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AAC Terminology from ISAAC (International Society for AAC)

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AAC Terminology from ISAAC (International Society for AAC)

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If you've found us, you're likely responsible for someone who struggles with communication, such as a child with autism who can't speak, a spouse with ALS who can't use their hands or voice, or a parent who suffered a stroke. You may have even heard about augmentative and alternative communication, also known as AAC.

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If you've found us, you're likely responsible for someone who struggles with communication, such as a child with autism who can't speak, a spouse with ALS who can't use their hands or voice, or a parent who suffered a stroke. You may have even heard about augmentative and alternative communication, also known as AAC.

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Does AAC Prevent Speech Development? [with research articles]

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Does AAC Prevent Speech Development? [with research articles]

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Will Using AAC Stop My Child From Speaking?

The simple answer is "no" and we will tell you why.

As a speech-language pathologist (SLP), I have received the question presented above on numerous occasions. I have received this specifically when working with individuals with autism, who often present with global (mixed receptive-expressive) communication disorders; usually including apraxia of speech, which creates difficulty motor planning to produce intelligible (understandable) speech. Use of augmentative alternative communication (AAC) can increase the clarity of the message(s) the user wants to communicate. Though, it is not limited to individuals with autism; many individuals benefit from using AAC.

The current research and our own clinical experience has suggested that AAC will not stop a person from speaking.

AAC serves as a system or group of systems that allow for increased ability to communicate messages for any individual (child or adult) who presents with no/minimal verbal language and/or whose verbal speech is difficult to understand. Using AAC can increase an individual's ability to get their message across to the individuals with whom they are interacting. Typically, you will find that SLPs are strong proponents for AAC because their goal is to maximize functional communication for the individuals they are providing services to, which can include both AAC and verbal language (speech). In many cases, individuals who use AAC are considered total communicators or multi-modal communicators, which means that they can use a variety of modalities interchangeably (think: verbal language and an AAC system) to communicate.
Low Tech AAC Mid Tech & High Tech AAC
AAC is not shown to prevent verbal language: the research

The current research and our own clinical experience have suggested that AAC will not stop a person from speaking. In many cases, it actually does the opposite. It is our ethical obligation to the individuals we serve that as SLPs, we educate ourselves and follow a systematic protocol of evidence-based practice. What does that mean exactly? Well, as much as our independent clinical experience might prove to us that AAC does not prevent the individuals we are treating from speaking; we also realize we cannot just go from our gut. We are instructed to follow the research as well. Below we have included some research articles that have investigated this topic:

Can AAC help a person speak?

It should also be noted that there is research to support that AAC can actually increase the development and use of verbal language and language learning for users. AAC systems are designed based on research that best supports functional use and development of language, and can be customized based on individual needs and abilities. Many high tech AAC systems (i.e., speech generating devices/SGDs) used by language learners are designed with a systematic core words approach that model the way that we develop natural language we use for speech production. Some of the newest SGD vocabularies systems are organized in this categorical fashion to increase efficient language use and access to communication. These SGD displays often provide visuals/symbols to support this, in addition to auditory models of accurate speech sound productions. Individuals who have already acquired language (usually adults) may use AAC due to brain injury, aphasia, or motor speech disorders. There are vocabulary systems on AAC devices that are more appropriate for them as well.

Overall, it is an SLPs goal to enhance one's functional communication, whatever means involved. Many times it involves introducing an AAC system, other times it may not be deemed necessary. It may involve the collaboration of multiple modalities, like speech and AAC, to generate the most language output. It is always important to consider each client or loved one on an individualized basis based on their life circumstances, wants, and needs. AAC has continued to advance and research is clear that AAC should be introduced as early as possible and can impact important developmental outcomes when used at home (Smith, Barton-Hulsey, Nwosu, 2016).

Citations/further resources: https://www.assistiveware.com/learn-aac/roadblock-aac-will-stop-a-person-from-learning-to-speak https://pubs.asha.org/doi/pdf/10.1044/1058-0360%282008/021%29 https://pubs.asha.org/doi/pdf/10.1044/persp1.SIG12.10 https://pubs.asha.org/doi/pdf/10.1044/1092-4388%282006/021%29 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017351/

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Does AAC Prevent Speech Development? [with research articles]

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Research has suggested that AAC will not stop an individual from speaking. In addition to the research, this has also been evident based on our own clinical experiences. We discuss commonly shared research articles and additional AAC-related information.

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Informed SLP: Setting the record straight on AAC and speech

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Informed SLP: Setting the record straight on AAC and speech

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Setting the record straight on AAC and speech

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In which we refute the myth that AAC hinders oral language development. Hang on, though… slinging citations won’t convert most skeptics. Bring your curiosity and empathy, too.

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AssistiveWare: Will AAC stop a person from learning to speak?

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AssistiveWare: Will AAC stop a person from learning to speak?

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Will AAC stop a person from learning to speak? - AssistiveWare

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Augmentative and Alternative Communication (AAC) won’t stop someone from learning to speak. This article, based on research, explains why.

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Best Practices in Assistive Technology The U.S. Department of Education (ED) has issued new guidance, expressing expectations and best practices for how to promote more inclusive learning experiences for all children and youth with disabilities. Myths and Facts Surrounding Assistive Technology Devices and Services MYTH 1: Assistive Technology (AT) should only be considered at some...

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CommunicationFIRST's Style Guide

About the Guide Below

We are often asked about the words we use to refer to ourselves and the people we aim to serve: people who cannot rely on speech alone to be heard and understood. We appreciate the question and the chance to respond. What follows is CommunicationFIRST's own style guide, not a directive for others to follow.

As we build the first civil rights organization led by and focused on the estimated 5 million people in the United States with speech-related communication disabilities, we are exceptionally conscious of the power and importance of language. This is particularly true when describing what we do, who we are or seek to represent, and what we aim to achieve.

We are finding our own voice, telling our own truths, and expressing our own individual and collective stories. We are naming ourselves. And we choose our words with great care. This document explains our reasoning behind the words we currently choose to use and avoid. It is the consensus result of many hours (over several years!) of thoughtful reflection, discussion, and debate among the diverse members of CommunicationFIRST's Board of Directors, Advisory Council, and staff . It is a work in progress.

1. d that too many of us still lack access to the tools and supports necessary to share our language preferences.Our Community Is Diverse. We know that people who use or need any kind of expressive communication tool, support, or strategy due to a speech-related disability or condition have much in common, but we also have many different disability experiences, medical conditions, and communication strategies. Because of biases and assumptions, we all face misunderstanding, low expectations, and discrimination. The justice we seek also is the same. But our varied life experiences also create unique identities. People who lose speech due to an acquired condition, like ALS or Parkinson's, have different journeys than people who are born with a lifelong condition, like autism or cerebral palsy. Because we choose different ways to describe ourselves, we may disagree about whether a term is liberating or offensive. These discussions can be difficult, but they are also natural, healthy, and necessary. Language can divide us, or we can use it to unite our common humanity. We aim to use words that honor the diversity of our community, while keeping in min

2. Respecting Individual Choice. CommunicationFIRST respects the right of each person to describe themselves however they choose, even if that preference differs from how we might describe a broader group. When in doubt, ask.

3. Language Evolves. What follows reflects the words CommunicationFIRST understands and chooses to use or avoid right now, as of the date of publication. We know that community understanding and preferences will change, and that we will adjust the words we use over time.

4. Language Is Powerful. The words we use have consequences. We must avoid further marginalizing those who have been denied access to free expression. This is not an effort to be politically correct, to police other people's language, or to suppress opinion. Language can empower or dehumanize. It can raise or lower expectations. It can change perceptions. And it can foster equity or sustain inequity. Words alone will not secure justice or equality of opportunity. Yet, how we describe who we are, our hopes, our fears, and the future we want to create is vital. And the words we use must be our own.

5. Asserting the Right To Name Ourselves. The power of free expression is vital to exercising all civil rights and liberties. Free expression includes access to language, naming who we are, shaping our lives, and conveying how we expect others to recognize, respect, and relate to us as their equals. People denied access to robust, language-based augmentative and alternative communication (AAC)* are robbed of this power. We disproportionately endure lifelong illiteracy, institutionalization, exclusion, poor health, and worse. We are regarded as having little to no ability, reason, and therefore no need or right to effectively communicate, or to lead lives of our own direction. The words most frequently used to describe us continue to be what others choose. Self-identifying is critical to every liberation movement.
* AAC includes all forms of communication other than speech, including gestures, eye gaze, vocalizations, taking someone by the hand, facial expressions, and body positioning. Language-based AAC is any type of AAC that allows the person to communicate using words.

6. Language Impacts Culture and Mindset. It is hard to imagine now that, well into the last century, deaf people were described as " deaf and dumb ," an odious term coined by Aristotle, who felt "that deaf people were incapable of being taught, of learning, and of reasoned thinking." CommunicationFIRST works to counter the dangerous assumption that not being able to rely on one's own speech to be heard and understood means we cannot understand and express . This will require a huge shift in culture and mindset, but this shift is possible. Such shifts continue to occur in the United States with respect to how people of color are perceived and treated. We are also encouraged by the cultural acceptance the LGBTQIA+ community has achieved over the last 25 years, including the creation of new language. We recognize that these civil rights movements overlap with us, potentially compounding both harm and liberatory lessons. language

7. Share Your Feedback! We invite others who use expressive communication tools and strategies, including various forms of AAC, to fill out the short survey at the end to let us know what you think.

The Words We Currently Use

There is no one, universally accepted term that describes our diverse community. As such, CommunicationFIRST chooses to be descriptive. We currently use phrases like " people who cannot rely on speech alone to be heard and understood " to refer to everyone whose rights and interests we work to advance.

In addition to being inclusive, the phrase "people who cannot rely on speech alone to be heard and understood":

Is easily grasped by the general public, policy makers, and media (including people who don't know the term "AAC").

Assumes that we have something to express, focuses on our need and right to be understood, and emphasizes that there are other ways besides speech that we can be heard.

Asserts that we do have the ability to hear, understand, and respond to others. We value what people have to say and respect others by responding. We expect the same in return.

Highlights the fact that communication always involves at least two parties, and tries to shift the focus, "blame," or burden of addressing any communication barrier away from the speech-disabled person to the context and interaction.

Respects people who, due to personal, cultural, generational, or other factors, may not identify with "disability" terminology.

Includes people who cannot speak at all, as well as people who may be able to use speech some of the time (e.g., in certain contexts, at certain times of the day, or with specific people) to communicate their thoughts effectively and be understood by others.

Depending on the context and audience, we may also use the following terms to broadly describe our community:

The Words We Currently Avoid

Nonverbal

The root of this word, "verb," comes from the Latin verbum , meaning "a word" or "language." To describe someone as nonverbal, then, is to say that they cannot understand or use language.

But this is a ation of words. Just because someone cannot rely on factually inaccurate way to describe someone who cannot speak. speech does not mean that they do not understand or cannot use language. Speech is just one way to express language. It is impossible to know what a person who cannot speak actually understands unless they have been given access to appropriate communication tools (and the training and supports to be able to use them).
There is no anatomical basis to assume that someone with a speech disability is incapable of understanding language. Speech is the motor process of expressing language. Language is a cognitive process that involves perceiving, understanding, and producing ideas and concepts through the symbolic represent

Yet, as any AAC user who cannot rely on speech to be heard will tell you, it's widely and wrongly believed that an inability to speak is an inability to understand. Other people regularly talk about us like we cannot understand you and like we are not even there. The assumption that we lack language dehumanizes us, and makes us invisible.

The term also suggests that it is a status that cannot be changed, which can contribute to a vicious cycle. When we don't have the tools we need to communicate, people will assume we can't communicate. When people assume we can't communicate, they won't give us the tools we need to communicate.

Note that many prefer the term " nonspeaking " over "nonverbal," especially in the autistic community. CommunicationFIRST may use the term "nonspeaking" when referring specifically to the autistic community, and, of course, with any individual who prefers that term. However, there are people in our community who can use spoken words and forms of AAC that generate speech or type for others to read and self-identify as "speaking." For this reason, we do not use the term to refer to our population more broadly.

Severe or Profound

There is nothing positive about these words. They have no scientific or clinical validity as a measurement. Instead of providing any useful or precise information about our needs, these words can work to cause fear and pity. It's hard to imagine that someone described as "severe" or "profound" could be a friend, ally, classmate, leader, or neighbor in your community.

We aren't extreme, foreign, rare, or inhuman. We are simply people who may need certain accommodations, supports, or services to live well. Describing those supports and services, instead of using dehumanizing words like "severe" and "profound," focuses on making sure that we get what we need. These words are also often associated with terms such as "mental retardation." This old language must be retired.

► Instead of calling someone or their condition "severe" or "profound," be descriptive. You can be as nonspecific as saying they have " disability-related access needs ," or you can describe a specific unmet need (e.g., " ") They cannot use speech to be understood, but we haven't yet found a form of AAC that works for them. (Note that the alternative term " significant " can also be seen as negative and have negative consequences. As a result, CommunicationFIRST will not use the term "significant" to describe our population generally, but may use it in specific policy or advocacy settings, especially because the term "significant disability" is used in some laws and regulations, including the Rehabilitation Act.)

Disorders, impairments, and deficits

. Communication is a collaboration-a two-way street-where we work together to exchange, express, receive, and understand information. When we view communication like this, telling one member of the conversation that they have a "deficit" doesn't make much sense. Disability is universal, and a natural part of human diversity. Communication comes in many forms other than speech, and each form is valuable and worthy of respect. Plus, communication isn't something we have -it's something we do together Why isn't it the receiving part of the conversation that has the deficit?

These terms are rooted in the "medical model" of disability, whereas the disability community prefers a "social model" of disability.

► Instead of "disorder," "impairment," or "deficit," consider the more neutral terms " condition " or " ," though note that different people may prefer one of these terms over the other (e.g., people who acquired their speech loss later in life may identify less with the disability community and terminology). If you're not sure which word to use, be descriptive: " disability " or " They use AAC ," instead of "they have a speech deficit." Whenever possible, ask people how they describe themselves. They require AAC to be understood

Complex communication needs

We believe this term, which emerged from a US government-organized consensus group on AAC in 1992, is similar to the harmful, othering, and inaccurate outdated euphemism " special needs ." People with disabilities don't have "special" or "complex" needs. We have the same needs as everyone else to communicate and be understood. We may employ complex strategies and require tools, supports, and services that may involve sophisticated technology, training, dedication, and ongoing support, but there's nothing complex about our need to communicate and be understood. Nor is it that complicated or difficult to get to know us or include us.

► When describing our needs, be clear and descriptive. Don't use a euphemism, or a word that is used to avoid saying something that someone thinks is unpleasant or offensive. The same goes for describing our communication. Explain that we use AAC, or be specific about the kind of AAC we use, or describe how we communicate.

Non-communicative

It's nearly impossible for anyone to be totally "non-communicative." AAC includes all forms of communication other than speech, including gestures, eye gaze, vocalizations, taking someone by the hand, facial expressions, and body positioning. All of those things are communication! If a communication barrier exists, the onus is-or should be!-on the people around the person without a communication disability to remove that barrier or build the bridge. Labeling us "non-communicative" also suggests a status that cannot be changed. And it removes the sense of urgency to find and provide us with language-based communication tools and supports.

► Instead of calling someone "non-communicative," describe and respect the ways they already communicate: " She doesn't yet have an effective, language-based form of AAC to express herself, but she's extremely effective at communicating her daily needs and preferences in other ways. "

Similarly, describing someone as a " beginning," " emerging," or " emergent" communicator disregards all the forms of communication the person has already figured out to express themselves on their own, with no support. And it privileges certain types of communication above others.

► When trying to convey the idea that the person is learning a certain type of AAC, say so: " The student is being supported to learn how to use [form of AAC] to communicate. "

It is impossible to know that someone has " no language." Over and over it has been demonstrated that people with no language-based expressive communication may have full receptive understanding of words. The inability to demonstrate language by using speech or sign or gesture is not evidence of its absence.

Behaviors

When people move or make noises in ways that are unexpected, un familiar, or unwanted, they are often labeled as "having behaviors." Human beings move in different ways. Some movement is planned and intentional. Some is unplanned and unintentional. Some is both at once. Some is triggered by sensory rea ctions to environmental inputs or lack of input, pain, trauma, emotions, or habit. No human is merely a bundle of behaviors. When we characterize human movement this way, we are more likely to view both the movement-and the human doing that movement-as "other" or inhuman. "Behaviors" become something to control or fix; "behaviors" often become a prerequisite to "address" before someone is given access to AAC. The word "behaviors" erases and dehumanizes the human behind the movement.

► In avoiding the term "behaviors," we try to be specific and descriptive about the what the person is doing. Or we say something like, " She's acting in ways that communicate her needs because she has no other way to communicate. "

Clients, consumers, or patients

These terms are often used by service providers to describe us, and they may make sense in certain contexts. CommunicationFIRST, a disability-led organization, however, does not use these terms to refer to our population generally because they can be "othering" and dehumanizing. In addition, the "services" employed, taught, or "provided" to assist others to understand what we want to say are actually for the benefit of, and are a service to, everyone involved-us and our interlocutors.

Communicative competence

This term was coined in 1989 to help communication professionals better understand and analyze all important interpersonal aspects of communication that everyone needs. The goal was to challenge beliefs that being given the tools to communicate a basic request was "good enough" for anyone. In 2014 , the authors revisited and expanded the framework after 25 years of technological and other developments in the field.

The ideas behind the "communicative competence" framework are helpful. In practice, however, the term itself may inadvertently shift the burden of addressing a communication barrier to the person who has the fewest tools to address it. The term also suggests a binary-that one is either a "competent communicator" or an " incompetent communicator." When someone is seen as " communicatively in competent," they're more likely to be denied access to robust, language-based AAC, segregated, or even institutionalized than they are to be given the supports and services they need to develop new skills. We urge that a new, less harmful term be adopted to describe the framework.

Survey

If you have a speech-related disability, please let us know what you think and what terms you prefer by filling out this short survey. We value your opinion-thank you for helping us improve this resource with your input! The survey will remain open indefinitely.

Additional Resources

(Note: Inclusion of a resource below should not imply endorsement)

Erin E. Andrews, Robyn M. Powell, & Kara Ayers (2022), " The evolution of disability language: Choosing terms to describe disability ," Disability and Health Journal , 15(3)

Kristen Bottema-Beutel, Steven K. Kapp, Jessica Nina Lester, Noah J. Sasson, & Brittany N. Hand (2021), " Avoiding Ableist Language: Suggestions for Autism Researchers ," Autism in Adulthood , 3(1)

Miliann Kang, Donovan Lessard, Laura Heston, & Sonny Nordmarken (2017), "Identity Terms," in Introduction to Women, Gender, Sexuality Studies

Steven Kapp (2023), " Profound Concerns about 'Profound Autism': Dangers of Severity Scales and Functioning Labels for Support Needs ," Education Sciences , 13(2)

National Center on Disability and Journalism, Disability Language Style Guide

New Jersey Autism Center of Excellence's Language Guide

Shruti Rajkumar (2022) , " How to talk about disability sensitively and avoid ableist tropes , " National Public Radio

Thinking Person's Guide to Autism (Sept. 4, 2023), " Grave Concerns About Profound Autism"

Alyssa Hillary Zisk, Lily Konyn, & David Niemeijer (2023), "What AAC terminology should I use?: Insights from a community survey"

Version 1.0 (July 2023)
CommunicationFIRST © 2023

Posted in: Resources

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We are naming ourselves. And we choose our words with great care. Our decisions are guided by respect for the diversity of our community and for every person's right to choose the words they use for themselves.

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ASHA: Position Statement on Restrictive “Eligibility” Policies

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ASHA: Position Statement on Restrictive “Eligibility” Policies

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National Joint Committee for the Communication Needs of Persons With Severe Disabilities

About this Document

This position statement was developed by the National Joint Committee for the Communication Needs of Persons With Severe Disabilities. This position statement is an official policy of the American Speech-Language-Hearing Association. National Joint Committee member organizations and their respective representatives who prepared this statement include the American Association on Mental Retardation, Mary Ann Romski; the American Occupational Therapy Association, Jane Rourk; the American Speech-Language-Hearing Association, Beth Mineo Mollica, Rose Sevcik, Diane Paul-Brown (ex officio), and Alex F. Johnson (monitoring vice president); the Council for Exceptional Children, Division for Communicative Disabilities and Deafness, Lee McLean (chair); RESNA, Kevin Caves; TASH, Pat Mirenda and Martha Snell; and the United States Society for Augmentative and Alternative Communication, David Yoder. This statement was approved by ASHA's Legislative Council (LC4 2002) at the Spring 2002 meeting.

Eligibility policies and practices often preclude children and adults with severe disabilities [1] from accessing needed communication services and supports. Communication services and supports may include instruction of individuals and their communication partners, assistive technology, and environmental modifications, and may be delivered through a variety of service delivery models. [2] The expected outcome of such services and supports is to increase or to prevent decline in the individual's meaningful participation in daily activities. Categorical denial of communication services and supports without consideration of a person's unique communication needs may violate federal statute, and may also violate state law, regulation, and policy.

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It is the position of the National Joint Committee for the Communication Needs of Persons With Severe Disabilities that eligibility for communication services and supports should be based on individual communication needs. Communication services and supports should be evaluated, planned, and provided by an interdisciplinary team with expertise in communication and language form, content, and function, as well as in augmentative and alternative communication (AAC). Decisions regarding team composition, types, amounts, and duration of services provided, intervention setting, and service delivery models should be based on the individual's communication needs and preferences. Eligibility determinations based on a priori [3] criteria violate recommended practice principles by precluding consideration of individual needs. These a priori criteria include, but are not limited to: (a) discrepancies between cognitive and communication functioning; (b) chronological age; (c) diagnosis; (d) absence of cognitive or other skills purported to be prerequisites; (e) failure to benefit from previous communication services and supports; (f) restrictive interpretations of educational, vocational, and/or medical necessity; (g) lack of appropriately trained personnel; and (h) lack of adequate funds or other resources.

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Morris, W. (Ed.). (1981). The American Heritage Dictionary of the English Language. Boston: Houghton Mifflin Company.

National Joint Committee for the Communication Needs of Persons With Severe Disabilities. (1992, March). Guidelines for meeting the communication needs of persons with severe disabilities. Asha, 34(Supplement #7), 1-8.

Paul-Brown, D., & Caperton, C. (2001). Inclusive practices for preschool children with specific language impairments. In M. J. Guralnick (Ed.), Early childhood inclusion: Focus on change (pp. 433-463). Baltimore: Brookes.

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Service delivery models include both direct service and "indirect," consultative/collaborative service models, and any combination of these models identified as most appropriate to meet the individual's needs ( See Paul-Brown & Caperton, 2001).

a priori is defined as "made before or without examination and not supported by factual study" ( Morris, 1981).

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Index terms: admission/discharge criteria, people with disabilities

Reference this material as: National Joint Committee for the Communication Needs of Persons With Severe Disabilities. (2003). Position statement on access to communication services and supports: Concerns regarding the application of restrictive "eligibility" policies [Position Statement]. Available from www.asha.org/policy or www.asha.org/njc.

Copyright © 2003, National Joint Committee for the Communication Needs of Persons With Severe Disabilities

Disclaimer: The American Speech-Language-Hearing Association disclaims any liability to any party for the accuracy, completeness, or availability of these documents, or for any damages arising out of the use of the documents and any information they contain.

doi:10.1044/policy.PS2003-00227

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Position Statement on Access to Communication Services and Supports: Concerns Regarding the Application of Restrictive "Eligibility" Policies

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It is the position of the National Joint Committee for the Communication Needs of Persons With Severe Disabilities that eligibility for communication services and supports should be based on individual communication needs.

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NWACS: Using AAC to Support Verbal Communicators

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NWACS: Using AAC to Support Verbal Communicators

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Using AAC to Support Verbal Communicators — NWACS

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NWACS President Tanna shares rationale for ongoing use of AAC tips and tools to maximize the total communication skills of emerging - or limited - verbal communicators.

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Intermittent, unreliable, insufficient, and expensive speech - AssistiveWare

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This article explores some of the varied experiences autistic people can have navigating the space between non-speaking and fully speaking.

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All people with a disability of any extent or severity have a basic right to affect, through communication, the conditions of their existence. Beyond this general right, a number of specific communication rights should be ensured in all daily interactions and interventions involving persons who have severe disabilities.

To participate fully in communication interactions, each person has these fundamental communication rights:

1. The right to interact socially, maintain social closeness, and build relationships

2. The right to request desired objects, actions, events, and people

3. The right to refuse or reject undesired objects, actions, events, or choices

4. The right to express personal preferences and feelings

5. The right to make choices from meaningful alternatives

6. The right to make comments and share opinions

7. The right to ask for and give information, including information about changes in routine and environment

8. The right to be informed about people and events in one's life

9. The right to access interventions and supports that improve communication

10. The right to have communication acts acknowledged and responded to even when the desired outcome cannot be realized

11. The right to have access to functioning AAC (augmentative and alternative communication) and other AT (assistive technology) services and devices at all times

12. The right to access environmental contexts, interactions, and opportunities that promote participation as full communication partners with other people, including peers

13. The right to be treated with dignity and addressed with respect and courtesy

14. The right to be addressed directly and not be spoken for or talked about in the third person while present

15. The right to have clear, meaningful, and culturally and linguistically appropriate communications

Download a PDF version of the National Joint Committee's Communication Bill of Rights [PDF].

cite as: Brady, N. C., Bruce, S., Goldman, A., Erickson, K., Mineo, B., Ogletree, B. T., Paul, D., Romski, M., Sevcik, R., Siegel, E., Schoonover, J., Snell, M., Sylvester, L., & Wilkinson, K. (2016). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. American Journal on Intellectual and Developmental Disabilities, 121(2), 121-138.

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All people with a disability of any extent or severity have a basic right to affect, through communication, the conditions of their existence.

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Alison's Communication Passport Template (Canva)

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Alison's Communication Passport Template (Canva)

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All About ME - Communication Passport (for canva)

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Check out this Trifold Brochure designed by aactivelycommunicating.

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CALL Scotland: Personal Communication Passports

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CALL Scotland: Personal Communication Passports

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Back around 1990, my colleague, Sally Millar (now enjoying her retirement), was working with an adult with communication difficulties. (We'll call her Mandy.) Everything seemed to be in place for Mandy to spend a weekend's respite with a family - her communication book had been updated with appropriate vocabulary for the visit. The following week, Sally contacted the family to find out how things had gone.

"It was a disaster - we just couldn't communicate with her."

"Did Mandy not use her communication book? It's in the bag on the back of her wheelchair, but you have to get it out for her."

"Oh, we didn't want to pry into her personal things."

Sally realised there was a need for a simple, accessible way to store and recall important information for people with communication difficulties who couldn't speak for themselves and began to work on the problem, eventually leading to the creation of the "Personal Communication Passport" (sometimes abbreviated to Communication Passport). Sally presented her findings at various conferences in the 1990s and 2000s and CALL Scotland is still recognised as the place to go to for information and advice on Communication Passports. The book, Personal Communication Passports: Guidelines for Good Practice, was published in 2003 and is still available from CALL. Further information is available on the Communication Passports web site.

What is a Communication Passport?

Personal Communication Passports are a practical and person-centred way of supporting children, young people and adults who cannot easily speak for themselves. A Communication Passport pulls together complex information about the individual and presents it in an easy to use format. It should be easy to read, informative, useful and fun. Above all, the Communication Passport should be In an accessible format, so that the individual can share some or all of the information contained and should try to reflect their personality and interests.

Templates and ideas for creating Communication Passports are available from CALL Scotland's Personal Communication Passports web site, and from other sites:

Templates provide ideas and a structure for creating a basic Communication Passport, but it can take a lot of effort, time and negotiation to produce a good Passport that meets the needs of an individual.

Digital Passports

Paper-based Communication Passports are used in many countries, but people are also starting to make digital passports due to the advantages of additional media such as video and speech/audio output, ease of updating and sharing. Pamis in Scotland, for example, have started to make Digital Passports for their clients in the form of an e-book that people can flick through on a smartphone or tablet. Practical uses of the Digital Passport from Pamis include:

establishing a communication pathway - for example, between school and home

empowering families with a tool they can use for training carers

supporting people to understand the needs of the individual - for example, facilitating care assessments.

CALL Scotland attempted to produce an iPad app for creating a Communication Passport a few years ago, but we became frustrated by the procedures for making an app available through iTunes. There are other apps that can be used to create excellent Communication Passports, though they don't necessarily advertise themselves in the context of making a Passport. Book Creator, for example, is a free / low cost app that is easy to learn and can combine text, images, sound and video to create an attractive, informative and fun Communication Passport in e-book format.

How can you find out more about Communication Passports?

CALL Scotland's Personal Communication Passports web site would be a good place to start. We are running a training course on Personal Communication Passports at CALL on 10 th May. This will be suitable for speech and language therapists and assistants; social work staff; additional supports needs staff in education settings; care staff with charities and other organisations supporting people with communication difficulties. CALL Scotland can also provide training in schools, local authorities and other settings.

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Back around 1990, my colleague, Sally Millar (now enjoying her retirement), was working with an adult with communication difficulties. (We'll call her Mandy.) Everything seemed to be in place for Mandy to spend a weekend's respite with a family - her communication book had been upd...

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ASHA: Augmentative and Alternative Communication (AAC)

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ASHA: Augmentative and Alternative Communication (AAC)

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Augmentative and alternative communication is use of external devices (e.g. dedicated tablets) to help people with speech/language impairments communicate.

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Definition of Communication and Appropriate Targets

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Communication involves both understanding and expression.

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ASHA: Definitions of Language and Speech

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ASHA: Definitions of Language and Speech

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Speech and language are different. A person can have problems with one or both. Learn about the difference here. See a speech-language pathologist, or SLP, if you have concerns.

Jorge is 4 years old. It is hard to understand him when he talks. He is quiet when he speaks, and his sounds are not clear.

Vicki is in high school. She has had learning problems since she was young. She has trouble reading and writing and needs extra time to take tests.

Maryam had a stroke. She can only say one or two words at a time. She cannot tell her son what she wants and needs. She also has trouble following simple directions.

Louis also had a stroke. He is able to understand everything he hears and speaks in full sentences. The problem is that he has slurred speech and is hard to understand.

All of these people have trouble communicating. But their problems are different.

What Is Speech?

Speech is how we say sounds and words. Speech includes:

Articulation
How we make speech sounds using the mouth, lips, and tongue. For example, we need to be able to say the "r" sound to say "rabbit" instead of "wabbit."

Voice
How we use our vocal folds and breath to make sounds. Our voice can be loud or soft or high- or low-pitched. We can hurt our voice by talking too much, yelling, or coughing a lot.

Fluency
This is the rhythm of our speech. We sometimes repeat sounds or pause while talking. People who do this a lot may stutter.

What Is Language?

Language refers to the words we use and how we use them to share ideas and get what we want. Language includes:

What words mean. Some words have more than one meaning. For example, "star" can be a bright object in the sky or someone famous.

How to make new words. For example, we can say "friend," "friendly," or "unfriendly" and mean something different.

How to put words together. For example, in English we say, "Peg walked to the new store" instead of "Peg walk store new."

What we should say at different times. For example, we might be polite and say, "Would you mind moving your foot?" But, if the person does not move, we may say, "Get off my foot!"

Language and Speech Disorders

We can have trouble with speech, language, or both. Having trouble understanding what others say is a receptive language disorder. Having problems sharing our thoughts, ideas, and feelings is an expressive language disorder. It is possible to have both a receptive and an expressive language problem.

When we have trouble saying sounds, stutter when we speak, or have voice problems, we have a speech disorder.

Jorge has a speech disorder that makes him hard to understand. So does Louis. The reason Tommy has trouble is different than the reason Louis does.

Maryam has a receptive and expressive language disorder. She does not understand what words mean and has trouble using words to talk to others.

Vicki also has a language disorder. Reading and writing are language skills. She could also have problems understanding others and using words well because of her learning disability.

Where to Get Help

SLPs work with people who have speech and language disorders. SLPs work in schools, hospitals, and clinics, and may be able to come to your home.

To find a speech-language pathologist near you, visit ProFind.

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Speech and language are different. A person can have problems with one or both. Learn about the difference here. See a speech-language pathologist, or SLP, if you have concerns.

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Except as otherwise provided, in this chapter:

(3) Child with a disability

(A) In general The term " child with a disability " means a child-

with intellectual disabilities, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance (referred to in this chapter as "emotional disturbance"), orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities; and

(B) Child aged 3 through 9 The term " child with a disability" for a child aged 3 through 9 (or any subset of that age range, including ages 3 through 5), may, at the discretion of the State and the local educational agency, include a child-

experiencing developmental delays, as defined by the State and as measured by appropriate diagnostic instruments and procedures, in 1 or more of the following areas: physical development; cognitive development; communication development; social or emotional development; or adaptive development; and

(5) Educational service agency The term " educational service agency "-

(A) means a regional public multiservice agency-

authorized by State law to develop, manage, and provide services or programs to local educational agencies; and

(19) Local educational agency

(B) Educational service agencies and other public institutions or agencies The term includes-

The term includes an elementary school or secondary school funded by the Bureau of Indian Affairs, but only to the extent that such inclusion makes the school eligible for programs for which specific eligibility is not provided to the school in another provision of law and the school does not have a student population that is smaller than the student population of the local educational agency receiving assistance under this chapter with the smallest student population, except that the school shall not be subject to the jurisdiction of any State educational agency other than the Bureau of Indian Affairs.

a natural, adoptive, or foster parent of a child (unless a foster parent is prohibited by State law from serving as a parent);

except as used in sections 1415(b)(2) and 1439(a)(5) of this title, an individual assigned under either of those sections to be a surrogate parent.

( Pub. L. 91-230, title VI, § 602, as added Pub. L. 108-446, title I, § 101, , 118 Stat. 2652; amended Pub. L. 110-315, title IX, § 941(k)(2)(C), , 122 Stat. 3466; Pub. L. 111-256, § 2(b)(2), , 124 Stat. 2643; Pub. L. 114-95, title IX, §§ 9214(d)(1), 9215(ss)(1), , 129 Stat. 2164, 2181.)

References in Text

The Elementary and Secondary Education Act of 1965, referred to in par. (8)(A)(ii), (iii), is Pub. L. 89-10, , 79 Stat. 27. Part A of title I of the Act is classified generally to part A (§ 6311 et seq.) of subchapter I of chapter 70 of this title. Part A of title III of the Act is classified generally to part A (§ 6811 et seq.) of subchapter III of chapter 70 of this title. For complete classification of this Act to the Code, see Short Title note set out under section 6301 of this title and Tables.

The Alaska Native Claims Settlement Act, referred to in par. (13), is Pub. L. 92-203, , 85 Stat. 688, which is classified generally to chapter 33 (§ 1601 et seq.) of Title 43, Public Lands. For complete classification of this Act to the Code, see Short Title note set out under section 1601 of Title 43 and Tables.

The Tribally Controlled Colleges and Universities Assistance Act of 1978, referred to in par. (17)(B), is Pub. L. 95-471, , 92 Stat. 1325, which is classified principally to chapter 20 (§ 1801 et seq.) of Title 25, Indians. For complete classification of this Act to the Code, see Short Title note set out under section 1801 of Title 25 and Tables.

Prior Provisions

A prior section 1401, Pub. L. 91-230, title VI, § 602, as added Pub. L. 105-17, title I, § 101, , 111 Stat. 42; amended Pub. L. 105-244, title IX, § 901(d), , 112 Stat. 1828, related to definitions of terms used in this chapter, prior to the general amendment of subchapters I to IV of this chapter by Pub. L. 108-446.

Another prior section 1401, Pub. L. 91-230, title VI, § 602, , 84 Stat. 175; Pub. L. 94-142, § 4(a), , 89 Stat. 775; Pub. L. 98-199, §§ 2, 3(b), , 97 Stat. 1357, 1358; Pub. L. 99-457, title IV, § 402, , 100 Stat. 1172; Pub. L. 100-630, title I, § 101(a), , 102 Stat. 3289; Pub. L. 101-476, title I, § 101, title IX, § 901(b)(10)-(20), , 104 Stat. 1103, 1142, 1143; Pub. L. 102-73, title VIII, § 802(d)(1), , 105 Stat. 361; Pub. L. 102-119, §§ 3, 25(a)(1), (b), , 105 Stat. 587, 605, 607; Pub. L. 103-382, title III, § 391(f)(1), , 108 Stat. 4023, related to definitions of terms used in this chapter, prior to the general amendment of subchapters I to IV of this chapter by Pub. L. 105-17.

Amendments

2015-Par. (4). Pub. L. 114-95, § 9215(ss)(1)(A), struck out par. (4). Text read as follows: "The term 'core academic subjects' has the meaning given the term in section 9101 of the Elementary and Secondary Education Act of 1965."

Par. (8)(A)(iii). Pub. L. 114-95, § 9215(ss)(1)(B), which directed substitution of "under part A of title III of that Act" for "under parts A and B of title III of that Act" in "paragraph (8)(a)(3)", was executed to par. (8)(A)(iii) to reflect the probable intent of Congress.

Par. (10). Pub. L. 114-95, § 9214(d)(1), struck out par. (10) which related to definition of highly qualified.

Par. (18). Pub. L. 114-95, § 9215(ss)(1)(C), added par. (18) and struck out former par. (18). Prior to amendment, text read as follows: "The term 'limited English proficient' has the meaning given the term in section 9101 of the Elementary and Secondary Education Act of 1965."

2010-Par. (3)(A)(i). Pub. L. 111-256, § 2(b)(2)(A), substituted "with intellectual disabilities" for "with mental retardation".

Par. (30)(C). Pub. L. 111-256, § 2(b)(2)(B), substituted "of intellectual disabilities" for "of mental retardation".

2008-Par. (17)(B). Pub. L. 110-315 substituted "college or university" for "community college" and "the Tribally Controlled Colleges and Universities Assistance Act of 1978" for "the Tribally Controlled College or University Assistance Act of 1978 ".

Statutory Notes and Related Subsidiaries

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Except as otherwise provided, in this chapter: (3) Child with a disability (A) In general The term " child with a disability " means a child- with intellectual disabilities, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance (referred to in this chapter as

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Types of Assistive Technology (AT)

Assistive technology isn't new. In fact, it has been a part of the human experience for thousands of years. It is believed that eyeglasses were invented in Italy between 1268 and 1289; and, the first recorded use of a wheelchair dates back to 5th Century China.

Assistive technology can range from no and low tech solutions to high tech solutions. For example:

using paint to help with wayfinding ("to get to the elevator follow the blue line on the floor")

homemade grips (wrapping duct tape around a pencil or pipe insulation around a spoon handle)

speech generating devices that can be activated using eye gaze

Assistive technology solutions may be store bought, such as speech recognition software; modified such as placing tennis balls on a walker to make it easier to glide over carpets; and, even custom made such as creating a prosthetic hand using a 3D printer.

Throughout this site, we will use the following ten categories below to group AT solutions. It may not surprise you to learn that AT may fit into more than one category depending upon the person's needs as well as how and where the person uses the AT.

Vision

Products for people who are blind or visually impaired, including AT used for daily living activities, accessing computers, wayfinding, and other needs. Examples include:

magnifiers,

talking devices such as a talking thermostat,

Braille displays,

screen reading software,

text-to-speech systems using Optical Character Recognition (OCR),

large print materials, and

phones with large tactile buttons.

Want to know more or explore a sampling of products? Check out the resource below.

Hearing

Products for people who are Deaf or hard of hearing, including AT used daily living activities, communication, and other needs. Examples include:

personal amplification systems,

wireless TV listening systems,

vibrating alarm clocks,

doorbell with flashing light alert,

portable closed captioning system,

face-to-face dual keyboard communication system,

amplified telephones,

phone with captioning, and

mobile devices with texting or specialized apps.

Want to know more or explore a sampling of products? Check out the resource below.

Speech communication

Products for people with speech disabilities who need assistance with speaking including face-to-face communication. Examples include:

voice amplification systems,

fluency assistance devices,

artificial larynx,

communication boards,

speech output software,

symbol-making software, and

speech generating devices.

Want to know more or explore a sampling of products? Check out the resource below.

Learning, cognition, and developmental

Products for people who need assistance with learning, attention, memory, and organization. Examples include:

Want to know more or explore a sampling of products? Check out the resource below.

Mobility, seating, and positioning

Products for people who need mobility assistance. Examples include:

Want to know more or explore a sampling of products? Check out the resource below.

Daily Living

Products for people with disabilities and older adults with functional limitations due to aging. These products increase independence when performing activities of daily living such as bathing, dressing, personal hygiene, eating and other basic home/life activities including shopping and money management. Examples include:

dressing aids such as zipper pulls and button hooks,

long handle shoe horn,

Reacher,

adapted kitchen tools and eating utensils,

walker carrying bag,

wheelchair cup holder,

book stand,

automatic soap dispenser,

vacuum robot, and

switch-adapted appliances.

Environmental Adaptations

Products designed to increase access to homes, businesses, and other buildings by people with disabilities and include systems to open/lock doors, control lighting, temperature and other environmental needs. Examples include:

Want to know more or explore a sampling of products? Check out the resource below.

Vehicle modification and transportation

Products that promote safe access to transportation and increase independence through vehicle adaptations. Examples include:

Computers and related peripherals

Products that help people with disabilities access and use computers. Examples include:

specialized software such as screen magnification software for people with low vision,

alternative keyboards and input devices, and

voice recognition.

Want to know more or explore a sampling of products? Here are a few resources to get you started.

Recreation, sports, and leisure

Products that help people with disabilities participate in sports, recreation, and leisure activities. Examples include:

switch adapted toys,

playing card shuffler,

camera mounts, and

adapted sporting equipment.

Want to know more or explore a sampling of products? Here are a few resources to get you started.

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Assistive technology isn't new. In fact, it has been a part of the human experience since Ancient times. Assistive technology can range from no and low tech solutions to high tech solutions.

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USDOE PDF: Myths and Facts Surrounding AT Devices and Services

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USDOE PDF: Myths and Facts Surrounding AT Devices and Services

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This resource guide on the assistive technology (AT) decision-making process was created to assist Ohio school districts in understanding their obligation to provide needed AT devices and services to students with disabilities. General information on the school district's responsibility to consider the AT needs of all students who are receiving special education services and on the legal implications for districts is provided.

As outlined in the Individuals with Disabilities Education Improvement Act (IDEA), the local school district must provide for the specific needs of students with disabilities through a team process, including assessment for AT needs and implementation of AT services. Local educators and related service providers must make sound judgments on AT solutions that will be a part of the student's individualized educational program (IEP). It is OCALI's hope that this resource guide will support schools in making sound judgments in these areas.

This guide was developed in collaboration with the Ohio Assistive Technology Network with funding from the Ohio Department of Education's Office for Exceptional Children.
Download Full AT Resource Guide (PDF)
AT Resource Guide Sections

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~ Douglas Fisher & Nancy Frey, 21st Century Skills

​Assistive technology (AT) is an umbrella term that encompasses a range of tools, strategies, and services that enables a student with a disability to complete a task they would otherwise have difficulty with or be unable to do. Accessible technology refers to technology that's been designed with the needs of many different users in mind. Often Accessible technology includes similar tools and features as AT. For example, think about closed captions... Providing text with video or audio is a well-established assistive technology support for students with hearing impairments. But the inclusion of video/audio materials can also be beneficial for students learning English, students who are visual learners, and even a student who comes to school with fatigue and just needs a little extra support that day. As a result, Accessible technology has broad implications. Universal Design for Learning tells us that what's good for a few can be good for many, and for educators, this is a good place to begin to make learning accessible. What can educators make available in the instructional design from the start that will enable ALL students (including students with disabilities) to be more successful?

When talking about students with disabilities, there are references to tools, strategies, and the supports, as "assistive technology" as this legally required mandate must be addressed the the IEP process. By expanding an understanding of how Assistive and Accessible technologies overlap and compliment each other, teachers can shift into supporting ALL students.

The Open Access training sequence called "Accessible Curriculum for ALL " is designed for both general and special education teachers.

Dive a bit deeper into this topic by exploring the article

Why is Technology So Important for our Students with Disabilities:

The National Education Technology Plan (NEPT, Office of Educational Technology, 2017) states that one of the main goals of education is that "all learners will have engaging and empowering learning experiences in both formal and informal settings that prepare them to be active, creative, knowledgeable, and ethical participants in our globally connected society." This requires that learning resources embody the "flexibility and power of technology to create equitable and accessible learning ecosystems that make learning possible everywhere and all the time for all students."

Think about the quote at the top of this page. It's not enough to provide teachers with a box of tools. Teachers need to understand how to leverage those tools using methodology that considers the variability of all learners, and how to strategically implement them to reduce the specific barriers to learning for the students they are teaching. By grounding the provision of assistive technology in the practices of universal design for learning, teachers can support the goal for students to be successful in inclusive settings.

What is the impact for our students with disabilities?

What are the mandates for providing assistive technology?

Because AT is so important for students with disabilities, there exist specific mandates for providing tools, strategies and the services that support their use. Since 1990, IDEA has required AT devices and services be available to every student with a disability - if that student needs AT in order to receive a free and appropriate public education (FAPE). Needing AT to access an educational program can mean access to special instruction; access to the general curriculum; and/or access to extracurricular activities. In many cases, the provision of assistive technology can be the most meaningful way of ensuring students can meet more challenging objectives and experience an appropriately ambitious program.

More than one federal law addresses the requirement that schools provide AT to students who benefit from it and have equal access to their educational programs.

This overview of the " Legal Basis for Assistive Technology " from Gayl Bowser and Penny R. Reed, includes key excerpts about assistive technology mandates.

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Accessible & Assistive Technology | Open Access 2.0

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The objective of the Open Access website is to facilitate the Learning and Participation for ALL students by eliminating barriers to learning.

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We hear a lot of reasons for not beginning high-tech Augmentative and Alternative Communication (AAC) with students who have Complex Communication Needs (CCN)...A LOT of reasons. I've chosen the top six and created a flow chart. I like flow charts, but for those of you who do not, I've also written a narrative version, with related links.
Cognition Myth: "His/Her cognitive skills are too low to learn to use AAC. The individual has the cognitive skills of a 9 month old. That system is for 'higher functioning' kids."
I am starting with this myth because it is the one that makes the hair on the back of my neck stand up. These statements are demeaning, and I have heard people make comments like this in front of the student. If the individual is not able to communicate at the same level as peers, his/her communication difficulties may be interfering with his/her ability to accurately express intelligence. If this individual is currently using AAC, the system may be too limiting. Research shows that when you expect more from a child, his/her intelligence increases. Give the individual the benefit of a positive self-fulfilling prophecy.

Behavior Myth: "We have to get his/her behaviors under control and then we can consider communication. We don't want the device to be thrown and damaged."

If the individual does not have a reliable, effective way to communicate, he/she has no choice but to use behaviors. Appropriate, functional, comprehensive communication is necessary for "appropriate" behavior.

If this individual is currently using AAC, the system may be too limiting.

Proof of desire myth: "We're waiting for him/her to develop more verbal speech so that we can tell if he/she actually wants to communicate."

Acknowledge button presses as intentional communication, even if you don't understand the relevance. Presume competence and give the individual your respect and attention as they learn the power and value of communication.

If the individual does not have access to a large expressive vocabulary, someone else has determined the (frequently small) vocabulary available to him/her. If the limited system insults the individual or doesn't have what he/she wants to say, it is often ignored.

When you give individuals with complex communication needs (CCN) a system with an extensive vocabulary, you give them the opportunity to explore language and talk about what THEY want, and that can make all the difference. We all enjoy talking to people who share our interests or who are at least willing to listen. It is the foundation of relationships and socialization.

Hierarchy Myth: "He/She can't use an AAC device unless the individual is able to combine 3 icons in the communication book."

Get another opinion. Making individuals prove themselves before they are given access to a comprehensive communication system is archaic. If PECs or sign (for a hearing child) are being used, it should be for a brief time as a long term system is evaluated. These systems do not provide auditory feedback and are not universally understood.

Kate Ahern wrote about this and you can link to her blog here. If a professional tells you that your child has to climb a hierarchy and prove that he can use a high tech device, find a new professional.

Motor skills myth: "They need bigger buttons (less language) because their motor skills are too poor for little buttons."

Is the individual able to purposefully move his/her hand? Is he able to access his mom's iPhone to get into YouTube?

Use a key guard and/or limit vocabulary on the screen initially to allow for more accurate "hits." Fine motor skills frequently improve with use of AAC as the child's language grows. Frequently, key guards improve accuracy more successfully than increasing the button size. This is especially true if the individual is having difficulty with finger isolation. Fingers dragging in the screen will access larger buttons just as readily as the smaller ones. If someone evaluates your child and says he can only access large buttons, ask if a key guard was trialed.

If the individual has severe physical impairments that make them unable to move purposefully, contact device companies that offer eye gaze technology. This technology allows cameras to read individuals eye movements and speak the words that they look at for a certain amount if time. Physical limitations can be challenging and require additional expertise and/or equipment, but they are not a reason to deny access to a comprehensive communication system.

Age Myth: "He/She has to be a certain age before we introduce AAC." Or, "Wait until kindergarten (2nd grade, middle school, high school...) and then we'll take a look at AAC."

Are other people able to say words and use language at this age? If your answer is yes, then the individual is a candidate for AAC. If your baby is at risk for speech or language delays or there is any indication that speech may be delayed/difficult for this baby (I.e. No cooing or babbling, diagnosis, surgeries, traumatic or premature birth...), start modeling as soon as you're concerned. Keep in mind that babies are immersed in language immediately, but it takes them two years to start putting words together.

Whether you are concerned or not, play and talk to your baby. Narrate your actions: explain what you're doing and why. Respond when he/she vocalizes. Cherish his/her words and enjoy the beautiful phenomenon of language development that so many take for granted.

Monitor speech milestones. If your baby regresses or begins missing milestones, don't "wait and see"... Introduce AAC as soon as you notice your child's frustration or regression. AAC use will support - NOT inhibit- verbal speech development.

Enough Verbal Speech Myth: "He/She has enough verbal speech and can say sentences so the individual doesn't need AAC."

This one isn't on the flow chart because, well, the flow chart was getting a little crowded.

Individuals with verbal speech may also be AAC candidates. If a child is only able to say the same scripted, limited sentences ("I want a cookie please." "I want computer please." "I watch Sponge Bob."), he/she may be having difficulty segmenting where one word starts and another ends. In essence, he may be handling each of those sentences like one big, long word. The benefit of being able to segment words is that they can then be re-combined to form novel utterances.

Some individuals who express themselves very well verbally may have times (I.e. following seizures or when they're exhausted or sick) when they are not able to speak verbally. AAC is appropriate and beneficial for these individuals to allow them to have a voice when they are at their most vulnerable.

Symbol representation myth: "He/She has to understand symbol representation before we can introduce AAC."

This is also not on the flow chart, but it's worth mentioning. Symbols are abstract to everyone. We learn their meaning through exposure and experience. If you want a child to have symbol representation, use AAC. If she loves to play ball and every time she touches the ball and the device says "ball" and someone throws a ball to her, she'll start to understand the representation of that symbol and use it functionally.

The bottom line is: Individuals are candidates for high-tech AAC if they are not able to express wants, needs, ideas, thoughts, questions, fears, and pain to whoever they want, whenever they want.

High tech, comprehensive AAC provides the means to: express cognition, replace behaviors with appropriate communication, and initiate conversations about self-selected (and sometimes surprising!) topics - which then leads to an increased interest in true, meaningful communication. There is no age requirement to start modeling and immersing a child in AAC. AAC WILL NOT HINDER A CHILD'S VERBAL SPEECH. The consistent auditory feedback provides a model and reduced pressure frequently improve verbal speech skills. Often, a "side effect" of AAC use is the improvement of fine motor skills and attention, driven by the motivation to communicate.

Communication is a basic human right, and there is no pre-requisite skill that justifies delaying access to that right. On the contrary, communication IS the pre-requisite skill to academic, social, and behavioral success.

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The Myth of Augmentative and Alternative Communication (AAC) Pre-Requisite Skills - Speak For Yourself AAC

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We hear a lot of reasons for not beginning high-tech Augmentative and Alternative Communication (AAC) with students who have Complex Communication Needs (CCN)...A LOT of reasons. I've chosen the top six and created a flow chart. I like flow charts, but for those of you who do not, I've also written a narrative version, with related links.

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ASHA: Roles and Responsibilities of SLPs and AAC

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ASHA: Roles and Responsibilities of SLPs and AAC

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The use of alternative methods of communication can be traced back to ancient times when individuals who were deaf or could not speak developed a manual language. Manual languages were also used by First Nations to communicate with members of other groups (Glennen).
Mountain Chief demonstrates the Plains Indian Sign and Gesture language.
By the early 1950s, manual sign language had taken its place as a legitimate form of communication for people with special needs. In the years that followed, the clinical and educational basis for AAC was established but little actual research was done.

In 1952, Goldstein and Cameron first published information about the use of communication boards.

1960s - Emergence of AAC

The 1960s were a decade of social and political change. One result was the development of American Sign Language (ASL) which helped raise public awareness of people's communication needs.

Most of the early technologies emerged in Europe, often as special systems designed to control a typewriter or other common items in the home such as bells, lights, radios, telephones and televisions.

The POSM (Patient Operated Selector Mechanism), a sip-and-puff typewriter controller prototyped by Reg Maling in 1960 was an early electric communication device. Clearly portability was an issue!

In the early 1960s Orest Z. Roy at the National Research Council of Canada designed and built a communication device called the Comhandi - an electronic letter board that allowed people to select letters and build up words. It was one of the first devices of its kind in the world.

In 1967, the Patient Initiated Light Operated Telecontrol (PILOT) allowed people to control typewriters by simply pointing a beam of light.

Morse code was also used for typewriter control through voiced or sip-and-puff Morse code in the VOTEM system (1969), as well as by oral muscular control (1972).

To learn more about these pioneering communications systems see the 1974 book, Aids for the Severely Handicapped, edited by Keith Copeland.

1970s - Transistors & Symbols

In the 1970s early mechanical systems began to be replaced by transistorized devices.

Some of these systems used Electromyography (The electrical activity generated by skeletal muscles) to control typewriters and other devices.

Richard Foulds of Tufts University, led the development of the Tufts Interactive Communicator (TIC) a scanning communication aid, and later the ANTIC, the first communication aid to change its scanning order in anticipation of the next most probable letter to be typed.

In 1973, The Talking Broach, a pocket display operated via a keyboard became the first wearable communication device and along with Lightwriter created by Toby Churchill, the first portable communication aids. Talking Brooch was also the first to allow face-to-face communication with near eye contact.

A series of US government acts including the Rehabilitation Act of 1973 which prohibited discrimination against Individuals with disabilities and the Education for All Handicapped Children Act of 1975 which mandated free special education services for all school aged children helped spur the further research and development of AAC devices. Initially therapists tended to avoid the use of AAC devices until they were sure that the person could not develop speech naturally. Later research showed that early interventions that included use of an AAC device actually encouraged them to use more speech to supplement the devices.
The SCRP "100 + 100" display developed by the Ontario Crippled Children's Centre, was designed specifically to be used with Bliss Symbols. Another early symbol-based system developed by the Fairchild Space and Electronics company
In the early 1970s, picture symbols for individuals who could not use the alphabet were introduced. The first graphic symbol system was called Blissymbols, created by Charles Bliss. The original system included 1,400 black and white symbols with written symbols. This system is still used and updated with new symbols yearly. The Blissymbolics Communication Institute was formed in Toronto in the early 1970's and professionals traveled there to be trained to use the symbol system.

The next big step in AAC devices for people with autism and ELD was speech synthesis. Initial experiments involved stationary computers and the first use of synthetic voice by someone who could not speak was probably done out of the Artificial Language Laboratory at Michigan State University. It was used in the most normal of ways - to order a pizza.
The first commercial mass-marketed communication aid with speech synthesis was probably the Handivoice from Federal Screw Works.
In the mid-70s the Trace Center created a "portable" voice synthesizer based on the commercial DecTalk synthesizer by Digital Equipment Corporation (DEC). It weighed about 20 pounds and was mounted on the back of a wheelchair.

1980's Period of growth and development

By the 1980's AAC became an area of professional specialization and the American-Speech-Language-Hearing Association recognized it as an area of practice. In 1978, Purdue University became one of the first universities to offer a course on AAC.

Around the world, countries began implementing programs to fund the provision and development of AAC devices. Many of the companies that would become dominant players in the AAC market were also being formed.
The original Light Talker from the 1980s, along with a more modern version.
Although Ed Prentke and Bill Romich had created their first AAC device - based on a discarded Teletype machine - in 1969, it wasn't until the 1980s that the Prentke-Romich Corporation became a leading player in AAC devices with the release of the Minispeak System in 1982 and the Touch Talker and LightTalker in 1984. As technology has evolved, Prentke-Romich has continually refined their dedicated devices ever since and produced their first tablet app in 2012.

The era of dedicated devices also prominently featured the companies that would become today's Dynavox Mayer-Johnson. In the early 80s, DynaVox's predecessor Sentient Systems Technology developed the EyeTyper which allowed people to type using eye movements. In the early 1990s, now know as DynaVox they produced first AAC products to feature touch screens with dynamic displays. Word and grammar prediction was introduced to allowed people to compose messages more quickly.
In 2004, DynaVox acquired Mayer-Johnson, makers of Boardmaker and Boardmaker software.
In 1996, DynaVox introduced the first AAC devices with universal remote controls. In 2001, DynaVox was also instrumental in the lobbying effort that resulted in Medicare coverage for AAC devices. As computers became more powerful so did AAC devices and Dynavox continued to add features to their devices.

These and other mainstream dedicated device manufactures continued to develop new products and new features throughout the early 2000s. In 2010, the first iPad was introduced - and that changed everything. Suddenly AAC devices would become more affordable and more accessible for millions of children with autism and Expressive Language Delay worldwide.

We will explore the growing world of tablets and smartphones as advanced AAC devices in a future blog post.

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NDi Media - A History of Augmentative and Alternative Communication (AAC) Devices - Part 1: The Pioneers

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The use of alternative methods of communication can be traced back to ancient times when individuals who were deaf or could not speak developed a manual language. Manual languages were also used by First Nations to communicate with members of other groups (Glennen). Mountain Chief demonstrates the Plains Indian Sign and Gesture language.

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Past, Present, and Future of Augmentative and Alternative Communication

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Past, Present, and Future of Augmentative and Alternative Communication

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Past, Present, and Future of Augmentative and Alternative Communication

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AAC can be a simple gesture or use a high-tech device. Here is a brief history, current state, and future of augmentative and alternative communication.

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ASHA: AAC Knowledge and Skills for Service Delivery

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ASHA: AAC Knowledge and Skills for Service Delivery

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ACTS: Common Diagnosis and Characteristics of Speech Impairments Necessitating an SGD

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ACTS: Common Diagnosis and Characteristics of Speech Impairments Necessitating an SGD

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Communication Passport One Page Template

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WAiS Communication Passport Getting to Know You Cards

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I talk about it when training teachers, parents/caregivers, therapists and paraprofessionals. I teach directly about the AAC Bill of a Rights with my AAC using students. I program specific messages about the AAC Bill of Rights onto my clients' AAC Systems so they can self-advocate quickly when needed. I talk about it when I teach about AAC and behavior because often times "challenging behavior" is an indicator that the AAC Bill of a Rights is not being respected. Years ago, I revised the AAC Bill of Rights into various common symbol sets used in the USA and colleagues followed suits in their own countries.

There are currently two versions of the full text of the Communication Bill of Rights available, the 1992 version and the 2016 version. Both have the basic and vital information. I adore them both. They frame all I do in my work with individuals with complex communication needs. I honor and respect those that created both versions. Their work was and is visionary and incredibly impactful. However, the truth is, both versions of the Communication Bill of Rights are largely inaccessible to lower level readers and some individuals with intellectual or cognitive disabilities.

That is because the 1992 version of the Communication Bill of Rights measures at about a grade 9 Flesch-Kincaid Reading Level; the 2016 version, despite being designed to be clearer, measures at an 11th grade Flesch-Kincaid Reading Level. (Those measures are only reflective of the enumerated text of each document and were calculated on the Readability Formulas website.)

The Communication Bill of Rights are also (both versions) inaccessible to same age peers in our elementary and middle school classrooms, peers who could can play a dramatic role in the lives of their friends who use AAC.

Finally, there is the population of AAC users themselves. It is well known that AAC users have in the past, and are still today, often educationally neglected. They are often, if not nearly always, excluded from literacy instruction. If they do receive literacy instruction it is frequently sight word based or "functional/survival reading". This means a large portion of AAC users cannot read the Communication Bill of Rights, which is written in the first person, because it is speaking from the view of the AAC user; the AAC user who probably can't read it. (Which is our fault as a field and NOT a reflection of the AAC user's ability to learn to read.) To bring the irony to its pinnacle the final right in the 2016 version is, "The right to have clear, meaningful, and culturally and linguistically appropriate communications." (Emphasis mine.)

To be fair, the Communication Bill of Rights wasn't created for caregivers or direct care workers or children or AAC users. The updated version included information on how practitioners, specifically practitioners, could use the document to advocate for communication supports and services, promote inclusion and encourage broader community acceptance. Clearly the intended audience was practitioners. I can't think of a better way for this practitioner to advocate for communication supports and services, promote inclusion and encourage broader community acceptance than to work towards a more accessible version of the Communication Bill of Rights.

So let's do it. Let's make a clear and meaningful Communication Bill of Rights, an Accessible Communication Bill of Rights. One that can be read by the average American, by the 1 in 5 Americans that read at or below a fifth grade level, by students from grade three and up. Let's add symbols to support understanding for those who need them. After all, it is October, AAC Awareness Month! What better way to create awareness than to make the Communication Bill of Rights more understandable to more people?

The following Accessible Communication Bill of Rights measures at a 3rd Grade Flesch-Kincaid Reading Level.

I am a person with a communication disability. I communicate using a communication system or device. This is can be called my book, my talker or my AAC. These are my rights:

1. I have the right to my own friends and social life.

2. I have the right to ask for what I want, who I want or where I want to go.

3. I ALWAYS have the right to say, "no"!

4. I have the right to say what I feel.

5. I have the right to make my own, real, choices.

6. I have the right to say what I think, how I want to say it.

7. I have the right to ask for, get and give information about myself, my life, my schedule or anything that changes.

8. I have the right to know about the people in my life and everything happening to me.

9. I have the right to have EVERYTHING I need to be able to communicate and to be taught how to communicate.

10. I have the right to be heard and answered, even if I can't have what I want.

11. I have the right to have my communication system (and other tools), to have them working and to be with people who know how to set up, use and fix my communication system.

12. I have the right to be part of my community, in the way that works best for me, and for my communication to be as important as everyone else's.

13. I have the right to be treated with respect.

14. I have the right to be talked with and not about.

Note: I reworded each of the 15 points myself, attempting to use clear, simple and understandable language. I revised the sentence lengths numerous times as they impact readability, but many of the rights have multiple important points. I used the website to check for difficult to understand words and phrases and remove them from the text. If you wish to test the original text of the Communication Bill of Rights Rewordify is a way to locate the difficult words and phrases, make vocabulary lists to pre-teach and make other modifications.

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Resources and ideas for teachers and caregivers of learners with severe, profound, intensive, significant, complex or multiple special needs.

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Association of Assistive Technology Act Programs

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Association of Assistive Technology Act Programs

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Congress Reauthorizes the Assistive Technology Act

As part of the final passage of the National Defense Authorization Act, the U.S. Congress also agreed to reauthorize the Assistive Technology (AT) Act by including The 21st Century Assistive Technology Act (AT Act) in the final package. Bipartisan sponsors of the AT Act include Representatives Mark DeSaulnier (D-CA), Joe Sempolinski (R-NY) and Senators Bob Casey (D-PA), Susan Collins (R-ME), Maggie Hassan (D-NH), Kevin Cramer (R-ND), and Lisa Murkowski (R-AK).

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The Association of Assistive Technology Act Programs (ATAP) is a national, member-based non-profit organization, comprised of state Assistive Technology Act Programs funded under the Assistive Technology Act (AT Act). ATAP facilitates the coordination of state AT Programs nationally and provides technical assistance and support to its members.

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FREE handout: Communication Bill of Rights — Bilingüe AAC

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An easy to read and helpful hand-out of the communication Bill of Rights by National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC). People with a disability should have these basic communication rights in their daily interactions and intervention. Brady, N.

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STAR Issue 1.1: Communication Bill of Rights (YouTube video)

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STAR Issue 1.1: Communication Bill of Rights (YouTube video)

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CTEC Communication Technology Education Center

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STAR Issue 1.1 The Communication Bill of Rights for AAC