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How Communication Passports Support Children’s Communication

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How Communication Passports Support Children’s Communication

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Communication Passports: Supporting Children’s Communication & Interactions — Sprouted Roots

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Discover how Communication Passports can enhance support for children with complex communication needs. Learn what these passports are, who benefits from them, and why they’re valuable tools for speech therapists, parents, and educators. Explore how to create effective passports that facilitate bett

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AAC Project Training 1 HANDOUT - 093024 (1)

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AssistiveWare: What AAC terminology should I use? - insights from a community survey

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AssistiveWare: What AAC terminology should I use? - insights from a community survey

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In early 2022, AssistiveWare ran an online survey, asking people with a variety of relationships to AAC what they thought about 119 different words and phrases. The first research of its kind, our survey resonated deeply with the community-in total, 556 people participated.

We reached out through many channels to ensure the survey respondents represented the community at large. AAC users, their families, and AAC professionals are all represented among our participants - including people with multiple relationships to AAC!

We picked the terms in the survey based on the language we saw in AAC-focused social media groups, advocacy organizations, and academic publications.

In our last blog post about the survey, we shared the perspectives of AAC users. Now, considering the preferences of people who use AAC, their relatives, and AAC professionals, we can share our overall recommendations.

Overview of our recommendations

Use

Think before using

Avoid using

Intermittently (non)speaking, minimally
speaking

Download an AAC terminology poster to use at home or in the classroom Some people have multiple relationships to AAC. AAC users can get into AAC research like we did. Siblings can become SLPs, and teachers can discover that their own kids need the same tools they work with every day at school. In this blog post, we consider people with just one role. If you see a number that doesn't quite match the last post - that's not an error! Some numbers change slightly when we pull out the AAC users with multiple roles.
We asked participants about their relationships to AAC; survey response options included "I use AAC" and "I use both AAC and speech." Most survey respondents who use AAC also use speech. Sometimes, AAC users have different opinions depending on whether or not they also speak, so we occasionally write about speaking AAC users and nonspeaking AAC users separately.

About people who use AAC

We recommend both AAC users and people who use AAC. Regardless of people's relationships to AAC, a majority liked or used both the person-first ( people who use AAC; 71%) and identity-first ( AAC users; 78%) construction.

Despite the popularity of people who use AAC, we don't suggest the acronym PWUAAC - it's the most frequently unfamiliar term in the survey (46%).

We don't suggest talking about people who rely on AAC or people who require AAC. The connotation of using something versus requiring it or relying on it makes a big difference in perception!

Other options depend on the context - they sometimes fit, but not always.

Part-time AAC users is primarily favored by speaking AAC users, unless they are also AAC professionals.

An educator says:

"I don't think it's necessary to differentiate part time vs full time, we all use alternative forms of communication sometimes"

A speaking AAC user explains:

"I don't like the differentiation between part- and full-time AAC users because people often think that we part-time users don't "really need" AAC, which is not the case. But sometimes, the differentiation seems needed? I often say, "I use a combination of speech and electronic speech/AAC to communicate"

An attorney who specializes in funding for AAC devices notes:

"My professional focus is funding and none of these phrases helps. A funding source once stated that a SGD will be covered only for someone who can demonstrate the device will be the sole method of expression. That 'demand' was dropped when it was made clear that no one fits that description, with or without disability. So, 'part-time' and 'full-time' is not helpful."

People with complex communication needs and multimodal communicators are both primarily favored by AAC professionals (76%-78%) and relatives of AAC users (58%-61%). AAC users aren't as likely to favor these terms overall, but these terms have their time and place. People with complex communication needs may be fine to refer to people who use AAC but not spoken language - almost half of them like or use the term (43%). Multimodal communicators, on the other hand, may be a better option for speaking AAC users: a small majority like or use the term (52%).

We don't recommend shortening people with complex communication needs with acronyms. A majority of respondents either dislike or are unfamiliar with the terms people with CCN (54%) and PWCCN (77%).

Not patients, consumers, or support recipients: we're just people

When we don't need to specify further, it's best to simply say people. Everyone who took the survey understands it, and it's the least disliked term in the whole survey (<1%).

When we do need to specify further, describing the relevant people is a good choice - people who use AAC is an example of this.

We don't suggest referring to people as patients, consumers, or support recipients outside very specific settings: regardless of people's relationships to AAC, these terms are commonly disliked (56% to 83%) and rarely liked or used.

Many people who took the survey made comments similar to this one from a speaking AAC user:

"Some are very context-specific. Patients- only in a medical setting. Clients- only in a setting where they are clients. Friends- only if they are actually friends. Learners- only in an educational setting or a context pertaining to them learning. Communicators- everyone communicates."

What should we call the device?

We suggest talking about AAC devices or simply devices when relevant. Referring to the hardware, like an iPad or a tablet, is also a good option when you know what the hardware is.

We recommend against talking about talkers in the general sense - when externally imposed, talker may be taken as too childish. Disabled children notice quickly when they're treated as younger than their abled peers, and adults definitely notice when they're considered childish!

Some AAC professionals note that they would only use talker with young children:

"this depends on age and context.. it's a slap in the face for my clients with MND [Motor Neuron Disease] to call their device a talker....."

"I think talker may be appropriate for a young child but not for older young people or adults"

"It depends on the child, but I have had children as young as 7 say they preferred "device" rather than "talker" because "talker" was too babyish"

A parent who uses talker explains:

"I struggle with what to refer to my kids aac device as. We settled on "talker" mostly to differentiate it from his gaming iPad."

Speech-generating device (SGD) may sometimes be necessary terminology to get a device funded. However, it's not an especially popular term, and we don't recommend it outside that context. As with the prior acronyms, SGD is less popular and more unfamiliar than speech-generating device.

How do we talk about not talking?

We usually suggest nonspeaking over nonverbal: it's the more popular term overall (51% vs. 36%) and strongly preferred by neurodivergent AAC users.

However, it is worth noting that people who use AAC and don't identify as neurodivergent are more likely to prefer nonverbal.

Functionally nonverbal, preverbal, and prevocal should simply be avoided in an AAC context.

Someone with a family member who uses AAC explains:

"I only like "preverbal" or "prevocal" when they refer generally to an infant early developmental stage. Beyond early infancy, pre indicates that you are trying to predict the future in the direction you want the future to go in. I'm not so comfortable with that. Maybe I feel it is insulting in that it tells us the person feels being verbal and vocal are better or that their child is not like some of our children in that they are only pre/temporarily such."

A friend of an AAC user notes:

"I use "preverbal" for young children, who are not yet speaking but are likely to do so in the future. I consider it highly inappropriate when applied to older children or adults."

Disability, disorder, deficit, or impairment?

When possible, we suggest disability terms, like communication disability or speech disability. There isn't a full consensus here, but fewer AAC users dislike disability terms (13%) than similar terms using difference (42%), disorder (46%), deficit (78%), or impairment (48%).

Deficit is the option we most strongly recommend against. It's widely disliked across a variety of relationships to AAC (61-92%).

Talking about talking

We suggest either spoken language or spoken words; They're the most liked and used options to discuss spoken language.

Natural speech and natural language should be avoided in an AAC context. One AAC user who also works with AAC as an educator notes,

"I don't like "natural speech" because it seems to imply other communication is unnatural."

Language and speech apply to more than just the words we speak orally - if you want to be more specific, these aren't the best choices. However, these terms are fine in their broader meanings.

Mouth words is community-specific: neurodivergent AAC users like and use mouth words, but no other groups do. Most negative comments about mouth words come down to it simply feeling strange. Sometimes people dislike words just for how they make you feel - like 'moist'!

One respondent outside the AAC field explains:

"I think I just don't like the word mouth. Not for any reason but that thinking about the bodily orifice makes me uncomfy"

However, a neurodivergent educator finds the term useful:

"Mouth words had been so helpful to be really specific and clear about exactly what I'm talking about, no ambiguity."

Communication supports

We suggest referring to Communication supports and AAC supports - these terms are broadly accepted. AAC strategies isn't quite as popular, but it's fine when the strategies, in particular, are a key part of the conversation.

However, we suggest avoiding AAC interventions whenever possible: intervention has rather different connotations for people who use AAC (57% dislike) than it does for professionals (51% like or use). If you need to talk about the education or instruction around teaching someone to use AAC tools, consider using the same kinds of words you'd use to describe teaching something new to a fully speaking person without disabilities. You wouldn't use "intervention" in that context either!

Intermittent, minimal, or unreliable?

There isn't a strong consensus about how to describe the reasons people might be able to speak - whether they use spoken language to communicate regularly, can technically say a few words, or have any other experience with speaking - and use AAC.

Whenever possible, we suggest following the lead of the person you're talking about. Some may prefer to simply say they are nonspeaking or nonverbal.

When an AAC user's ability to speak matters, we suggest one of intermittently speaking, intermittently nonspeaking, or minimally speaking. None of these are particularly popular, but they are less unpopular among the people they might describe.

Acronyms (other than AAC itself)

Whenever possible, we strongly suggest writing terms other than AAC out fully rather than shortening them to create acronyms. Whenever we asked about them, acronyms are less liked and used, more disliked, and more likely to be unfamiliar than their fully written out forms. The most extreme example of this compares people who use AAC, a highly popular term overall, with PWUAAC, the least understood term in the whole survey.

The difficulties understanding acronyms are extreme enough that on devices that support automatic replacements, it may be worthwhile to add text replacements that expand acronyms into their fully written out forms.

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What AAC terminology should I use? - insights from a community survey - AssistiveWare

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Read on for AssistiveWare's recommendations on what words to use and what words to avoid when talking about AAC based on a survey of the AAC community.

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AssistiveWare: How to talk about AAC and AAC users (according to them)

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AssistiveWare: How to talk about AAC and AAC users (according to them)

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We, Alyssa Hillary Zisk and Lily Konyn, know which of these AAC definitions we prefer, but we're only two AAC users. Our language preferences matter when people talk about us. But if we want to know how to talk about AAC users as a group, it's not enough to know what we like. It's not even enough to know what our friends like. We need to know what a lot of people prefer.

So we asked.

AAC terminology survey

In early 2022, AssistiveWare ran an online survey, asking people with a variety of relationships to AAC what they thought about 119 different words and phrases. The first research of its kind, our survey resonated deeply with the community-in total 556 people participated.

We reached out through many channels to make sure the respondents in the survey represented the community at large. We picked the terms in the survey based on the language we saw in AAC-focused social media groups, advocacy organizations, and academic publications.

One out of every three people who took the survey uses AAC. Of these, nearly a fifth (18%) do not use spoken words. Unless we say otherwise, this blog is talking about the perspectives of the 169 participants who use AAC. A future blog post will take a closer look at the perspectives of people who do not use AAC themselves.

AAC user opinions at a glance
Do say:
✅ AAC user

✅ People who use AAC

✅ Nonspeaking when referring to nonspeaking people as a group.

✅ When speaking with one person, ask what they prefer.

✅ People (when talking about groups of people). Not clients, consumers, or patients.
Don't use:

❌ Deficit-based terminology, such as people with highly unintelligible speech, or speech deficit.

❌ Acronyms, except for AAC itself.

Overview of AAC users' perspectives:

Unfamiliar terms
More than 20% of AAC users don't know the term

Disliked terms
More than 50% of AAC users don't like the term

Liked and used terms
More than 50% of AAC users use or like the term

People who use AAC

PWUAAC

PWCCN

People with CCN

People with highly unintelligible speech

patients

consumers

support recipients

AAC user

People

People who use AAC

Part-time AAC users

Full-time AAC users

Individuals

Users

Multimodal communicators

Devices used for AAC

AAC device(s)

Device

Communication device

Tablet / iPad / Phone /computer

Language/ speech

Communication deficit

Speech deficit

Natural language

Natural speech

Functionally nonverbal

Functionally nonvocal

Unreliably vocal

Prevocal

Preverbal

Residual language

Communication impairment

Minimally vocal

Nonspeaking

Spoken language

AAC service

Note: This table doesn't include every term we asked about. Instead, it shows the terms about which AAC users are most likely to have strong opinions.

The big debate: Identity-first vs. person-first language

A big debate we see again and again on our social media channels is around identity-first versus person-first language. In other words-do we say autistic person or person with autism. From our results, it is clear that identity-first language, such as disabled person, is the most common preference of neurodivergent respondents-at least half selected this option whether they used AAC, spoken language, or both.

For participants who do not identify themselves as neurodivergent, person-first language is the most common preference.

Overall, most participants support some mix of person-first and identity-first language. This includes people who say their preference depends on the diagnosis they're talking about. For example, people could follow community preferences and use person-first language for people with Down syndrome but identity-first language for autistic people.

What words do AAC users prefer?

Looking at the results, the terms that AAC users like or report using tend to be descriptive and direct.

AAC users

No matter how people communicate, the most frequently liked or used term in the whole survey is AAC users, with more than three-quarters of respondents who use AAC, liking or using the term.

People who use AAC

People who use AAC is the second most preferred term to refer to a group of people who use AAC. This is supported by nearly two-thirds of the participants.

AAC users who don't speak are more likely to dislike Multimodal communicators than speaking AAC users.

Part-time AAC users

Speaking AAC users tend to like and use the term part-time AAC users. Over two-thirds of participants who use both AAC and spoken words like or use this term.

Non-speaking AAC users have decidedly mixed opinions about part-time AAC users as a term. Less than one-third of participants who exclusively use AAC, like or use this term.

This term is also more popular among neurodivergent respondents, regardless of how they communicate.

Full time AAC users

Full time AAC users is a slightly less popular term than part-time AAC users overall. However, people tend to have very similar opinions about these two terms.

People

When discussing a group of people, the most commonly preferred term is simply people. Over three-quarters of the survey takers who use AAC like or use this term.

AAC device

AAC users like this term. Nearly three-quarters of participants like or use this term.

Spoken language

The terms spoken language and spoken words are equally popular, each liked or used by about half of AAC users.

Nonspeaking

There is no universally accepted way to describe someone who does not use spoken language. Three-quarters of neurodivergent AAC users like or use nonspeaking, whether or not they use speech along with AAC.

However, nearly half of people who use AAC but don't identify as neurodivergent, dislike the term nonspeaking.

AAC-related words to avoid

There are 18 terms that over half of AAC users dislike. Broadly, they can be grouped into four groups: deficit-based language, words that put the AAC user in a passive role, judgments about speech, and terms involving vocal. Note that for respondents who use AAC exclusively, this list increases to 40 highly disliked terms.

Unsurprisingly, language that presents speech as superior to other communication is not very popular. Words that put the AAC user in a passive role, like patients and support recipients were also unpopular. Terms that require an outside judgment of an AAC user's speech were also frequently disliked-they may also put the AAC user in a passive role.

Communication deficit

Among AAC users, communication deficit is the most disliked term in the entire survey. More than three-quarters of the survey takers who use AAC dislike this term!

Speech deficit

Speech deficit is the second-most disliked term among AAC users. More than three quarters dislike it, very similar to communication deficit.

Communication impairment

Communication impairment isn't as unpopular as communication deficit, but it still isn't popular among AAC users. Over half dislike it.

AAC intervention

AAC intervention is about as popular as preverbal: that is, AAC users don't like it.

Natural language

About two-thirds of AAC users dislike the term natural language.

Consumers

Consumers is very similar in popularity to patients as a group term-about two-thirds of AAC users dislike it.

Support recipients

S upport recipients is almost as widely disliked as patients or consumers, and slightly more AAC users don't know what it means. Support recipients is also slightly less likely to be liked or used. Just say people; people actually like that term.

Functionally nonverbal; Unreliably verbal

Vocal: Prevocal, vocal language

Acronyms

Acronyms (other than AAC itself) lead to both confusion and dislike. AAC users consistently prefer fully written out versions of phrases to their acronyms when asked about both forms.

PWUAAC

In contrast, most AAC users like or use people who use AAC.

Speech generating device (SGD)

Neither Speech generating device nor its acronym, SGD, are especially popular. However, more AAC users like or use speech generating device than dislike it, and nearly half are neutral to it.

However, very few AAC users like or use the acronym SGD, and more than a fifth aren't sure what it means.

It's complicated

There are some words where preferences among AAC users vary depending on whether or not they speak in addition to using AAC. Opinions on other words depend on whether or not respondents identify as neurodivergent. Sometimes, both of these are relevant.

This includes terms like nonspeaking, nonverbal, part-time AAC user, and full time AAC user. They aren't the only ones.

Intermittently speaking; intermittently nonspeaking

Opinions about the terms intermittently speaking and intermittently nonspeaking vary with whether or not an AAC user also speaks.

Nearly two fifths of speaking AAC users like or use the term intermittently nonspeaking, but a full fifth dislike it. Intermittently speaking is slightly less popular.

Neurodivergent AAC users are also more likely to like and use the phrases intermittently speaking and intermittently nonspeaking than AAC users who don't identify as neurodivergent.

Mouth words

A significant minority of neurodivergent AAC users dislike mouth words-a bit more than a quarter of them. However, nearly two-thirds like or use it.

AAC users who don't identify as neurodivergent, on the other hand, strongly dislike the term. Over three-quarters dislike the term. The few who use the term mouth words use both AAC and speech.

An AAC glossary is not a discussion

AAC users can and do have opinions on how we want to be described. There are some terms we're more likely to like and use, and others are widely disliked. We learned a lot by asking many people what they thought about different words and phrases related to AAC. We hope you learned something too. It's important to think about how our language positions people who use AAC and the ways we communicate.

However, it's important to know that AAC users also don't always agree with each other on the words we like and dislike. Except for people, every term is disliked by at least one AAC user. Every term also had at least one AAC user who says they use it.

This post can help advise you on referring to larger groups of AAC users, but we can't tell you how to describe yourself, nor your child, sibling, or colleague. Do you want to know what words a specific person in your life prefers? Ask them!

WRITTEN BY

There are a lot of terms frequently used in the world of Augmentative and Alternative Communication(AAC) that you might not know so here we have described the most frequently used terms.

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Our latest app duo is perfect for families new to AAC. The Proloquo app supports children's communication, language, and literacy growth. The Proloquo Coach app provides parents easy step-by-step guidance for using AAC at home.

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How to talk about AAC and AAC users (according to them) - AssistiveWare

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We, Alyssa Hillary Zisk and Lily Konyn, know which of these AAC definitions we prefer, but we're only two AAC users. Our language preferences matter when people talk about us. But if we want to know how to talk about AAC users as a group, it's not enough to know what we like.

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Learn what AAC and AT acronyms, concepts, and terms mean.

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Autism Spectrum Wheel: Supporting Each Individual

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Autism Spectrum Wheel: Supporting Each Individual

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Autism Spectrum Wheel: Supporting Each Individual

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The autism spectrum wheel. Why every autistic person and anyone who wants to support the autism community should have one. Free printable.

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Check out what's new on AAC Language Lab

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Alison's Communication Passport - All About Me (Canva Template)

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Alison's Communication Passport - All About Me (Canva Template)

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Check out this Trifold Brochure designed by aactivelycommunicating.

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NWACS compilation of posts all about the Communication Bill of Rights

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NWACS compilation of posts all about the Communication Bill of Rights

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The Communication Bill of Rights was our theme for 2022. In 1995, the National Joint Committee for the Communication Needs of Persons with Severe Disabilities ( NJC) published the first Communication Bill of Rights. It was later revised in 2016. It ensures the basic rights of people with disabilities to use communication to take part in managing their own lives. We spent the year learning about the different rights in this document and how they empower our AAC users!

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Articles on the NWACS blog related to the Communication Bill of Rights. The Communication Bill of Rights ensures the basic rights of people with disabilities to use communication to take part in managing their own lives.

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ASHA, NJC: Position Statement on Access to Communication Services and Supports (Concerns Regarding the Application of Restrictive “Eligibility” Policies)

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ASHA, NJC: Position Statement on Access to Communication Services and Supports (Concerns Regarding the Application of 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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ASHA, NJC: Communication Bill of Rights (PDF)

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ASHA, NJC: Communication Bill of Rights (PDF)

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NWACS Review: Communication Bill of Rights

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NWACS Review: Communication Bill of Rights

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by Alicia Alverson, MS, CCC-SLP, ATP (speech/language pathologist); NWACS board member
reading time: 7 minutes
Wow! 2022 is wrapping up. We were busy at NWACS this year covering the Communication Bill of Rights. This sparked a lot of great conversation. And provided new information for our blog. We dove into the conversations that are materializing around equity and access to communication. We renewed our torch of advocacy at NWACS. In this post, you will find a review of the Communication Bill of Rights and helpful tips related to each right. If you'd like to review the history, see our intro post.

How can you use the Communication Bill of Rights?

to help AAC users with self-advocacy

to guide SLPs, OTs, teachers, and other professionals in creating environments that foster AAC users' rights

for families to understand and advocate for the rights of their AAC users

to display in schools, medical settings, and more

to ensure we are treating individuals with disabilities and differences equitably

There are a variety of Communication Bill of Rights posters available:

The Communication Bill of Rights is a reminder that at the center of every conversation involving an AAC user, should be the AAC user. Their communication has power. Their communication is valid. Their communication is important. Their communication is valuable. Their communication matters. Their communication is their communication.

To summarize, according to the NJC, all people with a disability have the basic right to communication to relay their basic needs. In addition, each right guides us to foster environments that allow full communication participation, in all daily interactions and interventions, by people with disabilities ( Brady, A., Bruce, S., Goldman, A., et al., 2016). Some common themes that appeared among the rights were:

Opportunities for building and respecting autonomy are realized when respecting these Rights.

It is critical to ensure access to a variety of relevant vocabulary for a variety of communication interactions in AAC users' systems.

Honoring multiple means of communication is important and needed.

Communication partner coaching is an essential part of ensuring AAC users' communication rights are respected.

Making sure AAC users are aware of their Communication Rights.

Teach, teach, teach, teach, teach!

Give time. AAC users need time and patience from their communication partners so they can relay their intended message. We are used to a conversational pace that moves quickly. This can be prohibitive to an AAC user to say the things they want to say.

Let's summarize a few key points from each Right.

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2022 in Review - The Communication Bill of Rights - NWACS

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Join us to wrap up the year with a review of the Communication Bill of Rights. [7 minute read]

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Alison's Communication Passport - All About Me (PDF Template)

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Alison's Communication Passport - All About Me (PDF Template)

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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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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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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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TobiiDynavox: Busting AAC Myths (with PDF downloads and references)

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TobiiDynavox: Busting AAC Myths (with PDF downloads and references)

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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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Learn about AAC (augmentative & alternative communication) strategies, solutions & myths for people who can't speak or have language disabilities.

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Common Diagnosis and Characteristics Necessitating an SGD

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Common Diagnosis and Characteristics Necessitating an SGD

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Small Talk Speech Therapy: AAC Myths Busted

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Small Talk Speech Therapy: AAC Myths Busted

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AAC Myths: Busted » Small Talk Speech Therapy

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Speech Therapy for Children. At Small Talk Speech Therapy we specialise in helping kids find their voice. Call us 1300 651 704 to find. Speech Pathologist

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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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ASHA SIG Coordinator's Column: Banajee - Myths in the Field of AAC

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ASHA SIG Coordinator's Column: Banajee - Myths in the Field of AAC

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Journal Article: Jensen, Douglas, Gerde - Dispelling Myths Surrounding AAC Use for Children: Recommendations for Professionals

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Journal Article: Jensen, Douglas, Gerde - Dispelling Myths Surrounding AAC Use for Children: Recommendations for Professionals

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Journal Article: Smith, Barton-Hulsey, Nwosu - AAC and Families: Dispelling Myths and Empowering Parents

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Journal Article: Smith, Barton-Hulsey, Nwosu - AAC and Families: Dispelling Myths and Empowering Parents

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ASHA SIG 12 Article: Goldman - Ten Funding Myths Demystified!

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ASHA SIG 12 Article: Goldman - Ten Funding Myths Demystified!

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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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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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[ en Español]

Children and adults with severe speech or language problems may need to find other ways to communicate besides talking. There are many types of Augmentative and Alternative Communication (AAC) they can use. Speech-language pathologists, or SLPs, can help.

On this page:

About AAC

AAC means all of the ways that someone communicates besides talking. People of all ages can use AAC if they have trouble with speech or language skills. Augmentative means to add to someone's speech. Alternative means to be used instead of speech. Some people use AAC throughout their life. Others may use AAC only for a short time, like when they have surgery and can't talk.

There are a lot of different types of AAC. No-tech and low-tech options include things like

gestures and facial expressions,

writing,

drawing,

spelling words by pointing to letters, and

pointing to photos, pictures, or written words.

High-tech options include things like

using an app on an iPad or tablet to communicate and

using a computer with a "voice," sometimes called a speech-generating device.

A person may use different types of AAC because there are many ways that we all communicate. An AAC system means all of the tools of this type that a person uses.

Working With A Speech-Language Pathologist

An SLP can help find the right AAC system for you or your loved one. They also help you and the people you talk with learn how to use AAC to communicate. Not every tool works for every person, so it is important to find the right one for you. SLPs work with other professionals like occupational therapists and physical therapists if you have different physical skills that affect how you access your AAC system. Some AAC tools are covered by insurance, but some are not. Your SLP can help you understand your options.

Common Concerns

You may have questions or concerns about using AAC. Professionals have been studying AAC for years, so we've learned a lot about how AAC helps people communicate. Here are some of the areas that research has helped us understand.
Age, Skills, and Timing
Some people wonder if children need to be a certain age before they can use AAC. Research shows that AAC helps people of all ages (even those younger than 3 years old)! You can use AAC early. There are no thinking skills, test scores, or other milestones that you need to reach before AAC can help.
Talking and Motivation
A lot of people wonder if using AAC will stop someone from talking or will slow down language development. This is not true-research shows that AAC can actually help with these concerns! People who use AAC can also learn how to read and write.
Movement
You might wonder how someone can use AAC if they have trouble moving their arms and hands. There are many ways to use an AAC system besides touching it. Your SLP may work with occupational therapists (OTs) and physical therapists (PTs) to find the best way for each person to use their AAC system.

You probably have other questions. The best person to talk to about AAC is an SLP. A good place to find an SLP who specializes in AAC is ASHA's Profind.

Other Resources

This list does not include every website on this topic. ASHA does not endorse the information on these sites.

To find an SLP near you, visit ProFind.

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Augmentative and Alternative Communication (AAC)

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Children and adults with severe speech or language problems may need to find other ways to communicate. There are many types of AAC that they can use. Speech-language pathologists, or SLPs, can help.

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Definition of Communication and Appropriate Targets

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Communication involves both understanding and expression.

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National Joint Committee for the Communication Needs of Persons With Severe Disabilities (NJC): AAC

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National Joint Committee for the Communication Needs of Persons With Severe Disabilities (NJC): AAC

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Introduction to AAC

AAC is used by people who, some or all of the time, cannot rely on their speech. AAC incorporates the individual's full communication abilities and may include any existing speech or vocalizations, gestures, manual signs, and aided communication. AAC is truly multimodal, permitting individuals to use every mode possible to communicate. Over time, the use of AAC may change, although sometimes very slowly, and the AAC systems chosen today may not be the best systems tomorrow.

By recent estimates, well over 2 million persons who present with significant expressive language impairment use AAC. AAC users encounter difficulty communicating via speech due to congenital and/or acquired disabilities occurring across the lifespan. These conditions include but are not limited to autism, cerebral palsy, dual sensory impairments, genetic syndromes, intellectual disability, multiple disabilities, hearing impairment, disease, stroke, and head injury.
Bottom Line:
Unaided Versus Aided Communication

Typically, AAC includes unaided and aided modes of communication. Unaidedmodes of communication include nonspoken means of natural communication (including gestures and facial expressions) as well as manual signs and American Sign Language (ASL). These modes of communication often require adequate motor control and communication partners who can interpret the intended message. Aided modes of communication include those approaches that require some form of external support, such as a communication boards with symbols (e.g., objects, pictures, photographs, line drawings, visual-graphic symbols, printed words, traditional orthography) or computers, handheld devices, or tablet devices with symbols that generate speech through synthetically produced or recorded natural (digitized) means.

For individuals with severe disabilities, it can be helpful to encourage (and teach) both unaided and aided modes of communication. Individuals may need to be taught when it is appropriate to use different modes of communication. For example, the individual may sign when interacting with parents at home but may use a picture-based system or speech generating device (SGD) with other communication partners. Individuals with very complex needs and a limited communication repertoire can learn to use different systems in different contexts.
Bottom Line:
Decision Making About AAC Systems and Interventions

The currently accepted evidence suggests that there are no specific prerequisites (e.g., age, cognitive, linguistic, motor) for getting started with AAC. A number of AAC options are available to begin the intervention process. Ideally, the decision to introduce AAC should be made in consultation with the consumer, family, and a team of professionals. However, no individual should go without communication, and all individuals should have access to AAC systems that promote effective communication.

AAC should also be considered for individuals who have some speech or speech that is unintelligible to unfamiliar listeners. These individuals may use AAC to augment their communication. Other individuals may use speech in low-demand contexts but choose to use AAC to augment their communication in high-demand contexts. The presence of speech should not preclude the consideration of AAC as a support.

Decisions When Choosing Aided AAC

Choosing an aided AAC system requires careful consideration of an individual's current skills, strengths, and needs, but it is important not to restrict the individual's potential. Assessment strategies can lead to an understanding of:

Options for different symbols, systems, and access modes

The contexts where the individual must communicate

The skills and supports available to partners

The profile of the individual including: vision, hearing, sensory-motor, motivation, cognitive, linguistic, literacy skills, and current modes of communication

Dynamic assessment processes allow for this to happen while individuals are learning.
Bottom Line:
Resources

Beukelman, D. & Mirenda, P. (2013). Augmentative and Alternative Communication: Supporting Children & Adults with Complex Communication Needs 4th Edition. Baltimore: Paul H. Brookes Publishing.

ASHA Practice Portal's Augmentative and Alternative Communication webpage

ASHA's information for the public about Augmentative and Alternative Communication (AAC)

Return to the National Joint Committee for the Communication Needs of Persons With Severe Disabilities (NJC) topic areas list.

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Augmentative and Alternative Communication (AAC)

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AAC is used by people who, some or all of the time, cannot rely on their speech.

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Language

Language is a rule-governed behavior. It is defined as the comprehension and/or use of a spoken (i.e., listening and speaking), written (i.e., reading and writing), and/or other communication symbol system (e.g., American Sign Language).

Spoken and written language are composed of receptive (i.e., listening and reading) and expressive (i.e., speaking and writing) components.

Spoken language, written language, and their associated components (i.e., receptive and expressive) are each a synergistic system comprised of individual language domains (i.e., phonology, morphology, syntax, semantics, pragmatics) that form a dynamic integrative whole (Berko Gleason, 2005).

Descriptions of the five language domains follow:

Phonology-study of the speech sound (i.e., phoneme) system of a language, including the rules for combining and using phonemes.

Morphology-study of the rules that govern how morphemes, the minimal meaningful units of language, are used in a language.

Syntax-the rules that pertain to the ways in which words can be combined to form sentences in a language.

Semantics-the meaning of words and combinations of words in a language.

Pragmatics-the rules associated with the use of language in conversation and broader social situations.

The five basic language domains are part of a continuum which spans to higher order language skills, such as discourse, which is impacted by skills in the pragmatics domain.

Higher order language skills include inferencing; comprehension monitoring; interpretation of complex language, such as jokes and puns; and use of text structure knowledge. Metalinguistic awareness is requisite for the development of higher order language skills and is defined as "the ability to think about and reflect upon language" (Gillon, 2004, p. 10). Metalinguistic awareness includes phonological awareness, morphological awareness, syntactic awareness, semantic awareness, and pragmatic awareness. Metalinguistic skills are also critical for self-regulation and self-monitoring.

Spoken Language

Written Language

Pragmatics

(includes discourse)

understanding of the social aspects of spoken language, including conversational exchanges

social use of spoken language, including production of cohesive and relevant messages during conversations

understanding point-of-view, needs of the audience, etc.

conveying point-of-view, intended message, etc.

See ASHA's resource titled Developmental Norms for Speech and Language for more information.

Language Acquisition and Use

Language learning and use are determined by the interaction of biological, cognitive, psychosocial, and environmental factors. Language evolves within specific historical, social, and cultural contexts. Communication difference/dialect is a variation of a linguistic symbol system used by a group of individuals that reflects and is determined by shared regional, social, or cultural/ethnic factors (ASHA, 1993).

Effective use of language for communication requires an understanding of human interaction, including nonverbal cues, motivation, and sociocultural roles.

Relationship Between Spoken Language and Written Language

Phonological awareness underlies the ability to manipulate speech sounds (i.e., phonemes) in spoken words. It has been found to contribute notably to reading and writing development (Al Otaiba, Puranik, Zilkowski, & Curran, 2009; Lemons & Fuchs, 2010; Scarborough, 1998). Components of phonological awareness include syllable awareness (e.g., one syllable in "c ap" vs. two syllables in " ag ain"), onset-rime awareness (e.g., onset: cap vs. rime: c ap), and phoneme awareness (e.g., "cap" contains three phonemes: /k/ + /æ/ + /p/)

When instruction in phonological awareness is paired with knowledge of letter names (i.e., graphemic awareness), then phonics, a core written language skill for reading and writing development, is being addressed.

See ASHA's Practice Portal pages on Spoken Language Disorders and Written Language Disorders for more information.

Language Disorder

A language disorder is an impairment in comprehension and/or use of a spoken, written, and/or other communication symbol system (e.g., American Sign Language). The disorder may involve the form of language (phonology, morphology, syntax), the content of language (semantics), and/or the function of language in communication (pragmatics) in any combination (ASHA, 1993). In some cases, augmentative/alternative communication may be required for individuals demonstrating impairments in gestural, spoken, and/or written modalities. (ASHA, 1993).

Language disorders may persist across the lifespan, and symptoms may change over time (Bashir, 1989). Further, a language disorder can be a distinct diagnosis or may occur within the context of other conditions.

A regional, social, or cultural/ethnic variation of a symbol system should not be considered a disorder of speech or language (ASHA, 1993).

Relationship Between a Language Disorder and Social Communication Disorder

Children with language disorders may also present with social communication difficulty since social communication comprises social interaction, social cognition, pragmatics, and language processing. More information about social communication can be found on ASHA's Social Communication Disorder Practice Portal site.

References

Al Otaiba, S., Puranik, C., Zilkowski, R., & Curran, T. (2009). Effectiveness of early phonological awareness interventions for students with speech or language impairments. Journal of Special Education, 43(2), 107-128.

American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations [Relevant Paper]. www.asha.org/policy/.

Bashir, A. S. (1989). Language intervention and the curriculum. Seminars in Speech and Language, 10(3), 181-191.

Berko Gleason, J. (2005). The development of language (6th ed.). Pearson Education.

Gillon, G. T. (2004). Phonological awareness: From research to practice. Guilford Press.

Lemons, C.J., & Fuchs, D. (2010). Phonological awareness of children with Down syndrome: Its role in learning to read and the effectiveness of related interventions. Research in Developmental Disabilities, 31(2), 316-330.

Scarborough, H. S. (1998.). Early identification of children at risk for reading disabilities: Phonological awareness and some other promising predictors. In B. K. Shapiro, P. J. Accardo, & A. J. Capute (Eds.). Specific reading disability: A view of the spectrum (pp. 75-119). York Press.

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Language is a rule-governed behavior. It is defined as the comprehension and/or use of a spoken (i.e., listening and speaking), written (i.e., reading and writing), and/or other communication symbol system (e.g., American Sign Language).

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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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Ed. Code Definition of Assistive Technology (AT) Devices and Services

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Ed. Code Definition of Assistive Technology (AT) Devices and Services

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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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ASHA doc: SLP AAC Roles and Responsibilities Position Statement

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ASHA doc: SLP AAC Roles and Responsibilities Position Statement

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ASHA doc: SLP AAC Knowledge and Skills for Service Delivery

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ASHA doc: SLP AAC Knowledge and Skills for Service Delivery

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BilingϋeAAC’s English Bill of Rights with DrawnToAAC Images (PDF English)

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BilingϋeAAC’s English Bill of Rights with DrawnToAAC Images (PDF English)

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BilingϋeAAC’s Spanish Bill of Rights with DrawnToAAC Images (PDF Spanish)

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BilingϋeAAC’s Spanish Bill of Rights with DrawnToAAC Images (PDF Spanish)

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Kate Ahern's Accessible Communication Bill of Rights (Blog Post)

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Kate Ahern's Accessible Communication Bill of Rights (Blog Post)

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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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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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Kate Ahern's Symbolated Communication Bill of Rights (PDF, PCS symbols)

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Kate Ahern's Symbolated Communication Bill of Rights (PDF, PCS symbols)

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Kate Ahern's Symbolated Communication Bill of Rights (PDF, SymbolStix)

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Kate Ahern's Symbolated Communication Bill of Rights (PDF, SymbolStix)

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Communication Bill of Rights (Ahern, SS symbols) (1)

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Video: Communication Technology Education Center’s STAR Issue about AAC Bill of Rights

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Video: Communication Technology Education Center’s STAR Issue about AAC Bill of Rights

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CTEC Communication Technology Education Center

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STAR Issue 1.1 The Communication Bill of Rights for AAC

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Call Scotland: Communication Passport Template

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Call Scotland: Communication Passport Template

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Diagnostic Center, Northern California (DCN)

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Diagnostic Center, Northern California (DCN)

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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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WAiS Communication Passport Getting to Know You Cards

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WAiS Communication Passport Getting to Know You Cards

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Supported Decision Making Project Resources: Understanding the Person's Communication

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Supported Decision Making Project Resources: Understanding the Person's Communication