The Ever-Changing World of AAC
Augmentative and Alternative Communication (AAC), as a subdiscipline of Speech-Language Pathology, has been around for approximately 70 years (Beukelman & Light, 2020). During this time, AAC has been shaped by numerous trends. Most recently, these have included, but are not limited to, an evolution in technology, ever-evolving roles of individuals with disabilities and their stakeholders, and significant shifts in AAC assessment and intervention paradigms.
I’ve practiced Speech-Language Pathology since 1981 and been involved in AAC service delivery most of my career. Obviously, I’ve been impacted by each of the trends mentioned above. For the most part, change has been good; however, my final trend, shifting paradigms, offers challenges for today’s AAC provider. This brief article overviews changes in AAC with a focus on shifting AAC service delivery paradigms. For each trend, suggestions are offered to move the field forward during an evolving period AAC services.
Trend 1: Changing Technology
Today, technology is changing every aspect of AAC services. Devices are more powerful, yet easier to navigate and use. Device features often extend well beyond assistance with expressive communication, offering help with communication and language comprehension, literacy, and environmental control. Device access is rapidly expanding to include eye gaze and even brain interface technologies, opening AAC to populations previously considered too impaired to benefit from its use. Finally, AAC devices have become portable, sleek, and aesthetically pleasing and, given the ever-present nature of technology in society, no longer “badges of difference.”
In sum, then, technological change has all been positive, right? Not quite. Device costs can be prohibitive and, though the world has become more open to technology, many of us are technophobic, limiting device effectiveness. Furthermore, technologies are often created with a disposable mindset making them dated or unusable too quickly. Clearly, there is work to be done. Devices must be designed in ways that make them both affordable and easily accessible to users and their often technologically reluctant stakeholders. Designers and AAC companies must also work to limit costs and extend the lives the devices and systems they generate.
Trend 2: Changing Roles
As AAC found its footing in the 1970s and 80s, potential device or system users were too often considered passive recipients of therapeutic services. Likewise, parents, partners, and other stakeholders were kept at bay during assessments and interventions. Those of us in provider roles clung to service delivery models that emphasized our positions as experts, limiting the potential benefits of teaming as it is known today.
The disabilities rights movements of the late 20th century led to evolutions in education and health care. Team models evolved that featured primary roles for students/patients and those prominent in their lives. Likewise, professional providers extended their focus from the student/patient alone to his or her environments and partners, broadening the potential impact of assessments and interventions.
These changes were not lost on the field of AAC. Today’s recommended AAC practices include active roles for the potential user of a device or system as well as his or her stakeholders. Interests, preferences, and priorities of these individuals are paramount in all decision making from assessment to intervention.
So, again, is this a change without controversy? Unfortunately, not. Providers remain who implement services from an expert perspective. In addition, the flattening of our world has made user/stakeholder inclusion more complicated as AAC recipients and those interested in their lives are increasingly diverse (e.g., racially, culturally, linguistically, or with respect to sexual orientation). AAC providers’ work continues as we challenge ourselves to respect and include others not only for the professional benefits such actions bring, but because these are the right things to do.
Trend 3: Changing AAC Paradigms
Recently, Ogletree, McMurry, Schmidt, and Evans (2018) wrote of evolutions in AAC assessment practices that were potentially troublesome. These authors noted that in today’s world the traditional AAC assessment paradigm involving a team-based, multi-step assessment of potential users, environments, and partners leading to device and/or system trial and selection is being usurped. In its place, a consumer-driven process has arisen where stakeholders and potential users purchase readily available technologies without guidance. Similarly, once AAC solutions are in place, team-based interventions can be side stepped by well-intended stakeholders pursing fad applications lacking empirical support. Dolic, Pibernik, and Bota (2012) reported that consumer AAC is attributable to the relative affordability and availability of tablet technology and tablet/computer applications. In sum, anyone can buy a device and related applications from retail stores or on the Internet and “crowd source” their use online.
Ogletree and colleagues (2018) note three disadvantages to consumer driven AAC assessment or treatment paradigms. First, consumers will likely pursue solutions in a less informed manner than would the AAC team. This can easily lead to purchases that lack applicability or utility. In worst case scenarios, uninformed purchases can result in device or system abandonment. Second, naïve AAC consumers may fail to look beyond the potential user to possible barriers to device or system use. For example, an application may be quite appealing at first glance but require operating features unknown to the novice buyer. Finally, not apparent to the less informed technology consumer, manufacturers of readily available devices or applications may have not created their products with individuals with disabilities in mind. DeRuyter, McNaughton, Caves, Nelson Bryan, and Williams (2007) summarize this point noting that the principle of universal design has yet to be embraced by the “everyday” technology industry.
Ogletree, McMurry, Schmidt, and Evans (2018) suggest that a consumer-driven paradigm to AAC services is likely here to stay and that AAC providers and teams are the ones who must adapt. They propose streamlining AAC assessment to reduce its time-consuming and cumbersome nature and recommend preassessment staffing and triaging as tools to expedite services. They also advocate for referral and implementation networks to apprise potential users of AAC and their stakeholders prior to their pursing independent solutions. These networks may also create tutorials for stakeholders to inform actions when AAC professionals are not present. In sum, as traditional and consumer AAC paradigms collide, providers can’t become entrenched in “the way we’ve always done it” but must propose creative and innovative solutions for the future.
To conclude, AAC service delivery is both changing and challenging. The ideas posed in this brief article were intended to help AAC providers adapt and serve individuals with communication limitations more effectively. For more ideas, consider my new edited volume Augmentative and Alternative Communication: Challenges and Solutions soon to be published by Plural Publishing.
Beukelman, D. R., & Light, J. C. (2020). Augmentative and Alternative Communication: Supporting children and adults with complex communication needs (5th ed.). Baltimore: MD: Brookes Publishing Co.
DeRuyter, F., McNaughton, D., Caves, K., Nelson Bryan, D., & Williams, M. (2007). Enhancing AAC connections with the world. Augmentative and Alternative Communication, 23(3), 258–270.
Dolic, J., Pibernik, J., & Bota, J. (2012). Evaluation of mainstream tablet devices for symbol-based AAC communication. In G. Jezic, M. Kusek, N. T., Nguyen, R. J., Howlett, & L. C. Jain (Eds.), 2012 KES international symposium on agent and multi-agent systems: Technology and applications (pp. 251–260). Berlin, Germany: Springer.
Ogletree, B.T., McMurry, S., Schmidt, M., & Evans, K. (2018). The changing world of Augmentative and Alternative Communication (AAC): Examining three realities faced by today’s AAC provider. Perspectives of the ASHA Special Interest Groups SIG 12, Vol. 3(Part 3), 113–120.