Frequently Asked Questions



Frequently Asked Questions | General Info | Myths | Benefits | Obtaining a Device | Difficulties | From the Experts






This page contains Frequently Asked Questions (FAQs) from the members of CommunicatePA.
Administrators will attempt to find the best possible answers to these questions.
Please feel free to share your questions, experiences and/or answers on the Discussion Board.

General Info

What are "Complex Communication Needs" (CCN)?

  • Difficulty with understanding or expressing ideas. The previous term was “non-verbal” but this doesn’t accurately describe MOST people. Many AAC users can make sound by mouth (verbal), and even say some words. However, their communication needs are not met by verbal speech only - they need to use additional AAC strategies because of their complex communication needs.

What's the difference between Assistive Technology and AAC?

  • AAC (Augmentative and Alternative Communication) IS Assistive Technology (AT)!
    • Ways of Expression in addition to [or instead of] verbal "talking"
  • Assistive technology is equipment that can help people with disabilities in many different ways. When discussing supports for communication, use the term "AAC" to narrow it down.

  • For more information about the wide range of AT available, view the presentation (below or PDF file).


What are AAC Services?
  • Services provided (or directed) by a licensed speech-language pathologist (SLP). Services may include:
    • Initial assessment to select and acquire an appropriate AAC system
    • Making communication boards, Programming SGD devices
    • Training the person and/or team (staff, family) to support communication and use recommended AAC system
    • Therapy to assist person in meeting the full range of their communication need

Who works with AAC?

  • AAC is an interdisciplinary field of professionals. Speech-language pathologists provide knowledge of communication development and disorders. Other professionals (occupational or physical therapists, assistive technology professionals) may work with the team on technology, access and positioning issues.

Who can benefit from AAC?

  • Individuals with complex communication needs can use AAC to supplement their spoken language or replace speech that is not functional. No standard or "typical" AAC user exists. However, anyone whose communication needs are not being met can benefit from AAC.

When I communicate with a person who uses AAC, should I do anything differently?

  • Yes! There are several suggestions for being a good “communication partner” to an AAC User:
  • WAIT! Give them time to understand you and to respond.
  • Don’t assume. Ask how they prefer to communicate - don’t give help without asking and don’t guess what you think they’re going to say.

Are communication and behavior related?

Can individuals on the autism spectrum benefit from AAC?


Are communication and inclusion related?


Do communication skills relate to employment opportunities?


AAC & Children

  • According to the American Speech-Language Hearing Association (ASHA):
    • "Speech and language skills are essential to academic success and learning. Language is the basis of communication. Reading, writing, gesturing, listening, and speaking are all forms of language. Learning takes place through the process of communication. The ability to communicate with peers and adults in the educational setting is essential for a student to succeed in school." (Source:www.asha.org/public/speech/development/schoolsFAQ.htm)
  • For more information see the Young Children and Communication page


Myths

Is my adult child too old for SGDs?
  • No! Age is not a reason for excluding consideration of AAC
  • AAC (including SGDs) should be considered for ANYONE who doesn’t have a functional means of communicating today
    • Functional: can communicate with many different people, about many different things, for many different reasons
  • Transitions to new work and living environments in adulthood are likely to create a need for communication services to support development of communication forms and functions appropriate to new settings as well as to educate new communication partners about a person's communication forms and support needs.
  • Records indicating that an adult "did not benefit" in earlier years do not indicate inability to benefit from services in adulthood, because research has documented continued development of communication/language skills through young adult years. New approaches to intervention and advances in augmentative and alternative communication (AAC) technology offer a greater chance of success.
  • Bottom line: Communication is a lifelong activity of value to people of all ages. Intervention to facilitate effective communication is warranted for all ages. (Wilkinson, 2011)


Speech Generating Devices are a “last resort” – after speech therapy has “failed”
  • NO!
  • AAC is not a “last resort” but a means of providing communication TODAY!
  • The use of SGDs may go hand in hand with “traditional” speech and language therapy.


You need to have prerequisite skills (e.g., cause-effect, high vocabulary level) before trying AAC
  • The ONLY prerequisites for functional communication are Something (to talk about), Somebody (to communicate with), and Someway (to communicate)

You cannot get a speech generating device unless you prove you can use a “low tech” device, first.

  • No!
  • There are no skill requirements for “earning” your way to speech output.
  • SGDs may be more motivating than other approaches without speech output.
  • SGDs may overcome problems with low tech approaches, like finding the right picture in language book with many pages.
  • An individual’s communication “system” may have both low tech AND high tech components – as well as “unaided” components, including speech.

Sign Language should be tried before SGDs.

  • No.
  • Sign language may not be a good choice for the individual (e.g. because he doesn’t have good fine motor skills).
  • Sign language limits communication partners to those who are familiar or trained in sign language.
  • An individual’s communication “system” may have both sign language (unaided) and SGD (aided) components.

Won’t device-use slow speech development?

  • No! In fact, being able to communicate more effectively may help the person develop verbal speech – once they are successful using AAC, they may be more motivated to learn to talk.
  • The evidence tells us you shouldn’t worry.
  • When AAC is introduced to young children, they have a means to communicate TODAY!
  • People will use the most effective and efficient means to communicate – speech beats any other system.
  • Research indicates AAC helps spoken language by increasing interaction, language skills, and/or providing a model.
  • “Positive effects of AAC intervention on communication, language, and literacy skills come at no risk to speech development” (Light & McNaughton, 2012)
robot.jpg

All talking devices (SGDs) sound like robots

  • Digitized devices “record” speech – so the user can sound like a child or adult, male or female – depending upon who recorded the message.
    • Note: The user probably should NOT sound like his mother or speech therapist!
  • Synthesized devices may give the option for the age/sex of the “voice”, and the quality is improving all the time!

These devices are too complicated for people with intellectual disability to use.

  • SGDs can be simple or complex.
  • A good evaluation is needed to find the device that is “right”.
  • SERVICES are important to success in using an SGD! Make sure to think about training for the consumer, as well as family, DSP, etc.

You can only use “canned” messages

That limits communication... And it makes me wonder – is the person really doing the “talking”?

  • Many SGDs allow the user to put symbols together to make longer and unique messages.
  • For users who spell, unique messages are easy to create.

If you can't spell, you can't use an SGD.

  • Actually, most SGDs do NOT use spelling! They could use:
    • A picture = a word or sentence
      • “book” or “read me a book”
    • Combination of pictures = a word or sentence
      • “rainbow” + “apple” = red
    • Letter combinations = a message
      • “BA” = “I need to go to the bathroom”
comm builder.jpg


Benefits

How does AAC help?

  • “Strong evidence that AAC interventions result in significant decreases in challenging behaviors with concomitant increases in compliance and on-task behaviors” (Bopp, Brown, & Mirenda, 2004).
  • “Appropriate AAC intervention results in positive gains in skills” such as: Turn taking, Requesting, Commenting,Receptive & Expressive vocabulary, Mean length of message, Morphology, Phonological awareness, Reading & writing skills (Light & McNaughton, 2012)

What else can these devices do?

  • Integrated functions for communication and beyond!
  • Range of social communication – tell jokes!
  • Music (sing along!)
  • Interface with cell phone
  • Wireless remote
  • Alternate keyboard for computer use


Obtaining a Device

You need an assessment in order to identify the “right” SGD.

  • Yes!
  • There are many, many products on the market today.
  • Funding sources will require an assessment by a qualified individual (e.g. licensed/certified speech-language pathologist).
  • Assessment should NOT be conducted solely by the manufacturer’s or vendor’s representative.
  • Device trials may be a part of the assessment process.
  • Assessment should consider user/family preferences.
  • Assessment should identify ALL AAC strategies as well as the device(s) that form the consumer’s “communication system”.

Who pays for AAC and the services?

  • Eligibility for services depends on many factors, including:
    • The client's age, medical insurance, and enrollment in programs such as early intervention, special education, or vocational rehabilitation.
    • Whether or not the need for services is documented by an authorized individual (physician, case worker).
    • Bottom line: Payment for communication services involves individualized decisions and involvement of different professionals (See "The Bottom Line" in The ASHA Leader, Oct. 11, 2011).
  • AAC Devices may be funded as Durable Medical Equipment (DME) or Assistive Technology (AT) definitions for insurance
  • AAC Services may be covered under Speech-Language evaluation or therapy services
  • For adults:
    • There is no blanket entitlement to services or devices that enhance communication.
    • In some cases, services may be funded through state-administered programs, Medicaid, Medicare, or private insurance.
    • Every state has agencies responsible for providing services to individuals with disabilities.
    • The U.S. Department of Health and Human Services has links to these programs, and programs run by independent organizations, such as Kiwanis, can help.
      Bottom line: Creativity is key to accessing assistance through a variety of possible sources. (Wilkinson, 2011)
  • For more information, see the funding page


Difficulties

Why even bother thinking about SGDs – they are too expensive and no one will buy them!

  • There is more funding available than you may think!
  • Public funding
    • School System (EI, IUs)
    • Medicaid (including MA, ACCESS, waivers)
    • Office of Vocational Rehabilitation (OVR)
    • Medicare
    • Skilled Nursing Facility
    • Private Insurance
  • Private Funding
    • Insurance
    • Private foundations, charitable organizations
      • Pilot Club, Lions Club, etc.
    • Cash Loans
    • “Previously owned” or recycled equipment
      • PIAT’s REEP (disabilities.temple.edu/reep)
      • eBay
      • Craigslist


We already tried a device.

  • That device didn’t work – they must not have the “prerequisite” skills for AAC
    • Do you know why it didn't work?
      • The person may not have received enough training.
      • People who support the consumer may not have received enough training.
      • The device might not have the “right” vocabulary – the device has to help you “say what you want to say”!
      • The device might not be the “right” device!
    • Need to consider how to redesign AAC to better meet needs
    • Also true for AAC "apps" running on mobile technology (e.g., iPads, smart phones)
      • “Essentially we are running apps reflecting designs from the 1980s/1990s on cutting edge 21st century hardware.” (Light & McNaughton, 2012)

What if the consumer doesn't like (show interest in) the AAC system that was recommended during the evaluation?

  • "Lack of interest" may actually reflect lack of exposure to preferred activities or events. It is no surprise that a client is unmotivated to communicate if the available materials or activities are poorly matched to that client's interests. Clinicians have the responsibility to identify individual preferences and interests, and to tailor the communication supports accordingly.
    • The clinician must conduct preference assessments to identify a greater breadth of motivating activities. This information also can be solicited by interviewing an individual's caregivers.
    • The clinician follows up by providing the individual with opportunities to engage in the activities, and watching for signs of interest. These signs may be idiosyncratic, but are valid signals for the clinician to note.
    • Bottom line: A client's seeming lack of interest may actually indicate the professional's failure to identify activities in which the client is motivated to communicate. Clinicians should examine ways motivation can be enhanced and provide opportunities for communication. (Wilkinson, 2011)


It is too confusing if my consumer sees more than 8 pictures at a time.
  • Not a problem!
  • Some devices are flexible – with the same device, you can “grow” from 2 pictures to 16, or more!
  • Devices may have many “pages” that can be customized with just a few pictures on a page.
fanny pack.jpgGoTalk.jpg

Those devices are too big and heavy to carry around!

  • Devices range in size and weight.
  • Many come with carrying cases/straps.
  • Portability is not a concern if the device will be mounted on a wheelchair.
    • Don’t forget to order the carrying or mounting system!
headpointer.jpg

I’m not very good with my fingers – I can’t push small buttons, so I can't use AAC.

  • You can use:
    • Key guards to keep your fingers from slipping (built in or extra)
    • Adjustments you can make so you don’t activate a button by mistake
    • Devices with larger buttons
    • A way to activate the device without using your hands (called alternate access)

References

  • Bopp, K. D., Brown, K. E., & Mirenda, P. (2004). Speech-language pathologists' roles in the delivery of positive behavior support for individuals with developmental disabilities. American Journal of Speech - Language Pathology,13(1), 5-19.
  • Light, J., & McNaughton, D. (2012). Supporting the Communication, language, and Literacy Development of Children with Complex Communication Needs: State of the Science and Future Research Priorities. Assistive Technology, 24 (1), 34-44.
  • Wilkinson, K. (2011, November 22). Answers to Your Biggest Questions About Services for People With Severe Disabilities. The ASHA Leader.

From the Experts

What about individuals with severe disabilities?

  • The American Speech-Language-Hearing Association establishes guidelines and policies to support their mission of "Making Effective Communication, a human right, accessible and achievable for all."
  • The article below, written by a speech-language pathologist, responds to Frequently Asked Questions about communication services for people with severe disabilities.



November 22, 2011 Features

Answers to Your Biggest Questions About Services for People With Severe Disabilities

by Krista Wilkinson
see also

Significant advances in social, legal, vocational, technological, and educational domains have improved the quality of life of many people with severe intellectual and developmental disabilities (IDDs). Thanks in large part to parent advocacy and government and legal mandates, most of these individuals have been transitioned out of large residential institutions. All have the right to access clinical, educational, health, and other services (see ASHA, 2005, for an account of these changes, and Wilkinson, 2006, for a historical overview).

A critical component of service provision for people with IDDs is communication intervention (see "Communication Tools for Helping People With Severe Disabilities" below). Unfortunately, gaps persist in the provision of effective, evidence-based communication services for this population. Indeed, people with IDDs often are excluded from these services due to their poorly understood learning support needs. Particularly in the case of older individuals, services often are not considered after a certain point, perhaps because of a history of failed interventions and because significant change seems more difficult to achieve. This practice is suspect, however. Prior failure may be largely irrelevant to whether or not a contemporary approach can impart communication skills efficiently and effectively.

The remaining clinical challenges in service provision are evident in the ever-growing section of frequently asked questions (FAQs) on the website of the National Joint Committee for the Communication Needs of Persons With Severe Disabilities (NJC), an interdisciplinary group of professionals working to optimize services for individuals with severe disabilities (see "Communication Tools for Helping People With Severe Disabilities" below).

FAQs: Service Challenges and Solutions

The NJC developed the FAQs to provide basic information for consumers, families, professionals new to the area of severe disabilities, or any professional looking for ways to inform consumers. More in-depth responses also are available with detailed information, research summaries, and references.
The FAQs can be organized into three overarching, interrelated categories, as illustrated in this diagram [PDF]:
  • Issues related to accessing services, including eligibility.
  • Issues related to intervention practice.
  • Funding issues in service delivery.
A few questions from each area are presented here to illustrate some of the most critical challenges—as well as their solutions—in contemporary practice. The information has been summarized from full answers to these and other questions on the NJC website.

Accessing Services and Eligibility

Q: Some professionals from other disciplines are making recommendations about AAC and speech-generating devices. Is this okay?

This question touches on a number of important issues, including teaming, the necessary expertise to provide services, and scope of practice.
  • The guiding concern among team professionals must always be the best interest of the client.
  • Although there are some things that only the speech-language pathologist on a team is certified and licensed to do (and for which the SLP is the only professional eligible to receive insurance reimbursement), virtually all aspects of AAC service provision benefit from the insights of team members. Service provision for someone learning to use a speech-generating device should be interdisciplinary, as should services for all individuals.
Bottom line: The primary provider should be an individual with significant insight into language development, disorders, evidence-based practices, and AAC. Although SLPs often have the greatest expertise in these areas, professionals from other disciplines may have extensive knowledge as well.

Intervention Practices

Q: Why would an SLP work with a client who does not talk?

Speech-language services are, in fact, desperately needed for clients who "don't talk." Individuals whose communication skills are at early or prelinguistic levels are especially vulnerable to limitations in all aspects of daily living, including social relationships with diverse partners (including peers), access to core educational curricular content, entrée to vocational possibilities, participation in community activities, self-advocacy, and access to appropriate health supports. It is the SLP's responsibility to explore ways all clients can communicate effectively, including those with the most significant communication challenges.
  • Some of the most critical of these goals are early communication and pragmatic skills. When clients learn to take turns appropriately, make eye contact, greet new people, or ask questions, they have formed the foundation for later or more advanced skills. These skills also help foster important social, vocational, and educational outcomes.
  • Another critical role of communication support services for these clients is providing them with a means to understand what others are saying. A client who is "acting out" during transitions may be doing so because he or she is confused about what is happening and does not understand the spoken instructions. A visual schedule can reduce challenging behaviors by helping the client to understand and predict the next activity on the schedule.
  • A client who does not talk needs help building a functional system for communicating with others and understanding what is said to him or her.
  • In many cases, an AAC system can help with these needs.
Bottom line: Communication is broader than speech, and communication goals are just as important as speech-related ones.

Q: When should a caregiver start reading to a child? Why should we target reading for a child with severe disabilities?

A child is NEVER too young to begin learning about print, whether or not he or she has a disability. Shared book-reading has a wide range of benefits for all children, and has a strong evidence base to support it as an effective intervention tool.
  • Book reading exposes all children to emergent literacy and fosters vocabulary growth, development of narrative skills, engagement in social participation, and entry into later true literacy skills (e.g., Bus, van IzjenDoorn, & Pellegrini, 1995; see Ninio, 1983; Snow & Goldfield, 1983).
  • Shared book-reading also has been proven an effective language intervention for children with severe disabilities for goals including enhanced participation in interactions, vocabulary growth, and general linguistic development (e.g., Bellon, Ogletree, & Harn, 2000; Bradshaw, Hoffman, & Norris, 1998; Crowe, Norris, & Hoffman, 2000).
  • Although daily reading is essential to the acquisition of wide experience with print, other activities also are fun and important, including playing word games, arranging magnetic letters, and identifying letters and words in different environments.
  • For children with disabilities, reading development is sometimes neglected in favor of other types of language skills. However, the benefits of reading and literacy are as important for these children as they are for others, especially as reading may support the many other aspects of communication development.
Bottom line: Exposure to print and literacy is critical to development and should occur as early as possible for all children, including children with disabilities.

Funding Issues

Q: How can communication services be documented as educationally necessary?

Services can be both medically and educationally necessary, and the approach to payment for services depends on the payer being approached.
  • If the school is the targeted funding source, justify need in terms of educational necessity, such as the student's ability to access, participate in, and demonstrate progress with respect to the general education curriculum [documented in an individualized education program (IEP) or 504 plan]. Communication and assistive technology are among the "special factors" that must be considered by all IEP teams.
  • Public and private health insurers look for justification of need in terms of medical necessity (i.e., the communication limitation arises from a diagnosed condition). Communication services may restore lost function, forestall further functional decline, or provide an alternative means of performing the function.
Bottom line: Tailor the request to the domain of the funding source and confine your justification to one or the other.

The techniques and technology to support effective communication intervention in people with severe disabilities have advanced significantly over the last several decades, with an accompanying evidence base. However, clinicians may encounter barriers to optimal service provision, given the practical challenges of serving learners with pervasive support needs and the persistence of incorrect assumptions about their learning capabilities. The NJC information may prove valuable to clinicians, parents, educators, and others providing interventions to individuals of all ages with severe intellectual and developmental disabilities.


This article was written on behalf of, and in conjunction with, the members of the National Joint Committee for the Communication Needs of Persons With Severe Disabilities.
Krista Wilkinson, PhD, professor in the Department of Communication Sciences and Disorders at Penn State University, studies early communication and language in learners with intellectual and developmental disabilities (IDD). Her interests include vocabulary learning in children with and without IDD, and the design and use of augmentative and alternative communication systems in communication and education. Contact her at kmw22psu@gmail.com.

  • Wilkinson, K. (2011, November 22). Answers to Your Biggest Questions About Services for People With Severe Disabilities. The ASHA Leader.
  • Click here to see the original article.


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