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Procedia - Social and Behavioral Sciences 128 (2014) 77 – 81

EPC-TKS 2013

Augmentative and alternative communication - support for people

Abstract

Frequently, a child with severe disabilities is in an early stage of communication development, which is a disadvantage compared
to the chronological age. Although the child may display a repertoire of some early communication behaviors, it is possible that
because of the nature of the disability (motor, sensory, cognitive), the caring adults can not or do not know how to respond to
these behaviors. Moreover, when adults try to respond, it may happen that their signals can not be interpreted by the child. As a
result, the child can not acquire the necessary understanding that would enable him to make the cognitive leap from unintentional
to intentional communication. In these situations, the most important is that the family or carers get advice from specialists to
learn how to become aware of and respond to any of the child's attempts to communicate. Therefore, whenever a child's speech
does not develop normally or he can not communicate effectively through speech due to pre-existing conditions, it is
recommended for him to receive an augmentative and alternative communication (AAC) support as soon as possible. Even when
it can not be clearly established whether a child will ultimately develop normal speech (and often we are faced with this
situation), it is better for him to learn an alternative communication system until the emergence of speech is observed.

©
© 2014
2014 The Authors.
Elena [Link]
Publishedby
byElsevier
Elsevier Ltd.
Ltd. Open access under CC BY-NC-ND license.
Selection
Selection and
and peer-review under responsibility
peer-review under responsibilityof
of Petroleum-Gas
EPC KTS and University
Guest Editors – Dr Cristian
of Ploiesti, Vasile,
Education Dr Mihaela
Sciences Singer and Dr
Department.
Emil Stan.

Keywords: augmentative communication, alternative communication, speech disorder

1. Introduction

Some people with disabilities can not use speech as a primary means of communication and are forced to employ
other specific techniques. The idea behind "augmented communication" is to make use of all the available abilities
to compensate for the impairment of verbal communication. With technology that is constantly developing, new
opportunities open up for people with disabilities that allow them to achieve an increasingly better level of

* Corresponding author. Tel.: +004-074-334-1069

1877-0428 © 2014 Elena Simion. Published by Elsevier Ltd. Open access under CC BY-NC-ND license.
Selection and peer-review under responsibility of Petroleum-Gas University of Ploiesti, Education Sciences Department.
doi:10.1016/[Link].2014.03.121
78 Elena Simion / Procedia - Social and Behavioral Sciences 128 (2014) 77 – 81

functional communication. In the last five decades, but more prominently in 1980, international experts in diverse
fields, such as the field of special education (teachers dealing with students with severe disabilities and autism),
speech disorders therapy, occupational therapy and biomedical electronics engineering, have all made considerable
efforts to find and develop systems and methods for nonverbal communication.
Nonverbal means of communication can be defined as "coding and messaging procedures without encoding these
phonemes directly into the vocal tract" (Bridgman, 1927). Thus, any encoding and transmission of messages that
does not take place with direct production of sounds by the source may be classified as non-verbal means of
communication.
All people use augmentative communication and daily we may observe perswons using this mode of
communication around us. It is a way to communicate without speaking. Every day we use gestures, facial
expressions, body attitudes, shopping lists, notes that help us convey certain messages. The augmentative and
alternative communication phrase encompasses a wide range of adapted communication methods.
Alternative and augmentative communication (AAC) refers to all the methods and means of communication
designed to assist / replace speech (or / and writing) when these are affected. Augmentative communication
indicates communication methods that can be used to accompany an impaired speech for improving transmission
and message understanding, and thus improving communication itself. Alternative communication relates to
methods and means of communication used to completely replace speech (or / and writing) when it can not be
produced.
In line with the position of ASHA (American Speech-Language-Hearing Association) from the annual
publication of the Association (ASHA, 1991), AAC intervention is multimodal, so that it appeals to the individual
communication ability as a whole, including any residual speech or vocalization, gestures, signs or other means of
sustaining communication.
An augmentative and alternative communication is "an integrated group of components, including the symbols,
communication aids, strategies and techniques used by the individual to support communication" (ASHA, 1991,
p.10), this definition emphasizing the use of multiple modalities and components in the communication process.
Alternative and augmentative communication subsumes any device, system, method, which improves the ability
to communicate for a person with a communication disability. While AAC is often used to refer to formal
communication devices and communication systems such as the manual signs, communication boards and speech
generating devices , it also includes less sophisticated modes of communication such as vocalizations, facial
expressions , idiosyncratic gestures.
Alternative and augmentative communication is especially needed when a child acquires speech normally and
there is a significant delay in development, but it can and should not simply become a substitute for how the child
currently communicates. AAC is needed to support communication and to replace only the items that are
unintelligible, socially unacceptable or dangerous for the subject or those around him. Ideally, alternative and
augmentative communication includes more than one system of communication, so that the child may use the most
appropriate depending on the people he communicates with, the circumstances and the activities he is involved
[Link] often, one of the means of communication in an AAC program is speaking itself. So during AAC
interventions, subjects will be encouraged to use various methods and appropriate means in various situations and
with different communication partners. This follows the principles of total communication startegies and it implies
that AAC users will use multiple methods of communication to achieve the most effective communication possible
(Anne Warrick, 1998).
Alternative and augmentative communication is a kind of intervention that uses manual signs, communication
boards with symbols, devices that produce synthesized voice, all these whilst trying to incorporate all remanent
communication skills of the child. These skills can include any remaining speech or vocalization capacity, gestures,
manual signs, ability to use communication boards and electronic devices for synthesizing voice.
Some children do not have any conventional way to communicate and express their needs and desires, and
sometimes they do that in a socially unacceptable manner, for example, aggressive, destructive or self-stimulating
actions. Alternative and augmentative communication can replace these unacceptable forms with conventional
means of communication. In the same time, alternative and augmentative communication helps to increase access
to learning activities and thus improves cognitive development of the individual.
 Elena Simion / Procedia - Social and Behavioral Sciences 128 (2014) 77 – 81 79

To what extent a person with neurological deficiency, immobilized in a wheelchair, can reach a certain degree of
independence? Maybe the person will never be able to move, feed or dress independently, but certainly having
access to an AAC system would provide the opportunity to communicate with others. The AAC system would
provide the opportunity to acquire a certain degree of independence, ensuring a higher degree of autonomy,
contributing to a greater social participation by people with language and communication disabilities.

2. Who can benefit from augmentative and alternative communication?

Considering the AAC user types, they can be divided into three groups:
x People who need an alternative language - they possess a good speech understanding and a receptive internal
language, but they miss the sensorimotor ability to produce a correct articulation of sounds that would make the
speech process possible and understandable. Thus, they must be provided with suitable means of communication -
for example, a communication card, an electronic device, a body language approach; also, they need support in
order to be able to employ the appropriate techniques to access the related devices (especially for the persons with
well-preserved cognitive abilities, but with various neurological impairments like cerebral palsy, stroke, head
trauma, multiple sclerosis and so on).
x People who need an augmented language - they do not quite understand speech nor they can intelligibly and
coherently express themselves through speech. For them, the surrounding environment must be reorganized using
labelling and symbols that they can understand; hopefully, then they will be able to integrate those symbols in an
efficient communication approach (included here is the group of people with autism, severe mental deficiency,
dyslexia - dysgraphia).
x People who need AAC for a certain period of time in their lives: they are either children who exhibit a delayed
emergence and development of language (and who have managed to develop and acquire speech only after learning
and using an AAC system) or adults who have lost the ability to speak due to diseases (such as stroke, head trauma,
multiple sclerosis, senile dementia) and they currently need an AAC system or people who have underwent surgical
interventions and can not use speech for a certain period of time, so they transiently use AAC.
It can not be said that there exists a determined disability or handicap that specifically requires the use of
augmentative and alternative communication system. Moreover AAC is a system of strategies that can be used to
facilitate communication of people of different ages and with various disorders, such as cerebral palsy, mental
impairment, impaired language and communication, stroke, head trauma, multiple sclerosis, neuromuscular
disorders, multiple and profound learning disabilities, autism and others.
One can say that for a person, the more his speech is affected, the greater his need for AAC support. Some people
will need AAC as the primary means of expression throughout life due to physical or language disabilities or
defects. Others will use AAC in a later stage of life as a result of deficiencies acquired by accidents or diseases. For
others, AAC will be only a transitional stage, towards the development of the ability to speak. And some people can
speak properly and use AAC only for writing. A special category is people with hearing loss and deafness, who use
body language as a first or main communication system, which often replaces all speech, while for the other
categories of deficiencies, the alternative communication methods supplement speech abilities remnants. Also,
people who are blind or visually impaired who use Braille or Moon and technology based on these systems are
considered AAC users, while learning these systems is not handled by specialists in AAC, but by special education
teachers specialized in visual impairments.

3. Classification of augmentative and alternative communication systems

There are several classifications of augmentative and alternative communication systems in the literature. One of
the most comprehensive classification, which takes into account both the techniques and the type of the devices
used, but also the type of symbols that are combined according to the abilities of the AAC user, is the work done by
FH Silverman in Communication for the Speechless (1980).
80 Elena Simion / Procedia - Social and Behavioral Sciences 128 (2014) 77 – 81

The author classifies non-verbal communication systems into three major groups:
x gestural systems
x gestural-assisted systems
x neuro-assisted systems
A more simple and widely used classification divides augmentative and alternative communication systems into
two groups:
x direct AAC systems (unaided)
x mediated AAC systems (aided)
Direct AAC systems are those that do not require any other additional equipment or [Link] in this
category are gestures and hand signals systems.
Mediated AAC systems are represented by communication systems that uses certain objects or equipment, such
as tables with symbols, communication cards, computers or electronic devices for voice broadcasting. They may be
comprised of something as simple as alphabet letters written on a piece of paper or a very complicated electronic
system pre-programmed with a very rich vocabulary. Mediated AAC systems are exhibit both advantages and
disadvantages:
Advantages:
x they provide vocabulary richness and flexibility
x sophisticated methods of storing and reproducing vocabulary;
x provides users with specific access components, some of which are designed so that they require only minimal
movement, for example pressing a switch, and that can be accessible even for people with serious physical
disabilities;
x communication speed can be increased;
x voice synthesizers increase user independence and allow access to different forms of interaction, such as talks
inside a group, telephone calls, computer and internet use, for example social sites that extend, but also exceed face
to face communication.
Disadvantages:
x with regard to equipment, it can be expensive, difficult to transport, it may be lost, damaged, it may require
batteries or an electric charging system;
x it may be necessary that a wheelchair or a classroom seat is fitted with a support device for the AAC equipment;
x because it may happen at anytime that the equipment malfunctions or it remains without batteries, it is necessary
that the person always has a direct AAC also available;
x may raise unrealistic expectations of "instant success" due to the involvement of technology;
In mediated AAC systems, there are also two other kinds of categories that can be observed, namely:
x non-electronic communication systems ("low-tech") - includes all devices that do not require electricity or
technology: real objects, photographs, thematic tables of symbols (icons), communication cards, communication
rings, letters, words, E- tran frames.
x electronic communication systems ("high-tech") - includes all systems that use electricity or technology (devices
for symbol indication, switches, switch-operated toys, voice synthesizers with one or multiple messages, computer,
Ipad, communication software.
Whenever there is a delay or deficiency in language development, AAC should be taken into account, and below
are listed a few reasons:
x largely, the child cognitive and social development is dependent of the communication skills. AAC has been
shown to support the development of children skills in each of these areas. A child with severe disabilities is often
unable to acquire cognitive and social skills naturally, based on conventional communication. The inclusion in a
therapeutic educational program based on AAC will enable functional means of communication and at the same time
will boost the above mentioned related areas.
x parents are often unable to interpret the early attempts of communication from children with disabilities . This
leads to a distortion in the normal relations between the child and his carers, but it can also determine the child to
abandon additional attempts for further communication. An AAC program helps parents become more receptive to
 Elena Simion / Procedia - Social and Behavioral Sciences 128 (2014) 77 – 81 81

communication behaviours manifested by the child, and in addition it provides the child ways of communication that
are more easily decipherable.
x a child with a deficiency of communication is prone to what is called "learned helplessness" - (Beukelman and
Mirenda, 1992). Because adults do not expect to be informed of their child needs and desires, they anticipate and
often misinterpret their real needs. As a result, because the needs are met even before they are communicated, the
child may waive any attempt to make his needs known, becoming extremely passive. AAC gives the child the tools
and means by which he is able to make choices and to indicate what he likes and what he does not like. In fact,
giving children more control over the environment is often one of the first objectives of the communication program.
x a child who is frustrated by his inability to communicate, to be understood by others, may resort to behavioural
disorders to get what he wants. AAC provides children socially acceptable ways to communicate their needs and
desires. All children sometimes exhibit unwanted behaviors. However, when these unwanted behaviours become so
intense and frequent that affect the child's safety or ability to learn, it is necessary to intervene on them. Behavioral
problems may include tantrums, throwing objects, kicking, scratching, biting others or ourselves. Self-stimulation
(waving fingers or throwing eyes) is also a behavioral problem. In the past, a variety of techniques have been used to
try to control improper social behavior. One of the most recent and successful methods is called "functional
behavioral analysis" or "positive behavioral support" (Reichle, York and Sigafoos, 1991).
To prevent all these unwanted side effects related to communication disabilities, early intervention is through
augmentative and alternative communication is indicated. Early intervention services are usually provided by a
multidisciplinary team of specialists that includes doctors, special education teachers, social workers, speech
disorder therapists and augmentative and alternative communication specialists. They include various activities that
can be carried out in hospitals or special clinics, in special schools or at home. The augmentative and alternative
communication specialist will advise the family on how to interpret and develop the child's means of
communication, on how to organize the communication within the home environment and to schedule learning
opportunities through play and games that make use of augmentative and alternative language. During individual
therapy sessions when the parent is also present and involved, the augmentative and alternative communication
specialist will implement an individual intervention program aimed at developing the child's language functions and
encourage transition to intentional and symbolic communication, so that a recovery or compensation of language
function is achieved.

References

American Speech-Language-Hearing Association (1991). Report:Augmentative and Alternative Communication , 33, 9-12.
Beukelman, D., R., Mirenda, P. (1992). Augmentative and alternative Communication, management of severe communication. Disorders in
Children and Adults. Paul H. Brooks Publishing Co.
Bridgman, P.,W. (1927). The logic of Modern Physics, New York:The Macmillan Company.
Popovici, D.,V., Racu, A ., CreĠu, V., Dani, A., (2009). IntervenĠia recuperativ - terapeutică pentru copiii cu dizabilităĠi multiple. Chiúinău:
Ruxandra.
Reichle, J., York, J., Sigafoos, J. (1991). Implementing augmentative and alternative communication. Baltimore: Paul H. Brookes
Silverman, F., H. (1980). Communication for the Speechless. Prentice-Hall: Englewood Cliffs Inc.