Beccy Timbers and Kate Duggan explore the difference communication aids can make to users’ everyday lives and future life chances
This article will discuss how alternative and augmentative communication strategies can be used to maximise communication opportunities for children and young people with complex communication difficulties. It will look at the need for a creative approach to ensure individualised strategies are identified, and the importance of involving all the people in the individual’s environment to ensure they are able to experience successful communication across different contexts.
Augmentative and alternative communication (AAC) refers to the communication methods used to supplement or replace speech or writing for those who have difficulty producing and/or understanding spoken or written language. It can include signing, gesture, symbols and photographs, as well as high-tech devices that produce a voice output. Generally, society places a great deal of emphasis on the ability to utilise speech and written communication, but it is important that all different methods of communicating are valued. A “total communication approach” sees all ways of communicating as equally valid, and should be encouraged when supporting those with communication difficulties.
At our school for children and young people with complex communication difficulties, many students use a range of different approaches depending on the situation; for example, they may exchange a photograph to request an item in a group activity but at lunch time they may point to say which of the options they want to eat. This flexible approach should be supported by teams working with children and young people with complex needs to ensure the student has the skills to know when to use the different approaches, in order to maximise their communication success in different contexts.
To identify the most effective communication system for each individual there should be a thorough assessment which takes into consideration the person’s communication environment and needs. This should consider what they want and need to communicate, and where they will be doing this.
An assessment would look at whether the person would benefit from having a high-tech AAC device to support their communication. In addition, if it’s appropriate to do so, the individual’s vision and hearing should be monitored to help inform the decision as to which type of system would be appropriate.
It is also important to take a creative and innovative approach in order to adapt communication systems so that they are accessible to the individual. Trial and error is usually required to come up with the system best suited to a particular student.
Examples of bespoke systems created for students with sensory impairments could include tactile communication books, the development of raised grids for keyguards for high-tech AAC and the use of simple switches with tactile markers to develop talking communication boards. Ongoing assessment should also monitor how the student is using the AAC support provided and how well it is working for them in practice.
Here are a few key questions that practitioners may want to consider: what are the student’s reasons for communicating? What words do they need to say? What motivates them to communicate effectively?
Practitioners should also regularly observe the activities that the individual participates in to help them get a feeling for which people the student most needs to be understood by and where; this could include school, local shops, the park or even on public transport. When the individual experiences success with communication in these areas, it will help to improve their self-esteem and confidence.
Educating others about AAC
For AAC to be successful, practitioner’s need to upskill communication partners across the various settings the individual operates within: for example, parents and carers, friends and staff who work closely with them. This supports the student to be able to engage in successful communication when they are away from school. It also encourages them to develop their communication skills by modelling their preferred method of communication.
It is also increasingly important that the general public and society are made more aware of the issues facing individuals with communication difficulties, to ensure that information is shared in a way which is accessible for AAC users, for example, through the use of symbols or audio.
Many children and young people with communication difficulties can successfully communicate with familiar communication partners such as family members using non-verbal communication signals, including their own gestures or vocalisations. Those who use signing as their first language rely on proficient communication partners who can understand them and who enable them to develop their conversational skills. However, while people who are proficient with signing may exist in some school settings, they are very rare in wider society. This immediately creates barriers in accessing the community independently.
As technology is evolving, it is increasingly being made available to individuals with more complex disabilities, including those who have not previously been considered for voice output systems. Communication aids provide many people with SEN and disabilities with a way of communicating which can be understood by the vast majority of people across a very wide range of environments. This can make such a difference by enabling AAC users to take part in every day activities that most of us take for granted, such as shopping or simply interacting with others. This technology can also help to improve the life chances of AAC users by enabling them to undertake work experience, helping them to build their confidence and skills, and facilitating new social and employment opportunities.
About the authors
Beccy Timbers and Kate Duggan are speech and language therapists at Seashell Trust, which supports children and young people with complex communication difficulties.