Chapter 1

People Who Require Augmentative and Alternative Communication

Introduction to AAC

  • Augmentative and Alternative Communication (AAC) is a significant area of clinical practice designed to support individuals with complex communication needs.

  • Effective communication is crucial for various aspects of life including self-determination, education, social engagement, employment, and medical care.

  • Quote by Bob Williams (2000): "The silence of speechlessness is never golden. We all need to communicate and connect with each other—not just in one way, but also in as many ways possible. It is a basic human need, a basic human right. And much more than this, it is a basic human power."

Definition and Importance of AAC

  • According to the American Speech-Language-Hearing Association (ASHA), AAC refers to interventions aimed at addressing severe communication disabilities related to speech-language production and/or comprehension.

  • Individuals with complex communication needs face obstacles in education, healthcare, and social integration without the appropriate AAC supports.

  • AAC interventions are categorized into two main types:

    • Habilitation: Helping individuals develop skills they have not yet acquired (e.g., children with developmental disabilities).

    • Rehabilitation: Helping individuals regain lost skills due to acquired disabilities (e.g., stroke survivors).

Types of AAC Systems

  • Unaided AAC: Does not require external technology; includes vocalizations, gestures, signs, and eye blink codes.

  • Aided AAC: Requires some form of technology, which can be low-tech (communication boards, picture exchange systems) or high-tech (computer-based speech-generating devices, mobile technologies with AAC applications).

    • Representations for vocabulary concepts can include photographs, picture symbols, written words, etc.

Who Relies on AAC?

  • AAC users come from diverse age groups, socioeconomic statuses, ethnic backgrounds, and have a variety of communication needs.

  • Common conditions leading to the need for AAC include:

    • Developmental disabilities like severe intellectual disability, cerebral palsy, Down syndrome, and autism spectrum disorder (ASD).

    • Acquired conditions such as ALS, multiple sclerosis, traumatic brain injury, stroke, and cognitive disorders like Alzheimer's disease.

  • Research indicates that around 5 million Americans and 97 million people worldwide may benefit from AAC.

Personal Experiences with AAC

First-person Accounts

  • Rick Creech described the feeling of not being able to speak as isolating, comparing it to being treated like "a piece of furniture."

  • Jim Prentice stated AAC allowed him to forge rewarding relationships, emphasizing that without it, one could feel socially, intellectually, and emotionally isolated.

  • Tracy Rackensperger noted using AAC to aid communication when interactions became challenging due to unfamiliarity.

  • Christy Brown recounted how his first written letter, created with a chalk held in his foot, symbolized his mental freedom.

  • Gus Estrella highlighted the pivotal role AAC plays in facilitating family conversations, sharing personal anecdotes about connecting with family members.

  • Godfrey Nazareth and Stephen Hawking shared their journeys using AAC for professional and personal communication, emphasizing that technology has opened possibilities for engagement in various aspects of life.

Purposes of Augmentative and Alternative Communication

  • AAC serves multiple key purposes:

    1. Communication of Needs/Wants: Enabling individuals to express desires and regulate the behavior of others.

    2. Information Transfer: Sharing knowledge and details about various topics, crucial in educational and employment settings.

    3. Social Closeness: Building relationships and connectedness through non-verbal interactions.

    4. Social Etiquette: Practicing conventional politeness in brief communications.

    5. Internal Dialogue: Allowing for personal reflection and planning through self-communication.

Communicative Competence

  • Communicative competence for AAC users involves:

    • Linguistic skills (understanding and using their language and AAC system).

    • Operational skills (technical competence in using AAC devices).

    • Social skills (understanding social contexts and nuances).

    • Strategic skills (overcoming barriers and maximizing communication opportunities).

  • Continuous support, practice, and tailored interventions are essential for AAC users to succeed communicatively.

Supporting Individuals Who Rely on AAC

Roles in AAC Support

  • Various professionals support individuals relying on AAC through different roles:

    • AAC Intervention Specialists: Coordinate interventions and work across settings (educational, medical, etc.).

    • Daily AAC Facilitators: Provide ongoing support for daily communication needs.

    • Communication Partners: Engage with AAC users to co-construct meaningful interactions.

    • AAC Finders: Identify individuals in need of AAC and connect them to resources and services (often medical professionals).

    • AAC Experts: Educate future professionals and establish AAC-related policies and research.

Call for Awareness and Education

  • There is a critical need for increased awareness of AAC among healthcare and educational professionals to ensure timely identification and support for individuals with complex communication needs.

  • Educational institutions should incorporate AAC training in their curricula to enhance service provision and advocacy.

Conclusion

  • The AAC community is vast and ever-evolving, requiring continued investment in knowledge, expertise, and resources to ensure that all individuals with complex communication needs can communicate effectively and participate fully in society.