Augmentative and alternative communication to support receptive and expressive communication for people with autism
Introduction
It is now well recognized that autism is a syndrome characterized by qualitative impairments in social interaction and in verbal and nonverbal communication (APA, 1994). People with autism experience a wide range of difficulties with the form, content, and especially the use, of language in social interactions. It has been estimated that approximately 50% of individuals who have autism do not develop sufficient natural speech to meet their daily communication needs (Wing & Attwood 1987). Furthermore, many individuals with autism experience substantial difficulties with receptive language skills as well (Mirenda & Mathy Laikko 1989). Augmentative and alternative communication (AAC) offers the potential to augment comprehension and expression for many individuals with autism. As defined by the American Speech-Language-Hearing Association (1989), AAC is “ … an area of clinical practice that attempts to compensate (either temporarily or permanently) for the impairment and disability patterns of individuals with severe communication disorders” (p. 107). AAC systems include unaided systems that do not require any external devices (e.g., gestures, signs) and aided systems that require external devices (e.g., communication boards or books of line drawings, words, and/or the alphabet as well as computer-based technology with voice output and/or print output). Traditionally, AAC interventions focused on augmenting expressive communication; more recently, AAC (or augmented input) has been applied as a technique to enhance comprehension as well (Beukelman & Garrett 1988; Romski & Sevcik 1988Romski & Sevcik 1993).
The purpose of this article is to discuss the use of AAC as means to augment expression and comprehension for those individuals with autism whose speech is inadequate to meet their daily communication needs and who experience significant difficulties understanding spoken input from others. Specifically, the article provides a theoretical framework for AAC assessment and intervention planning, and illustrates application of the framework with a report on a 6-year-old boy with autism who experienced severe expressive and receptive language impairments and who benefitted from AAC interventions to augment comprehension and expression.
Section snippets
Background information
Josh (pseudonym) was 6 years 4 months old when he was referred for services. He lived with his parents and one older sibling. According to his parents, there were no complications reported during the pregnancy or post-natally. Josh’s parents reported that he met all developmental milestones within normal limits until approximately two years of age; then he stopped talking. Josh was diagnosed at age 3;6 by a neurodevelopmental team as a child with “… all of the cognitive, social, and
Aac assessment model
Current research in AAC supports the efficacy of a two-pronged model of assessment-intervention that focuses on the individual to ensure that he or she has the means and skills to communicate effectively and on the facilitators (Biklen 1990)1to ensure that the individual has the opportunity and necessary support to communicate effectively (Beukelman & Mirenda 1988; Culp & Carlisle 1988; Light, Dattilo, English, Gutierrez, & Hartz 1992; McNaughton & Light 1989). The overall purpose was to
Identify communication needs
AAC intervention should be driven by the individual’s communication needs within his or her daily environment at home, school, and in the broader social community, thus assuring that the intervention is truly functional and consumer-responsive (Technology-Related Assistance for Individuals with Disabilities Act, 1989, 1994). The individual’s communication needs determine, at least in part, the requirements that must be met by the individual’s AAC system(s) (Beukelman and Mirenda 1992;
Assess the individual’s skills
Assessment of communication needs is not sufficient in determining appropriate AAC interventions. Careful assessment of skills in various domains is also required. Given the breadth of skills addressed, AAC assessment requires the input and expertise of professionals from multiple disciplines (e.g., speech language pathology, physical/occupational therapy, education, vocational counseling, psychology, medicine, engineering and computer technology, social services, audiology, ophthalmology); the
Expressive Communication Skills
Assessment of the individual’s current expressive communication provides information on the individual’s turn-taking patterns, initiation/response patterns, range and frequency of communicative functions, range and frequency of the individual’s modes of communication and the effectiveness, efficiency, and the appropriateness of these modes, natural speech production and intelligibility, and content and form of communicative messages.
Investigate facilitator strategies and opportunity barriers
The first two components of the AAC assessment focus on the needs and skills of the individual who requires AAC. However, building communicative competence is an interpersonal process, not an isolated, intrapersonal phenomenon (Light 1989). Communication is a transactional process; the participants influence each other in the course of the interaction (McNaughton & Light 1989). Therefore, it is critical to consider not only the person who requires AAC, but also the facilitators.
Intervention plan
Based on best practices in AAC (Beukelman and Mirenda 1992; Light, Dattilo, English, Gutierrez, & Hartz 1992), Josh’s intervention plan provided intervention to ensure that Josh had the tools and skills required to communicate effectively, as well as intervention with Josh’s facilitators to ensure the opportunity and the support required for effective communication. Illustration of issues in each of these areas of intervention follow.
Concluding remarks
It is approximately two years since Josh’s initial AAC assessment. Josh has made significant gains in both receptive and expressive communication. He responds appropriately to wh- questions about stories read in the class and at home. He follows orally-presented one-step instructions involving prepositions correctly; he responds appropriately to two- and three-step instructions presented orally and in writing. His facilitators obtain his attention before speaking to him; they augment complex
Acknowledgements
A pseudonym has been used in this case and some specific details have been modified to protect confidentiality. The authors are grateful to “Josh,” his family, and professional team for their support in this project.
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