Multilingualism and Augmentative and Alternative Communication: A Review of the Literature

Overview of the Article

  • Title: Multilingualism and Augmentative and Alternative Communication: A Review of the Literature, offering a comprehensive analysis of existing research and practices in this critical area.

  • Authors: Natalie R. Andzik and Hannah N. LaMarca, both affiliated with Northern Illinois University situated in DeKalb, demonstrating institutional backing for their research.

  • Publication Details: This article followed a rigorous peer-review process, being received on May 26, 2023, revised on October 15, 2023, and officially accepted for publication on February 19, 2024. It was subsequently published in Perspectives of the ASHA Special Interest Groups, a notable journal recognized for its contributions to speech-language pathology research.

  • DOI: The Digital Object Identifier for this scholarly work is https://doi.org/10.1044/2024_PERSP-23-00111, providing a permanent link to the article.

  • Correspondence: Any inquiries or further discussion regarding the content of this article can be directed to nandzik@niu.edu.

  • Disclosure: The authors have explicitly stated that no competing interests were declared, affirming the objectivity and integrity of their review.

Abstract

  • Purpose: The foundational problem identified is that individuals from diverse linguistic and cultural backgrounds who rely on Augmentative and Alternative Communication (AAC) often receive English-only AAC systems, which are inherently inadequate for addressing their complex and multifaceted language needs across various communicative environments. The article's aims are threefold: to meticulously describe the existing published research on multilingual AAC, to delineate and define emerging best practices that facilitate effective communication, and to critically highlight significant gaps in the current literature, all with the overarching goal of ensuring equitable language access for all learners who require AAC.

  • Method: The systematic literature review was executed by performing exhaustive searches across prominent academic databases, including CINAHL, PubMed, and ERIC. A diverse array of search terms was employed, such as “multilingual,” “bilingual,” “code-switching,” “children,” “adolescents,” “adults,” “disability,” “complex communication needs,” “speech-language pathology,” and “AAC.” Following a rigorous application of pre-defined inclusionary and exclusionary criteria, which filtered for articles focusing on aided AAC and multilingualism published in English and excluding reviews, dissertations, or studies lacking comprehensive AAC focus, a final cohort of 15 articles was selected for detailed analysis and subsequent pattern reporting.

  • Results: The analysis of the 15 selected articles revealed that the vast majority consisted of expert opinions, primarily addressing AAC delivery, identifying barriers specific to AAC and multilingualism, and exploring the phenomenon of code-switching when using AAC. Among the data-based studies, qualitative research primarily summarized perceptions regarding AAC services and their profound impact on communication outcomes for individuals from diverse linguistic backgrounds. Notably, only two quantitative studies met the inclusion criteria, underscoring a significant paucity of empirical data.

  • Conclusions: Based on the review, practitioners are ethically and professionally obligated to provide comprehensive support to multilingual clients using AAC, ensuring that all languages spoken in their various settings are acknowledged and facilitated. A critical finding is the severe limitation in the accessibility of effective multilingual AAC systems. Consequently, there is an urgent and pressing need for more robust empirical studies to support evidence-based practices in this area. The review also contextualizes this need by noting that approximately 2 million individuals in the U.S. have complex communication needs, necessitating AAC to supplement or entirely replace their natural speech.

Augmentative and Alternative Communication (AAC)

  • Definition: AAC encompasses any method of communication that exists outside of typical vocal speech. It is broadly categorized into two primary forms:

    • Unaided AAC: This form involves using only one’s own body for communication, without external tools, examples include gestures, facial expressions, and formal sign language systems.

    • Aided AAC: Conversely, aided AAC relies on external resources or devices to facilitate communication. These can range from simple tools to advanced technology, for example symbol boards or sophisticated speech-generating devices.

  • Types of aided AAC: Aided AAC devices are further classified by their technological sophistication:

    • High-Tech Devices: These are advanced electronic tools such as iPads equipped with specialized communication applications, offering dynamic displays and extensive customization.

    • Mid-Tech Devices: These include simpler electronic devices like switches that can play pre-recorded messages, often used for specific communication needs or limited vocabulary.

    • Low-Tech Devices: These are non-electronic tools, such as letter boards, picture communication symbols, or communication books, providing basic communication support.

  • High-Tech AAC: Offers significant advantages over its lower-tech counterparts. Users can select voices that accurately represent their vocal preferences, considering factors like age, gender, and linguistic background, thus promoting a stronger sense of identity and authenticity. Furthermore, high-tech systems support an expansive vocabulary and more complex sentence structures, enabling richer and more nuanced interactions, and reducing the reliance on non-AAC supported interactions.

Multilingualism in AAC

  • Statistics: The prevalence of multilingualism in the U.S. is substantial, with over 67 million Americans identifying as multilingual, according to the U.S. Census (2022). This demographic reality significantly impacts educational settings, where 5.1 million students in U.S. schools are classified as English Language Learners (ELLs), constituting a notable 10.4% of the entire student population. A dominant linguistic group among ELLs is Spanish speakers, representing 77% of this population, though over 400 different languages are reported to be spoken in the homes of these students, highlighting immense linguistic diversity.

  • Terms: The term ELL has evolved from its predecessor, “English as a Second Language,” to more accurately reflect the reality that many students are acquiring English as a third, fourth, or even fifth language, rather than exclusively a second one, thereby acknowledging a broader scope of language acquisition.

  • Special Education Statistics (2020-2021): Data from this period indicates that specific communication and developmental needs are prevalent among students. Approximately 19% of eligible students receive special education services due to a speech/language impairment. Other significant categories include 12% for autism, 7% for developmental delay, and 6% for intellectual disabilities. Within the younger population, a study by Binger and Light (2006) revealed that 12% of preschoolers receiving special education services required AAC. Furthermore, a noteworthy finding from sociologists indicates that a significant percentage, specifically 20%, of Speech-Language Pathologists (SLPs) provide AAC services in both English and at least one other language, underscoring the growing demand for multilingual AAC support.

Clinical Implications and Recommendations

  • Communication Interventions: It is imperative that communication interventions for multilingual individuals comprehensively include their home languages and integrate relevant cultural elements. This approach is crucial for fostering effective communication and promoting generalization of communication skills across diverse settings, thereby enhancing meaningful contact with families and broader communities. Clinical practices should therefore be deeply embedded in culturally sensitive frameworks.

  • Culturally Responsive Teaching: Educators bear the responsibility of ensuring that multilingual children have unrestricted access to all their languages for learning and communication. This involves not only pedagogical adjustments but also judiciously utilizing available technology, such as tablets, within the teaching process to support diverse linguistic needs and learning styles.

  • Culturally Responsive AAC Framework: Implementing a culturally responsive AAC framework necessitates adopting a holistic view of the child. This framework must prioritize ensuring access to all of the child’s languages and actively celebrate their unique cultural practices, moving beyond a monochromatic approach to communication support. The focus must be on empowerment through linguistic and cultural affirmation.

  • Research Gaps: A critical finding of the review is the significant gap in empirical studies specifically addressing multilingual AAC practices. The existing literature predominantly focuses on monolingual interventions, leaving a substantial void in evidence-based strategies for multilingual contexts. There is an urgent need for more rigorous research to inform best practices in this area.

Research Methodology of the Review

  • Compliance with PRISMA Statement: The review rigorously adhered to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. This commitment ensured transparency and reproducibility in the systematic review methodologies, which were explicitly outlined via a detailed PRISMA flowchart illustrating the search and selection procedures.

  • Inclusion Criteria: Specific criteria guided the selection of articles for the review. These included a primary focus on aided AAC in conjunction with multilingualism, publication in the English language, and the exclusion of literature reviews, dissertations, or studies that lacked a comprehensive focus on AAC. This ensured a targeted and relevant body of literature for analysis.

  • Search Strategy: The search strategy was comprehensive, employing several prominent databases: CINAHL (Cumulative Index to Nursing and Allied Health Literature), PubMed (a vast biomedical and life sciences database), and ERIC (Education Resources Information Center). A range of specific phrases (e.g., “multilingual AAC,” “bilingual communication boards”) were used to target relevant articles. A meticulous screening process was then applied to eliminate duplicates and studies that were deemed irrelevant to the review’s scope.

  • Data Extraction: Once articles were selected, a systematic data extraction process was undertaken. Each article was coded based on its methodological approach (categorized as qualitative, quantitative, or expert opinion), its key topics of discussion, its primary findings, and any specific recommendations put forth by the authors. This structured data extraction facilitated a thematic analysis of the aggregated content.

Results of the Review

  • Summary of Findings: The comprehensive analysis encompassed 15 articles. The breakdown revealed a strong bias towards theoretical work, with 10 articles being expert testimonies or opinion pieces, and only 5 being data-based studies. Of these empirical studies, 3 were qualitative, and a mere 2 were quantitative. The journals represented in the review included respected publications such as Perspectives of the ASHA Special Interest Groups, the American Journal of Speech-Language Pathology, and Augmentative and Alternative Communication, among others. The bulk of the discussions concerning multilingualism in AAC centered around critical issues such as intervention delivery strategies, prevalent barriers to effective communication, and the complex practice of code-switching.

  • Expert Opinion Themes: The expert opinion articles coalesced around three prominent key themes:

    • AAC Intervention Delivery: This theme focused on providing recommendations and strategies for effectively supporting multilingual learners. A consistent emphasis was placed on the crucial incorporation of family input and the cultivation of cultural awareness in the design and implementation of AAC interventions.

    • Barriers in AAC and Multilingualism: Discussions within this theme explored the societal biases and widespread misinformation that often surround the capabilities of bilingual individuals, particularly those requiring AAC. These misconceptions frequently yield inequitable access to appropriate AAC services and devices.

    • Code-Switching: This theme highlighted the need for further rigorous investigation into the phenomenon of code-switching specifically within multilingual AAC settings. Experts underscored the complexity of this practice and the importance of understanding its implications for AAC users.

Detailed Findings from Articles

  • Expert Opinion Articles (summarized from the study):

    • Dukhovny & Kelly (2015): The authors asserted the fundamental necessity to support all languages utilized by a client. They emphasized the vital role of family involvement throughout every stage of the AAC process, advocating for a truly person-centered and family-centered approach.

    • McNamara (2018): This expert opinion article delves into a range of barriers, including prevalent societal misconceptions surrounding the capabilities of bilingual individuals with complex communication needs. These misconceptions, McNamara argues, frequently contribute to inequitable access to effective AAC support and resources.

    • King & Soto (2022): The authors suggested a concentrated focus on the practice of code-switching within AAC interventions. They underscored the importance of comprehensively understanding a client’s proficiency across their multiple languages to effectively integrate code-switching strategies into their AAC system.

Conclusion

There is a clear and unequivocal obligation for practitioners in the field of Augmentative and Alternative Communication to implement comprehensive supports that profoundly acknowledge and actively facilitate all languages utilized by their clients who present with complex communication needs. The review distinctly recognizes a significant literature bias towards expert opinion, validating the urgent and exigent need for more robust, empirical research to further explore and improve multilingual AAC access and outcomes for this diverse population.