what is a competent aac user? perspectives from aac interventionists

What is a competent AAC user? Perspectives from AAC interventionists

Erna Alant (D.Phil); Lindsey Ogle (MS – Psychology); Ohoud Alhajeri (MS- Educational Leadership)

AAC LAB, Indiana University, Bloomington

Acknowledgements Members of the AAC lab at Indiana University who assisted in

recruiting participants for this study Participants who unselfishly shared their perspectives Jesse Smith – who assisted in transcriptions Financial Support from the Otting Foundation Disclosure: The main researcher is currently employed by IU and

the other researchers are PhD students. There are no conflict of interests associated with this study.

Why this research? Major strides in technology and intervention:

New technologies Opportunities within schools – partial to full inclusion in school

curricula Significant increase in mobile technology applications for AAC

Concern about persistent isolation and lack of friendships for young people with severe communication problems.

Is there an association between these concerns and the perceptions of AAC interventionists in relation to the definition of what a competent AAC user is?

Research questions How do AAC interventionists define a competent user of AAC? What aspects of an AAC system do they regard as critical to

facilitate effective communication? What do they see as the main challenges in interactions between

AAC users and their typical peers? What are the most important facilitators of these interactions? What do communication partners need to know? What should be

the main focus in training? What is the role of social media in AAC intervention?*

*Not included in preliminary analysis.

Historical Perspectives Speed, accuracy and adaptability (use in different contexts? 1990: Janice Light: Competent AAC user include the following skills:

Linguistic Operational Social Strategic

1997: Lloyd – Communication model focused on: Purposes of Communication Multi-modal aspects of communication

Table 1.2 Characteristics of interactions intended to meet various social purposes (Light, 1988)

Social Purpose of interactionExpression of wants/needsInformation transferSocial closenessSocial Etiquette

Characteristics of interaction (Light, 1988) described according to:

Goals of interaction Focus of interaction Duration of interaction Content of communication Predictability of communication Scope of communication

Rate of communication Tolerance for breakdowns Number of participants Independence of communicator Partners: familiar/unfamiliar

Characteristics of Interaction

Laws for Applying Technology (Lloyd et al., 1997)

Law of Parsimony Law of minimal learning Law of minimal energy Law of minimal interference Law of Best fit Law of Practicality and Use

Light & Mc Naughton (2014): A new definition for a new era in AAC?

Not just 4 areas of competency is necessary but also a variety of psychosocial factors (e.g., motivation,

attitude, confidence, resilience) as well as barriers and supports in the environment.

In the 25 years since this definition of communicative competence for individuals who use AAC was originally proposed, there have been significant changes in the AAC field.

Three fundamental Constructs:

Functionality of Communication - Environmentally and socially oriented; i.e use in different context, different partners, peers

Adequacy of Communication - use of language and modalities for specific purposes, but not with reference to social context, i.e. range or scope (different vocabulary, different functions, multimodal) to bridge gap between skills and functional communication in context.

Sufficiency of Knowledge, Skills and Judgment - specific skills, knowledge to use system, language structure and content (vocab), specific strategies for operational use

Primary Changes in Communication Competence: Not so much what needs to be achieved as how

Main Difference – inclusion of social media – operational competence

Social – more emphasis on interpersonal and social interactions. More emphasis on social contact

Broader range of devices – iPads, Facebook and SGDs Fortify psychosocial supports to increase motivation, confidence,

resilience Environmental supports – partner training, polices etc

Methodology

ParticipantsIndividual interactions with 12 AAC interventionists

in Indiana8 Interviews and 4 email responses Demographic description

ID Age Sex Years AAC Experience

Overall Experience in the Field

Education Training in AAC

US1

32 F 6 6 MA ccc 2006 Indiana University

No coursework, AAC diagnostics lab

US2


AAC covered as topic in course, Clinical supervision of AAC users, Vendor training, Self-training

US3


No coursework, On-the-job training in low-tech AAC, In-service training in AAC

US4

63 F 30 (as parent)

18 MA Special Education 1997 Indiana University

No coursework, Training by child’s SLPs and vendors, Self-training

US5


AAC course, CE in AAC and Hearing, Vendor training, Self-training

US6


No coursework, CE in AAC, On-the-job training, Self-training

US7


No coursework, CE in AAC, Clinical supervision of AAC users, Self-training

US8


No coursework, CE in AAC, On-the-job training, In-service training

US9

31 F 7 7 MA Behavioral Analysis 2007 Indiana University

No coursework, Clinical supervision of AAC users, Self-training

US10

52 F 28 28 MA ccc 1985 Ball State

AAC course, CE in AAC, Self-training

US11

29 F 6 6 MA ccc 2008 Ball State

No coursework, CE in AAC, Mentored by expert in AAC, Self-training

US12

50 M 15 23 MA ccc 1991 Purdue

AAC course, Clinical supervision of AAC users, Presented at conferences and workshops on AAC

Analysis of Data

Coding semantic units Grouping codes into categories Assigning codes to three fundamental constructs (Light, 1989; Light and

McNaughton, 2014) Functionality of communication: Environmentally and socially oriented; i.e use in

different context, different partners, peers Adequacy of Communication: use of language and modalities for specific

purposes, but not with reference to social context, i.e. range or scope (different vocabulary, different functions, multimodal) to bridge gap between skills and functional communication in context.

Sufficiency of knowledge, skills, and judgment: specific skills, knowledge to use system, language structure and content (vocab), specific strategies for operational use

Trustworthiness of Data – Three researchers analyzed data and consensus (Creswell, 2007, p. 147)

Analysis of Data – Categorical Coding ExampleCategory Code

Content Express wants and needs

Express thoughts and ideas

Different functions Multiple language functions

Repair communication breakdowns

Self-initiates, independent use, novel utterances

Sensitive to others Listen to others/observe/ take turns

Others are able to understand what is said

Different modalities Combine different modalities

Different contexts & partners

Communicate in more than one context/ environment

Communicate with different communication partners

Enjoy Use of system Enjoys their device/ good use of their system

Understand and learn language like others

Results What is a competent AAC user? What are the features of an effective AAC system? What are the biggest challenges for AAC users to

interact with typically developing communication partners?

What are the main facilitators for AAC users to interact with typically developing communication partners?

What skills do you think communication partners need to interact with people with little or no functional speech?

What is a competent AAC user?

Total Construct Code9 A Express wants and needs7 A Express thoughts and ideas2 A Multiple language functions2 A Repair communication breakdowns6 A Self-initiates, independent use, novel utterances2 F Listen to others/observe/ take turns4 F Others are able to understand what is said3 A Combine different modalities4 F Communicate in more than one context/ environment2 F Communicate with different communication partners2 S Enjoys their device/ good use of their system2 S Understand and learn language like others

Construct Total Comments

Sufficiency of Knowledge & Skills

4

Adequacy of Communication

29

Functionality of Communication

12

What are the features of an effective AAC system? Total Construct Code

4 A Rich broad vocabulary4 A Use of core vocabulary3 A Expand & grow with individual1 S Access to full sentences not just words3 A Meet needs of individual1 A Repair communication breakdowns2 A Self-initiates, independent use2 F Others need to be able to understand2 F Turn-taking: master exchanges- getting something from others3 A Combine different modalities/ voice/ speech5 F Communicate in more than one context/ activity4 F Well-trained partners/ Expect communication6 S Accessible motorically, visually, & across contexts3 S Easy to manipulate vocabulary3 S Consistency of system over time/ Motor Planning5 S Easy to use/ efficiency/ speed1 F Minimal intrusion & distraction/ Reliable4 S Motivated and able to use3 S Sufficient rate for communication



25


20


14

What are the biggest challenges for AAC users to interact with typically developing communication partners? Total Construct Code

3 F Use across contexts – school, home, community, activities8 F Patience of partners: don’t interrupt or guess messages, ask yes/no questions4 F Partner attitudes: expect AAC user has something to communicate4 F Uncomfortableness of partners with system3 F Observation skills of partner: scanning, reading expressions2 F Trust that partners will be patient and listen and allow AAC user to initiate not

just respond1 S AAC users want to show they are cognitively able – want to spell out

everything 3 S AAC users’ lack of interest in others (autism). Going beyond just responding2 F Recognize need for AAC in all environments, see device as not necessary

throughout day1 F Partners are distracted/ overly fascinated by device2 F Needs to be used to communicate not just to participate in activities2 S How to use a teachable moment without predicting what the person would

say2 S Balance device training & use1 F Accommodating parents –lower own expectations3 S Lack of training of SLPs, teachers and aides in schools1 S Successful assessment in AAC



14


0


31

What are the main facilitators for AAC users to interact with typically developing communication partners? Total Construc

tCode

1 F Awareness that communication is all the time/ create opportunities 2 F Importance of advocacy and modeling in the community for unfamiliar

communication partners 5 F Attitudes and Dispositions – Patience, observant of AAC user expressions1 F Expectation of Communication4 F Encourage typical speakers to use AAC user’s system - fosters acceptance 4 S Modeling communication on device to teach unfamiliar utterances1 S Comfort of AAC user with the communication system, Persistence3 F Desire for facilitating authentic communication to build relationships1 F Observe communication between familiar communication partners (i.e.

with family at home)2 A Use of an activity or topic to ground conversation1 S Teaching Self-Instruction3 F Collaboration with colleagues and families



6


2


20

What skills do you think communication partners need to interact with people with little or no functional speech?Total Construct Code

5 S Natural dispositions (patience, friendliness, honesty, persistence) vs. what can be taught

2 S Age appropriate communication10 F Patience – willingness to listen, observe, give enough space to communicate3 F Honesty – willing to admit when you don’t understand3 A Strategies to repair communication breakdowns6 F Interest in what the AAC user is communicating/ maintaining attention. Interest in

device/strategy4 F Understanding of AAC user’s experience of using communication system/ device/

model use of device2 A Acceptance of all modes of communication/behavior as communication1 A Peers as therapists/teachers instead of friends and communication partners1 F Importance of authentic communication to build relationships1 F Importance of facilitating shared experiences and fun for building camaraderie1 F Desire to work with SLP/teachers/ parents 1 A Partner “ownership”/ empowerment in the intervention process 1 A Advocate use of AAC device 1 A Communication opportunities through day



7


9


26

Summary Analysis Sufficiency of

Knowledge and SkillsAdequacy of

CommunicationFunctionality of Communication Total

Competent AAC User 4 29 12 45Features of AAC System 25 20 14 59Challenges 14 0 31 45Facilitators 6 2 20 28Partner Skills 7 9 26 42

Total 56 60 103 219

Interpretation What is a competent AAC user?

Expressing of needs and wants- ideas and thoughts Multimodality:

“[Someone] who can get their wants and needs and thoughts expressed and understood by the recipient of that information. Whether it’s through body language, using pictures, using voice, and/or using a device. Many times it’s a combination of things to get their full thoughts across to people – to be understood.” Relatively few commented on the AAC users ability to understand others

– to enhance interactionPerspective-takingEmotional resonanceUnderstanding of social interactions

Features of an effective AAC system System characteristics, operational Multi-modality, easy access to broad vocab

“Well, I think it has to be efficient - as efficient as it can be. If the user is really struggling with figuring it out and it’s easier to use a different means or not talk at all, then it’s not going to be effective. So, I think that’s critical. It shouldn’t be limiting for what they want to communicate… As someone grows with a system, you would hope that it would not put limits on what they want to express and what they’re able to express. I would say a system would need to be versatile so that it can move and grow with the user.”

Relatively few: Impact of the device in facilitating social interaction – ease of infusion

into social setting Seeing others as part of the AAC system

Challenges in interaction with typical individuals

Difficulties in using the device By far the majority focus on difficulties with social interaction:

“I think that the biggest challenge is, well, I think that there are a couple of them. One that it is not completely therapist driven. That it is completely like they are using their system to participate in the activity. So, it is not necessarily communicative in nature. It’s just more of a participatory tool. I feel like that is a big challenge - making the leap to use it and in a more interactive way.”

Facilitators for interaction with typical individuals Majority by far:

Ability to interact in the real life Patience of partners

“I was thinking about this this morning and you know, kids are easy when communication is easy, but when you give them lots of guidelines and structure it doesn’t happen as easily. Some really natural interactions I’ve seen have happened when the communication partner, if it’s a child, is able to use the device themselves, right?”

What should Partners be trained to do? Majority focus on social interaction:

“Well, I think the ability to listen and wait is huge. Because communicating with AAC is by nature just not as efficient as communicating verbally. So, if you have a communication partner who is constantly talking verbally and constantly jumping in then it’s going to be a less interactive exchange. So, that’s something I think that needs to be taught.”

Conclusion Current: Focus on social skill training – how to get the individual to get

better access to his/her own system, and those in the environment to be patient, to listen better.

Gap: AAC intervention as the development of meaning between people – it goes beyond sending and receiving messages. Interest in the other; common ground (Clark, 1996) Awareness of interaction as the development of meaning (Alant, 2005) Uniqueness of interaction – to facilitate the development of relationships

(Crossley, 1996) Emotional resonance (beyond perspective taking) – to facilitate “real”

interaction.

Development of Meaning between individuals

Transmission Environments

Sender/Encoder with endogenous feedback

Receiver/Decoder

Transmission/Signal Channels

Communication Environments

Communication Contexts

or Receiver/Decoder

or Sender/Receiver with endogenous feedback

exogenous feedback

(taken from Lloyd et al., 1997, p. 7, Fig. 1.1)

References Alant, E. (2005). Intervention issues. In Alant, E & Lloyd (Eds). Augmentative and Alternative

communication: Beyond poverty. London: Whurr Publishers, 9-29.

Bruner, J. (1990). Acts of Meaning. London: Harvard University Press.

Clark, H. (1996). Using language. NY: Cambridge University Press.

Creswell, J. W. (2007). Qualitative Inquiry & Research Design. London: Sage Publications.

Crossley, N. (1996). Intersubjectivity: The fabric of social becoming. London: Sage Publications.

Light, J. (1988). Interaction involving individuals using augmentative and alternative communication systems: State of the art and future directions. AAC, 4, 66-82.

Light, J. (1989). Toward a definition of communicative competence for individuals usingaugmentative and alternative communication systems. Augmentative & Alternative Communication, 4, 137-144.

Light, J. & McNaughton, D. (2014). Communicative Competence for Individuals who require Augmentative and Alternative Communication: A New Definition for a New Era of Communication? AAC, 30(1): 1–18.

Lloyd, L. L.; Fuller, D. & Arvidson, H. (1997). Augmentative and Alternative Communication: A Handbook of Principles and Practices. Boston: Allyn Bacon.

what is a competent aac user? perspectives from aac interventionists

Documents

competent aac user

competent user of aac

aac field

aac users

aac system

functionality of communication

effective communication

communication partners