Since word production skills emergeso quickly in typical children, they may maskand overshadow the continuing role speechcomprehension plays in the early language de-velopment process. Comprehension may playa particularly important role for the young 'child who is encountering great difficultywith this process.

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Language Production

Young children typically begin to speak be-fore 2 years of age. From birth to approxi-mately 18-21 months of age, the young typ-ically developing child advances through thestages of intentional communication devel-opment (perlocutionary or preintentional, il-locutionary or intentional) learning that heor she can control the world through com-munication. (See Brady & McLean, 2000, fora review.) Somewhere between 12 and 15months the young child begins to producefirst word approximations and slowly starts todevelop a vocabulary. At about the same timethat the young typically developing child at-tains a 50-word productive vocabulary (18-21 months) and experiences a spurt in vo-cabulary size, he or she is also beginning tocombine words. So, prior to the time a childhas a 50-word vocabulary, the focus of com-munication development is on learning aboutthe social functions and the meaning of lan-guage rather than on its grammatical dimen-sions. The child who is not yet talking may usecomprehension skills as a way to break intolanguage.

OverviewThe beginning period of language develop-

ment is rich with opportunities for the youngchild to develop a firm language foundationeven though he or she is not yet talking. Thisfoundation includes opportunities to developcomprehension skills and to communicate viavocalizations, gestures, and other means evenbefore he or she uses a conventional out-put mode such as speech, manual signs, orsymbols. The literature on typically develop-ing children's language development stronglysuggests then that these early types of expe-riences are important for later language de-velopment. It also illustrates the developmentof communication, language, and speech—3distinct but related processes. Early languageinterventions must consider how these recep-tive and expressive experiences can be in-corporated into intervention strategies duringthe beginning developmental period throughthe means of AAC.

YOUNG CHILDREN WITHDEVELOPMENTAL DISABILITIES

Every day, children who cannot speak facesocial and educational isolation as well as sig-nificant frustration because they are unableto communicate their necessities, desires,knowledge, and emotions to their parents, sib-lings, extended family members, peers, andteachers. These limitations may be due tosome type of congenital disability that hinderstheir development of speech or having experi-enced an injury or illness very early in life thatsubstantially limits the speech and languageabilities they are developing. Autism, cerebralpalsy, cognitive disabilities, dual sensory im-pairments, genetic syndromes, multiple dis-abilities (including hearing impairment), oreven a stroke at or near birth are congenitaldisabilities that may impede the developmentof speech and language skills. A young childalso may encounter difficulty communicatingvia speech through a traumatic brain injury asa result of an accident, stroke, or, in rare in-stances, even severe psychological trauma.

Most children with developmental disabil-ities do develop functional spoken com-munication skills during their childhood(Abbeduto, 2003); thus children who do noteventually speak form a relatively low inci-dence population. There are certainly indi-vidual differences in communication patterns.Not every child presenting w ith one of thesedisorders is, or will be, nonspeaking acrosshis or her entire life span, but children withinthis broad range of disabilities may use AAC atsome point during their early development toaugment natural speech so that they can com-municate and develop language skills.

WHAT IS AUGMENTATIVE ANDALTERNATIVE COMMUNICATION?

Communication is defined in the broadestsense as "any act by which one person givesto or receives from another person informa-tion about that person's needs, desires, per-ceptions, knowledge, or affective states" (Na-tional Joint Committee [NJC], 1992; http://www.asha.org/njc). Language is an arbitrary

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code that we use to communicate with oneanother and speech is an output mode thatuses the oral mechanism.

By definition, AAC is an intervention ap-proach (Glennen, 2000) that uses manualsigns, communication boards with symbols,and computerized devices that speak andincorporate the child's full communicationabilities. These abilities may include anyexisting speech or vocalizations, gestures,manual signs, communication boards andspeech-output communication devices. (SeeAmerican Speech-Language-Hearing Asocia-tion [ASHA], 2002, for a comprehensive defi-nition of AAC) In this sense, then, AAC is trulymultimodal, permitting a child to use everymode possible to communicate messages andideas, AAC abilities may change over time, al-though sometimes very slowly, and thus theAAC system selected for use at one age mayneed to be modified as a young child growsand develops (Beukelman & Mirenda, 2005),

A child can communicate using a rangeof representational mediums from symbolic(e,g,, speech or spoken words, manual signs,arbitrary visual-graphic symbols, printedwords) to iconic (e,g,, actual objects, photo-graphs, line drawings, pictographic visual-graphic symbols) to nonsymbolic (e.g., signalssuch as crying or physical movement), (SeeMineo Mollica, 2003, and Sevcik, Romski,& Wilkinson, 1991, for discussions of visual-graphic representational systems,) In addi-tion to the vocalizations and gestures thatsome young children use, they may benefitfrom other dimensions of AAC when com-municating with familiar and unfamiliarpartners across multiple environments. Someyoung children have no conventional w ay tocommunicate and may express their commu-nicative wants and needs in socially unac-ceptable ways, such as through aggressive ordestructive, self-stimulatory, and/or persever-ative means, AAC systems can replace theseunacceptable means with conventional formsof communication.

Typically, forms of AAC are divided into 2broad groups, known as unaided and aidedforms of communication. Unaided forms ofcommunication consist of nonverbal means

of natural communication (including gesturesand facial expressions) as well as manual signsand the American Sign Language (ASL), andcan be employed by children who are able touse their hands and have adequate fine-motorcoordination skills to make fine-grained pro-duction distinctions between hand-shapes. Ofcourse, communication partners too must beable to understand the signs for communica-tion to take place.

Aided forms of communication consist ofthose approaches that require some addi-tional external support, such as a commu-nication board with symbols (i,e,, pictures,photographs, line drawings, symbols, printedwords) or a computer that "speaks" for itsuser (also known as a "speech-generating" de-vice) via either synthetically produced speechor recorded natural (digitized) speech. Fromlaptop computers that talk and can performa wide range of other operations (e,g,, wordprocessing. World Wide Web access) to com-puterized devices dedicated to communica-tion, technological advances have produceda range of opportunities for communication.These boards and devices typically displayvisual-graphic symbols that stand for, or rep-resent, what the child wants to express.Some children create messages using printedEnglish words or letters of the alphabet. Ac-cess to aided forms of communication canbe via direct selection or scanning. Direct se-lection techniques include pointing with, forexample, finger, hand, head (through a headstick), eyes, or feet. Scanning is a techniquein which the message elements are presentedto the child in a sequence either by a personor the device. The child specifies his or herchoice by responding yes or no to the personor the device after each element is presented.Scanning can be, for example, linear, circu-lar, or row-column and encoding (e,g,, MorseCode; see Beukelman & Mirenda, 2005, for adetailed description of these techniques),

AAC can play at least four different roles inearly intervention. The role(s) an AAC systemplays will vary depending on an individualchild's needs. These roles are as follows: aug-menting existing natural speech, providinga primary output mode for communication.

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providing an input and an output mode forlanguage and communication and serving asa language intervention strategy. The mostcommon and well-known role is to pro-vide an output mode for communication. Forexample, Janie is a 24-month-old girl withspastic cerebral palsy and quadraplegia whoseattempts at speech are unintelligible to every-one other than her family members owing tosevere dysarthria. She understands almost ev-erything that is said to her, Janie could use anAAC system as a primary communication out-put mode in her interactions with adults andother children across a variety of settings. Theother roles, however, can be equally impor-tant, especially for the very young child justbeginning to develop communication skills,David is 36 months old, has some challeng-ing behavior (i,e,, head banging) and a very re-cent diagnosis of autism. He understands lessthan 20 words and has just a few undifferen-tiated vocalizations. He is learning to use AACto indicate his wants and needs to his familyand teachers. In this case, AAC serves a verydifferent role than it did for Janie functioningas an input-output mode and a language inter-vention strategy. Using a developmental per-spective, AAC interventions (i.e,, gestures, de-vices, switches) can be viewed as a tool thataids or fosters the development of early lan-guage skills and sets the stage for later vocabu-lary development and combinatorial languageskills regardless of whether the child eventu-ally talks or not,

MYTHS ABOUT AAC

A myth is defined as "a widely held butfalse belief (Oxford, 2002), Clinical myths

are derived from individual professional's be-liefs or assumptions sometimes without anyempirical support. Sometimes myths are per-petuated despite empirical evidence to thecontrary, A limited research base along w iththe immediate demands of providing clini-cal services have fostered practice that re-Ues more on a professional's clinical intuitionthan on current data (Cress, 2003; NJC, 2002),There are at least 6 myths, listed in Table 1,that have developed about the use of AAC,Each myth has grown out of information ex-pressed in clinical literature but has not neces-sarily been backed up by empirical evidenceto support or refute its use. Unfortunately,the myths remain and have become inte-grated into clinical practice. Their use in clin-ical practice may result in young childrenbeing inappropriately excluded from AACsupports and services ("AT/AAC Enables" Website (http://depts,washington.edu/enables/);Cress & Marvin, 2003; NJC, 2002).

Myth 1: AAC is a "last resort" inspeech-language intervention

When AAC was first emerging as an in-tervention strategy, it was considered a "lastresort," to be employed only when everyother option for the successful developmentof speech had been exhausted. In 1980, Millerand Chapman argued for a set of decisionrules that indicated AAC was to be consid-ered when speech had not developed by age8 years (Miller & Chapman, 1980), Since thattime, additional information has emerged tochange the use of decision rules such as these.The use of AAC interventions should not becontingent on failure to develop speech skills

Table 1. Myths about AAC use

Myth 1 AAC is a "last resort" in speech-language intervention.Myth 2 AAC hinders or stops further speech development.Myth 3 Children must have a certain set of skills to be able to benefit from AAC,Myth 4 Speech-generating AAC devices are only for children w ith intact cognition.Myth 5 Children have to be a certain age to be able to benefit from AAC,Myth 6 There is a representational hierarchy of symbols from objects to written words (traditional

Orthography),

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or considered a last resort because AAC canplay many roles in early communication de-velopment as described earlier (e.g.. Cress &Marvin, 2003; Reichle, Buekelman, & Light,2002). In fact, it is critical that AAC be intro-duced before communication failure occurs.This change means that AAC is not only forthe older child who has failed at speech de-velopment but also for a young child duringthe period when he or she is just develop-ing communication and language skills, to pre-vent failure in communication and languagedevelopment.

Myth 2: AAC hinders or stops furtherspeech development

The myth that AAC is a "last resort" goeshand in hand with another myth about AAC.It is the impression that AAC will becomethe child's primary communication mode andtake away the child's motivation to speak. Infact, the fear many parents, and some practi-tioners, have is simply not supported by theavailable empirical data. The literature actu-ally suggests just the opposite outcome. Thereare a modest number of empirical studies thatreport improvement in speech skills after AACintervention experience (see Beukelman &Mirenda, 1998; Romski & Sevcik, 1996, for re-views). Sedey, Rosin, and Miller (1991), for ex-ample, reported that manual signs had beentaught to 80% of the 46 young children withDown Syndrome (mean chronological age3 years, 11 months) that they surveyed. Thefamilies of these children also reported thatthey discontinued the use of the manual signswhen the child began talking or when thechild's speech became easier to understand.Miller, Sedey, Miolo, Rosin, and Murray-Branch(1991) also reported that when sign vocab-ularies were included, the initial vocabular-ies of a group of children with Down Syn-drome were not significantly different fromthose of mental-age-matched typically devel-oping children. Adamson and Dunbar (1991)described the communication developmentof a 2-year-old girl with a long-term hospi-talization and a tracheostomy (i.e., an inci-sion into the trachea [windpipe] that forms

a temporary or permanent opening for thechild to breathe) who used manual signs tocommunicate. When the tracheostomy tubewas removed, she immediately attempted tospeak and quickly used speech as her primarymeans of communication. Romski, Sevcik,and Adamson (1997) evaluated the effects ofAAC on the language and communication de-velopment of toddlers with established devel-opmental disabilities who were not speakingat the onset ofthe study. Although the familiesof these very young children were much morereceptive to using AAC than the investigatorsinitially thought they would be, they werequick to focus exclusively on speech whentheir child produced his or her first word ap-proximation. For very young children, the useof AAC does not appear to hinder speech de-velopment (Cress, 2003). In fact, it may en-hance the development of spoken communi-cation, which should be a simultaneous goalfor intervention.

Myth 3: Children must have a certain setof skills to he ahle to henefit from AAC

In the past, young children with some de-gree of cognitive disability were frequently ex-cluded from AAC intervention because theirassessed levels of intelligence and their sen-sorimotor development were not commen-surate with cognitive/sensorimotor skills thathad been linked to early language develop-ment (Miller & Chapman, 1980; Mirenda &Locke, 1989; Romski & Sevcik, 1988). Whileone may argue that some basic cognitive skillsare essential for language to develop, the ex-act relationship between language and cogni-tion have not been specified clearly (see Rice,1983; Rice & Kemper, 1984, for reviews).Investigators have argued against excludingchildren from AAC interventions based uponintellectual performance and/or prerequisitesensorimotor skills (Kangas & Lloyd, 1988;Reichle & Karlan, 1988; Romski & Sevcik,1988). Given the overall impact language ex-erts on cognitive development, a lack of ex-pressive language skills may put an individ-ual at a distinct developmental disadvantage(Rice & Kemper, 1984). Some individuals

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with severe sensori-motor disabilities cannotdemonstrate their cognitive abilities withouta means by which to communicate so we can-not insist on evidence of those abilities beforeproviding AAC services and supports. Thereis also some evidence that severe physical dis-abilities and limited communication skills mayinterfere with the course of early cognitivedevelopment, in particular the developmentof object permanence and means-ends skills.Thus, developing language skills through AACmay be of critical importance if the individualis to make functional cognitive gains as well.

Myth 4: Speech-generating AACdevices are only for children withintact cognition

The cognitive skills a young child brings tothe intervention task can vary from no evi-dence of cognitive disabilities to that of severecognitive disabilities. Another myth related toMyth 3 relates to the use of speech-generatingdevices. In the past, computer-based AAC de-vices were often limited to children who hadintact cognition by clinicians for 2 main rea-sons. First, the devices were expensive andthus it was argued that the money should onlybe spent on children who could "truly bene-fit" from the device (Turner, 1986), Second,early computer-based devices often requireda fairly sophisticated set of cognitive skills inorder to operate them and thus were pro-vided only to those children who had such alevel of skill. Neither of these 2 reasons aretrue today. The technological developmentsin AAC devices have made a broad range ofoptions available to young children. There arenow many choices of AAC devices that speakfrom simple inexpensive technology (like sin-gle switches) to complex systems that per-mit access to sophisticated language and liter-acy skills. This broad range of options includedevices that are modestly priced (<$ 100.00)to expensive ($10,000,00 or more). Thesenewer devices sometimes require little skilland can provide a place of introduction toAAC for the young child. The AAC device issimply a tool, a means to an end—languageand communication skills—not the end in it-

self. Having a voice at a young age can facili-tate self-identity as well as communication.

Myth 5: Children have to be a certainage to he ahle to heneflt from AAC

There is no evidence suggesting that chil-dren must be a certain chronological ageto optimally benefit from AAC interventions.Chronological age is often mentioned as an ar-gument against the provision of AAC servicesto young children. Specifically, some parentsand professionals believe that the introduc-tion of an AAC mode at an early age w ill pre-clude the child from ever developing speechas his or her primary mode of communication.Current research clearly documents the effi-cacy of communication services and supportsprovided to infants, toddlers, and preschool-ers with a variety of severe disabilities (Bondy& Frost, 1998; Cress, 2003; Pinder & Olswang,1995; Romski, Sevcik, & Forrest, 2001;Rowland & Schweigert, 2000), Studies alsohave demonstrated that the use of AACdoes not interfere with speech development(Romski, Sevcik, & Hyatt, 2003, for a review)and actually has been shown to support suchdevelopment (see Millar, Light, & Schlosser,2000, for a review of research demonstratingthis effect; Romski & Sevcik, 1996; Romski,Sevcik, & Pate, 1988),

Myth 6: There is a representationalhierarchy of symbols from objects towritten words (traditional orthography)

This myth suggests that a child can onlylearn symbols in a representational hierarchy.The hierarchy begins with real objects tophotographs, to Une drawings, to moreabstract representations, and then to writtenEnglish w ords (traditional orthorgraphy).Namy, Campbell, and Tomasello (2004)suggested that 13- to 18-month-olds' early de-velopment of word learning is not specific toa predetermined mode of symbolic referencebecause their comprehension of referents intheir environments is in the developmentalstage, Iconicity did not impact the ability tolearn symbol-referent relationships at the on-set of language development but did make a

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difference by the time the typically devel-oping chitd was 26 months old. The child'sexpectation about the relationship betweena symbol and its environmental referent maychange throughout their development. By thetime children are 4 years old, they may havedeveloped a greater awareness of symbolicfunction, have a larger vocabulary, and maybe more open to using various symbolicmodes. This empirical evidence from theliterature on typical language developmentsuggests that this myth is not based onevidence about how young children learn.In fact, during early phases of development,it may not matter if the child uses abstractor iconic symbols because to the child theyall function the same. The choice of symbolset may be complicated by what familiesperceive as appropriate for young children,

ISSUES IN DELIVERING AAC SERVICESAND SUPPORTS TO YOUNG CHILDREN

These 6 myths grew out of early thinkingabout how to use AAC services and supports.None of these myths are supported by thecurrent literature on early intervention andAAC, However, they are often discussed whenAAC is considered as part of the interventionplan for a young child. The delivery of AACservices and supports must be accomplishedin the broader context of early interventionservices. There is a growing recognition ofthe merits of implementing AAC interventionswith young children (Cress & Marvin, 2003;Culp, 2003), First, the use of AAC is mandatedas part of the implementation of Part C of theIndividuals With Disabilities Education Act.And, second, AAC technologies are becomingincreasingly available at a reasonable cost. Im-plementing AAC raises a number of issues thatare only beginning to be explored. These is-sues include, though are not limited to, fami-lies as partners, assessment issues, transitions,and training for professionals.

Families as partners

There are a number of important issues re-lated to the family and the child. When AAC

intervention is begun early in life, at least 2additional issues need to be considered byprofessionals and families (Berry, 1987), First,families are still coming to terms with theiryoung child's disability (Wright, Granger, &Sameroff, 1984) and often seek a broad va-riety of interventions (e,g,, speech-languagetherapy, occupational therapy, physical ther-apy, educational therapy) to help their childovercome his or her limitations. These inter-ventions may include highly publicized inter-ventions (e,g,, direct instruction, floor-time)or multiple types of speech-language ther-apy (e,g,, therapy focused on feeding issues,therapy focused on speech-language develop-ment). Second, there appear to be fewer struc-tured routines outside the home in which toplace AAC intervention, than in the schoolchild's day, including opportunities for com-munication with others during the youngchild's day. Thus, the toddlers' family may takea primary role in the intervention processin addition to their other parenting respon-sibilities (Crutcher, 1993), Fulfilling this pri-mary interventionist role may require differ-ent external supports and organization thanis the case when a child is school-aged. Kaiserand Hancock (2003) reported that parent-implemented language intervention is a com-plex phenomena that requires a multicompo-nent intervention approach, Romski, Sevcik,and Adamson's (1997) preliminary findings re-garding initial choice about AAC suggest thatengaging in early augmented language inter-vention may be a more complex decision thanprofessionals initially anticipate. Parent per-ception about communication and parentalstress may play roles in augmented languageintervention. In general, today's parents maynot be afraid of the use of technology be-cause of extensive parent education about theimportance of getting communication startedand the increased use of computers in dailyUfe, Understanding how to arrange early aug-mented language intervention to be able tocapitalize on the communicative roles fam-ily members may typically play has not beenexamined to date. In addition, sometimes,parental knowledge about AAC device choice

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exceeds professional knowledge and experi-ence with AAC devices because parents read-ily use the Internet to gain information. Suchdiscrepancies in knowledge and experiencecan serve to create challenges for teams in de-termining and providing services.

One of the difficulties families face is thatthey want their young children to talk. Theirexpectations for production may lead to acompetition between a focus on developinga way to communicate and a focus on hav-ing the child speak, even if the speech thechild produces is imitative in nature. Thus,interventions that do not confuse the par-ents or children but instead permit them tofocus their energies on a specific goal areneeded.

Assessment Tools

For young children who present with sig-nificant communication disabilities, there arealso limited tools available that can providean adequate assessment of the young child'scommunication strengths and w^eaknesses.The more challenging the child's disabilities,the more difficult it can be to assess thechild's language and communication skills.One particularly important, yet challenging,area of research need is that of language andcommunication measurement tools (Sevcik,Romski, & Adamson, 1999). Attention mustbe focused on the development of assessmenttools that provide a fine-grained analysis ofthe child's language and communication skillsacross modes and that measure a range of in-tervention outcomes over time. Sevcik andRomski (2002) reviewed assessment optionsavailable for the examination of early com-prehension skills during the child's commu-nication assessment. Some outcomes of usingAAC go beyond the development of specificcomprehension and production vocabulary,and even grammatical skills, and have beensomewhat elusive to quantitative measure-ment. Communication access can also pre-vent the emergence of secondary disabilities(e.g., challenging behaviors). Tools that per-mit measurement of these elusive outcomesare important to develop.

TransitionsThe young child can make a number of tran-

sitions during this early period. Over a pe-riod of 3 years, the child must transition fromearly intervention services that are usually de-livered in the famUy or home environment toa preschool classroom. This type of transitionis complex and includes many different as-pects. It is important to stress that parents area source of expertise about how a child com-municates when service providers change. In-corporating AAC during early communicationdevelopment requires a focus on languageand communication development within thecontext of the AAC mode. Sometimes school-based clinicians are not open to the use ofAAC because it is not readily available or theyare constrained by 1 or more ofthe 6 myths. Itis particularly important that communicationbe a focus during the transition process.

Training for professionals and families

To ensure that AAC services and supportscan be provided to children receiving early in-tervention services, training about AAC mustbe included for professionals and families.When serving young children, instructionfor the early intervention team must includeinformation about the philosophy of com-munication, technology, and assessment andintervention strategies, with particular em-phasis on the role of the speech-languagepathologist. Assessment must include infor-mation about test adaptations, standardizedand informal or experimental measures, andparental report. Intervention strategies mustdiscuss linking speech and language therapywith AAC, as the goal is language and commu-nication development.

CONCLUSIONS

The reality is that it is never too early to in-corporate AAC into language and communica-tion intervention for the young child with asignificant communication disability. The AACdevices and strategies are a tool, a meansto an end—language and communication

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skills—not the end. Incorporating AAC duringearly communication development requires afocus on language and communication devel-opment within the context of the AAC mode,AAC is sometimes thought of as a separate areaof practice, and thus clinicians do not alwaysincorporate the information they know aboutlanguage and communication developmentas they consider AAC assessment and inter-vention. Often speech-language pathologiststhink that "someone else" w Ul provide AACservices for the children on their caseloads.It is imperative that AAC be linked to earlylanguage and communication development.There is a strong history of empirical data to

draw on as clinicians make practice decisionsabout intervention strategies for early com-munication development. Clinical decisionsmust be guided by empirical data in the con-text of clinical judgment not just by "beliefs"(Romski, Sevcik, Hyatt, & Cheslock, 2002),AAC is not a last resort but rather a first line ofintervention that can provide a firm founda-tion for the development of spoken languagecomprehension and production. It can set thestage for further language and communicationdevelopment during the child's preschooland early school years. It also can open thedoor for the child's overall developmentalprogression.

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