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What is a competent AAC user? Perspectives from AAC interventionists. Erna Alant ( D.Phil ); Lindsey Ogle ( MS – Psychology ); Ohoud Alhajeri ( MS- Educational Leadership) AAC LAB, Indiana University, Bloomington. Acknowledgements. - PowerPoint PPT Presentation
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What is a competent AAC user? Perspectives from AAC interventionists
Erna Alant (D.Phil); Lindsey Ogle (MS – Psychology); Ohoud Alhajeri (MS- Educational Leadership)
AAC LAB, Indiana University, Bloomington
Acknowledgements Members of the AAC lab at Indiana University who assisted in
recruiting participants for this study Participants who unselfishly shared their perspectives Jesse Smith – who assisted in transcriptions Financial Support from the Otting Foundation Disclosure: The main researcher is currently employed by IU and
the other researchers are PhD students. There are no conflict of interests associated with this study.
Why this research? Major strides in technology and intervention:
New technologies Opportunities within schools – partial to full inclusion in school
curricula Significant increase in mobile technology applications for AAC
Concern about persistent isolation and lack of friendships for young people with severe communication problems.
Is there an association between these concerns and the perceptions of AAC interventionists in relation to the definition of what a competent AAC user is?
Research questions How do AAC interventionists define a competent user of AAC? What aspects of an AAC system do they regard as critical to
facilitate effective communication? What do they see as the main challenges in interactions between
AAC users and their typical peers? What are the most important facilitators of these interactions? What do communication partners need to know? What should be
the main focus in training? What is the role of social media in AAC intervention?*
*Not included in preliminary analysis.
Historical Perspectives Speed, accuracy and adaptability (use in different contexts? 1990: Janice Light: Competent AAC user include the following skills:
Linguistic Operational Social Strategic
1997: Lloyd – Communication model focused on: Purposes of Communication Multi-modal aspects of communication
Table 1.2 Characteristics of interactions intended to meet various social purposes (Light, 1988)
Social Purpose of interactionExpression of wants/needsInformation transferSocial closenessSocial Etiquette
Characteristics of interaction (Light, 1988) described according to:
Goals of interaction Focus of interaction Duration of interaction Content of communication Predictability of communication Scope of communication
Rate of communication Tolerance for breakdowns Number of participants Independence of communicator Partners: familiar/unfamiliar
Characteristics of Interaction
Laws for Applying Technology (Lloyd et al., 1997)
Law of Parsimony Law of minimal learning Law of minimal energy Law of minimal interference Law of Best fit Law of Practicality and Use
Light & Mc Naughton (2014): A new definition for a new era in AAC?
Not just 4 areas of competency is necessary but also a variety of psychosocial factors (e.g., motivation,
attitude, confidence, resilience) as well as barriers and supports in the environment.
In the 25 years since this definition of communicative competence for individuals who use AAC was originally proposed, there have been significant changes in the AAC field.
Three fundamental Constructs:
Functionality of Communication - Environmentally and socially oriented; i.e use in different context, different partners, peers
Adequacy of Communication - use of language and modalities for specific purposes, but not with reference to social context, i.e. range or scope (different vocabulary, different functions, multimodal) to bridge gap between skills and functional communication in context.
Sufficiency of Knowledge, Skills and Judgment - specific skills, knowledge to use system, language structure and content (vocab), specific strategies for operational use
Primary Changes in Communication Competence: Not so much what needs to be achieved as how
Main Difference – inclusion of social media – operational competence
Social – more emphasis on interpersonal and social interactions. More emphasis on social contact
Broader range of devices – iPads, Facebook and SGDs Fortify psychosocial supports to increase motivation, confidence,
resilience Environmental supports – partner training, polices etc
Methodology
ParticipantsIndividual interactions with 12 AAC interventionists
in Indiana8 Interviews and 4 email responses Demographic description
ID Age Sex Years AAC Experience
Overall Experience in the Field
Education Training in AAC
US1
32 F 6 6 MA ccc 2006 Indiana University
No coursework, AAC diagnostics lab
US2
32 F 8 8 MA ccc 2006 Indiana University
AAC covered as topic in course, Clinical supervision of AAC users, Vendor training, Self-training
US3
34 F 9 10 MA ccc 2004 Indiana University
No coursework, On-the-job training in low-tech AAC, In-service training in AAC
US4
63 F 30 (as parent)
18 MA Special Education 1997 Indiana University
No coursework, Training by child’s SLPs and vendors, Self-training
US5
58 F 22 23 MA ccc 1991 Indiana University
AAC course, CE in AAC and Hearing, Vendor training, Self-training
US6
51 F 10 17 MA ccc 1992 Indiana University
No coursework, CE in AAC, On-the-job training, Self-training
US7
50 F 9 24 MA ccc 1990 Indiana University
No coursework, CE in AAC, Clinical supervision of AAC users, Self-training
US8
37 F 10 12 MA ccc 2001 Indiana University
No coursework, CE in AAC, On-the-job training, In-service training
US9
31 F 7 7 MA Behavioral Analysis 2007 Indiana University
No coursework, Clinical supervision of AAC users, Self-training
US10
52 F 28 28 MA ccc 1985 Ball State
AAC course, CE in AAC, Self-training
US11
29 F 6 6 MA ccc 2008 Ball State
No coursework, CE in AAC, Mentored by expert in AAC, Self-training
US12
50 M 15 23 MA ccc 1991 Purdue
AAC course, Clinical supervision of AAC users, Presented at conferences and workshops on AAC
Analysis of Data
Coding semantic units Grouping codes into categories Assigning codes to three fundamental constructs (Light, 1989; Light and
McNaughton, 2014) Functionality of communication: Environmentally and socially oriented; i.e use in
different context, different partners, peers Adequacy of Communication: use of language and modalities for specific
purposes, but not with reference to social context, i.e. range or scope (different vocabulary, different functions, multimodal) to bridge gap between skills and functional communication in context.
Sufficiency of knowledge, skills, and judgment: specific skills, knowledge to use system, language structure and content (vocab), specific strategies for operational use
Trustworthiness of Data – Three researchers analyzed data and consensus (Creswell, 2007, p. 147)
Analysis of Data – Categorical Coding ExampleCategory Code
Content Express wants and needs
Express thoughts and ideas
Different functions Multiple language functions
Repair communication breakdowns
Self-initiates, independent use, novel utterances
Sensitive to others Listen to others/observe/ take turns
Others are able to understand what is said
Different modalities Combine different modalities
Different contexts & partners
Communicate in more than one context/ environment
Communicate with different communication partners
Enjoy Use of system Enjoys their device/ good use of their system
Understand and learn language like others
Results What is a competent AAC user? What are the features of an effective AAC system? What are the biggest challenges for AAC users to
interact with typically developing communication partners?
What are the main facilitators for AAC users to interact with typically developing communication partners?
What skills do you think communication partners need to interact with people with little or no functional speech?
What is a competent AAC user?
Total Construct Code9 A Express wants and needs7 A Express thoughts and ideas2 A Multiple language functions2 A Repair communication breakdowns6 A Self-initiates, independent use, novel utterances2 F Listen to others/observe/ take turns4 F Others are able to understand what is said3 A Combine different modalities4 F Communicate in more than one context/ environment2 F Communicate with different communication partners2 S Enjoys their device/ good use of their system2 S Understand and learn language like others
Construct Total Comments
Sufficiency of Knowledge & Skills
4
Adequacy of Communication
29
Functionality of Communication
12
What are the features of an effective AAC system? Total Construct Code
4 A Rich broad vocabulary4 A Use of core vocabulary3 A Expand & grow with individual1 S Access to full sentences not just words3 A Meet needs of individual1 A Repair communication breakdowns2 A Self-initiates, independent use2 F Others need to be able to understand2 F Turn-taking: master exchanges- getting something from others3 A Combine different modalities/ voice/ speech5 F Communicate in more than one context/ activity4 F Well-trained partners/ Expect communication6 S Accessible motorically, visually, & across contexts3 S Easy to manipulate vocabulary3 S Consistency of system over time/ Motor Planning5 S Easy to use/ efficiency/ speed1 F Minimal intrusion & distraction/ Reliable4 S Motivated and able to use3 S Sufficient rate for communication
Construct Total Comments
Sufficiency of Knowledge & Skills
25
Adequacy of Communication
20
Functionality of Communication
14
What are the biggest challenges for AAC users to interact with typically developing communication partners? Total Construct Code
3 F Use across contexts – school, home, community, activities8 F Patience of partners: don’t interrupt or guess messages, ask yes/no questions4 F Partner attitudes: expect AAC user has something to communicate4 F Uncomfortableness of partners with system3 F Observation skills of partner: scanning, reading expressions2 F Trust that partners will be patient and listen and allow AAC user to initiate not
just respond1 S AAC users want to show they are cognitively able – want to spell out
everything 3 S AAC users’ lack of interest in others (autism). Going beyond just responding2 F Recognize need for AAC in all environments, see device as not necessary
throughout day1 F Partners are distracted/ overly fascinated by device2 F Needs to be used to communicate not just to participate in activities2 S How to use a teachable moment without predicting what the person would
say2 S Balance device training & use1 F Accommodating parents –lower own expectations3 S Lack of training of SLPs, teachers and aides in schools1 S Successful assessment in AAC
Construct Total Comments
Sufficiency of Knowledge & Skills
14
Adequacy of Communication
0
Functionality of Communication
31
What are the main facilitators for AAC users to interact with typically developing communication partners? Total Construc
tCode
1 F Awareness that communication is all the time/ create opportunities 2 F Importance of advocacy and modeling in the community for unfamiliar
communication partners 5 F Attitudes and Dispositions – Patience, observant of AAC user expressions1 F Expectation of Communication4 F Encourage typical speakers to use AAC user’s system - fosters acceptance 4 S Modeling communication on device to teach unfamiliar utterances1 S Comfort of AAC user with the communication system, Persistence3 F Desire for facilitating authentic communication to build relationships1 F Observe communication between familiar communication partners (i.e.
with family at home)2 A Use of an activity or topic to ground conversation1 S Teaching Self-Instruction3 F Collaboration with colleagues and families
Construct Total Comments
Sufficiency of Knowledge & Skills
6
Adequacy of Communication
2
Functionality of Communication
20
What skills do you think communication partners need to interact with people with little or no functional speech?Total Construct Code
5 S Natural dispositions (patience, friendliness, honesty, persistence) vs. what can be taught
2 S Age appropriate communication10 F Patience – willingness to listen, observe, give enough space to communicate3 F Honesty – willing to admit when you don’t understand3 A Strategies to repair communication breakdowns6 F Interest in what the AAC user is communicating/ maintaining attention. Interest in
device/strategy4 F Understanding of AAC user’s experience of using communication system/ device/
model use of device2 A Acceptance of all modes of communication/behavior as communication1 A Peers as therapists/teachers instead of friends and communication partners1 F Importance of authentic communication to build relationships1 F Importance of facilitating shared experiences and fun for building camaraderie1 F Desire to work with SLP/teachers/ parents 1 A Partner “ownership”/ empowerment in the intervention process 1 A Advocate use of AAC device 1 A Communication opportunities through day
Construct Total Comments
Sufficiency of Knowledge & Skills
7
Adequacy of Communication
9
Functionality of Communication
26
Summary Analysis Sufficiency of
Knowledge and SkillsAdequacy of
CommunicationFunctionality of Communication Total
Competent AAC User 4 29 12 45Features of AAC System 25 20 14 59Challenges 14 0 31 45Facilitators 6 2 20 28Partner Skills 7 9 26 42
Total 56 60 103 219
Interpretation What is a competent AAC user?
Expressing of needs and wants- ideas and thoughts Multimodality:
“[Someone] who can get their wants and needs and thoughts expressed and understood by the recipient of that information. Whether it’s through body language, using pictures, using voice, and/or using a device. Many times it’s a combination of things to get their full thoughts across to people – to be understood.” Relatively few commented on the AAC users ability to understand others
– to enhance interactionPerspective-takingEmotional resonanceUnderstanding of social interactions
Features of an effective AAC system System characteristics, operational Multi-modality, easy access to broad vocab
“Well, I think it has to be efficient - as efficient as it can be. If the user is really struggling with figuring it out and it’s easier to use a different means or not talk at all, then it’s not going to be effective. So, I think that’s critical. It shouldn’t be limiting for what they want to communicate… As someone grows with a system, you would hope that it would not put limits on what they want to express and what they’re able to express. I would say a system would need to be versatile so that it can move and grow with the user.”
Relatively few: Impact of the device in facilitating social interaction – ease of infusion
into social setting Seeing others as part of the AAC system
Challenges in interaction with typical individuals
Difficulties in using the device By far the majority focus on difficulties with social interaction:
“I think that the biggest challenge is, well, I think that there are a couple of them. One that it is not completely therapist driven. That it is completely like they are using their system to participate in the activity. So, it is not necessarily communicative in nature. It’s just more of a participatory tool. I feel like that is a big challenge - making the leap to use it and in a more interactive way.”
Facilitators for interaction with typical individuals Majority by far:
Ability to interact in the real life Patience of partners
“I was thinking about this this morning and you know, kids are easy when communication is easy, but when you give them lots of guidelines and structure it doesn’t happen as easily. Some really natural interactions I’ve seen have happened when the communication partner, if it’s a child, is able to use the device themselves, right?”
What should Partners be trained to do? Majority focus on social interaction:
“Well, I think the ability to listen and wait is huge. Because communicating with AAC is by nature just not as efficient as communicating verbally. So, if you have a communication partner who is constantly talking verbally and constantly jumping in then it’s going to be a less interactive exchange. So, that’s something I think that needs to be taught.”
Conclusion Current: Focus on social skill training – how to get the individual to get
better access to his/her own system, and those in the environment to be patient, to listen better.
Gap: AAC intervention as the development of meaning between people – it goes beyond sending and receiving messages. Interest in the other; common ground (Clark, 1996) Awareness of interaction as the development of meaning (Alant, 2005) Uniqueness of interaction – to facilitate the development of relationships
(Crossley, 1996) Emotional resonance (beyond perspective taking) – to facilitate “real”
interaction.
Development of Meaning between individuals
Transmission Environments
Sender/Encoder with endogenous feedback
Receiver/Decoder
Transmission/Signal Channels
Communication Environments
Communication Contexts
or Receiver/Decoder
or Sender/Receiver with endogenous feedback
exogenous feedback
(taken from Lloyd et al., 1997, p. 7, Fig. 1.1)
References Alant, E. (2005). Intervention issues. In Alant, E & Lloyd (Eds). Augmentative and Alternative
communication: Beyond poverty. London: Whurr Publishers, 9-29.
Bruner, J. (1990). Acts of Meaning. London: Harvard University Press.
Clark, H. (1996). Using language. NY: Cambridge University Press.
Creswell, J. W. (2007). Qualitative Inquiry & Research Design. London: Sage Publications.
Crossley, N. (1996). Intersubjectivity: The fabric of social becoming. London: Sage Publications.
Light, J. (1988). Interaction involving individuals using augmentative and alternative communication systems: State of the art and future directions. AAC, 4, 66-82.
Light, J. (1989). Toward a definition of communicative competence for individuals usingaugmentative and alternative communication systems. Augmentative & Alternative Communication, 4, 137-144.
Light, J. & McNaughton, D. (2014). Communicative Competence for Individuals who require Augmentative and Alternative Communication: A New Definition for a New Era of Communication? AAC, 30(1): 1–18.
Lloyd, L. L.; Fuller, D. & Arvidson, H. (1997). Augmentative and Alternative Communication: A Handbook of Principles and Practices. Boston: Allyn Bacon.