This approach can lead to increased symbol comprehension in young AAC users and in users with severe cognitive or intellectual disabilities (Binger & Light, 2007; Drager et al., 2006, 2010), as well as increased symbol comprehension and production (Binger & Light, 2007; C. Goossens, 1992; M. D. Harris & Reichle, 2004). https://doi.org/10.1080/02656730701189123, Lke, C. (2014). This helps ensure carryover and functional use of the system in everyday life. (2016). Alternative communication is the term used when a person has no speaking ability. PECS is based on applied behavior analysis. The core vocabulary may consist of only written words, depending on premorbid and current literacy level for those with acquired disabilities. AAC may also serve as a tool to aid in expressive and receptive language acquisition and literacy development in this population. Items on the screen are presented one by one, in a row, column, or quadrant. The goal of AAC intervention is to facilitate communication between the individual and their communities. Pragmatic Organization Dynamic Display (PODD) communication books: A promising practice for individuals with autism spectrum disorders. SLPs writing AAC evaluations and completing funding requests must disclose any financial relationships that they have with device manufacturers and must certify that their recommendation for device selection is based on a comprehensive evaluation and preferred practice patterns and is not due to any financial incentive. Use evidence-based practice to evaluate functional outcomes of AAC intervention. Journal of Speech, Language, and Hearing Research, 49(2), 248264. AAC interventions address the development of adequate, functional communication skills to support individuals with complex communication needs in developing, rebuilding, or sustaining communicative competence to express needs and wants, develop social closeness, exchange information, and participate in social etiquette routines (Drager et al., 2010; Light & McNaughton, 2014). Brown et al. Provision of powered communication aids in the United Kingdom. WebAugmentative systems are used by people who already have some speech but are either unable to be understood or have limited speaking ability. Common questions about AAC services in early intervention. Communicative competence for individuals who use AAC: From research to effective practice. AAC uses a variety of techniques and tools to help the individual express thoughts, wants and needs, feelings, and ideas, including the following: AAC isaugmentativewhen used to supplement existing speech,alternativewhen used in place of speech that is absent or not functional, or temporary as when used by patients postoperatively in intensive care (Elsahar et al., 2019). ), Handbook of augmentative and alternative communication (pp. In addition to helping the individual identify goals and objectives for treatment, they often have input into the type of AAC system used, daily communication needs, and vocabulary incorporated into the system. Harris, L., Doyle, E. S., & Haaf, R. (1996). These could be children with delayed or disordered speech and language, perhaps due to autism, apraxia of speech, cerebral palsy, developmental delays, genetic syndrome, or traumatic accident. Semanticsyntactic displays are useful for adults with relatively intact language (e.g., individuals with ALS) or language learners, and they can facilitate efficient production of grammatically complex messages. Kent-Walsh, J., & McNaughton, D. (2005). PODD communication books can vary depending on the specific needs of the individual, in. Other conditions Discrete trial training (DTT) is a one-to-one instructional approach that uses behavioral methods to teach skills in small systematic steps. Visual prompting strategies can help increase an individuals ability to independently initiate tasks, sustain participation in an activity, perform multistep tasks, and participate in an increased variety of activities. https://doi.org/10.1080/07434610500483588. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 223,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. Concerns about the overuse of screen time, particularly for young children, do not apply to the use of screens as part of an AAC system. Unique characteristics, linguistic background, and cultural variables that affect communication style and use are considered and reflected in assessment and treatment plans. Communication interventions for minimally verbal children with autism: A sequential multiple assignment randomized trial. It considers the individuals full communication abilities and may include existing speech, vocalizations, gestures, and/or some form of external system (e.g., SGD). Porter, G., & Cafiero, J. M. (2009). Augmentative and alternative communication (AAC) and inclusive education for students with the most severe disabilities. See Person-Centered Focus on Function: Augmentative and Alternative Communication for Adult with Amyotrophic Lateral Sclerosis (ALS) [PDF] and Person-Centered Focus on Function: Augmentative and Alternative Communication for Child with Cerebral Palsy [PDF] for examples of assessment data consistent with the ICF framework. The first pages of the PODD book often include words or phrases to support behavioral and environmental regulation and may also include pragmatic starters, such as Somethings wrong, I want something, or Im asking a question, to help individuals convey contextual information (Porter & Cafiero, 2009). Delmar. Perspectives of the ASHA Special Interest Groups, 5(6), 15861592. For example, a bilingual individual with aphasia may no longer be as proficient in all languages used prior to the injury. According to the Individuals with Disabilities Education Act (2004), Section 300.105 on AT, on a case-by-case basis, the use of school-purchased AT devices in a childs home or in other settings is required if the childs IEP team determines that the child needs access to those devices in order to receive free appropriate public education.. https://doi.org/10.1111/1460-6984.12235, Cress, C. J., & Marvin, C. A. Impact of speech-generating devices on the language development of a child with childhood apraxia of speech: A case study. (2014). See Collaboration and Teaming and Interprofessional Education/Interprofessional Practice (IPE/IPP). Community-based employment: Experiences of adults who use AAC. Many literacy activities can be adapted to meet the needs of AAC users, for example. https://doi.org/10.1016/j.aucc.2018.09.002, Fuller, D., & Lloyd, L. (1991). (2016). 947). Books include symbols for navigation, such as I have something to say and Go to page____; colored page tabs that match page numbers; and symbols for specific operational commands, such as Turn the page, Go back to page__, and so forth. The SLP should complete a comprehensive speech and language assessment relative to an individuals needs. Vision specialists assist in determining the best ways for an individual to process and understand symbols and to reduce visual barriers to symbols. Inadequate training of communication partners has been identified as a barrier to device use in addition to limitations of the AAC device itself and insufficient involvement in device selection (Bailey et al., 2006). 3590, Pub. See End-of-Life Issues in Speech-Language Pathology for more information. For more information about the AT Act, go to National Assistive Technology Act Technical Assistance and Training (AT3) Center - AT Act Information. Even Sedey, A., Rosin, M., & Miller, J. Grammatical issues in graphic symbol communication. L. No. People who use AAC should always have access to their communication tools or devices. PECS training consists of six progressive instructional phases: PECS requires the facilitator to prepare pictures on and the user to accept and have the ability to transport a communication board or book (Flippin et al., 2010). Rehabilitation engineers or AT professionals help SLPs and AAC users with programming, accessibility, and efficient use of the AAC device. Balanced reading intervention and assessment in augmentative communication. A: AAC is an acronym for Alternative Augmentative Communication. The first A stands for Alternative. as the official journal of the international society for augmentative and alternative communication (isaac) , augmentative and alternative communication (aac) publishes scientific articles related to the field of augmentative and alternative communication (aac) that report research concerning assessment, treatment, Conduct a culturally and linguistically relevant, comprehensive assessment of the individuals speech, language, and overall communication abilities. There is also utility for people with acquired communication needs such as aphasia (Dietz et al., 2020). With increasing numbers of children being diagnosed with Autism Spectrum Disorder, it is necessary to find effective methods of communication for these children. Therefore, incorporating family members into the AAC process is crucial (Bailey et al., 2006; Moorcroft et al., 2019). Environmental modifications should be made to accommodate vision or hearing deficits and any other physical difficulties. https://www.liberator.co.uk/media/wysiwyg/Documents/Autism_Spectrum_LAMP_Research_Report.pdf[PDF], Bailey, R. L., Parette, H. P., Jr., Stoner, J. Perspectives on Augmentative and Alternative Communication, 22(2), 7990. AAC needs for individuals with acquired disabilities vary and may change over time, depending on language and cognitive status at the time of injury as well as on disease onset and progression. Augmentative and Alternative Communication, 13(4), 207225. For instance, one advantage of sign language is its portability and the vocabulary size is potentially unlimited with a manual signing system. SLPs should obtain documentation of hearing and vision evaluations or make referrals as appropriate. Memory, attention, problem-solving, and executive skills in the context of functional AAC use. CRC Press. Members of the medical team include nurses, doctors, case managers, and social workers to assist with medical management and transition planning. providing an AAC system that allows the student to access the general education curriculum; supporting the transition between home and school and between classrooms and schools; and. Augmentative and alternative communication is not appropriate for everyone https://doi.org/10.1080/07434610400006646, Kristoffersson, E., Sandber, A. G., & Holck, P. (2020). Developmental Medicine & Child Neurology, 62(8), 933938. Communication ability and communication methods in children with cerebral palsy. 235253). Prediction and selection of vocabulary for two leisure activities. Augmentative and Alternative Communication evidence map, Augmentative and Alternative Communication (AAC) Evidence Map, Assessment Tools, Techniques, and Data Sources, Collaborating With Interpreters, Transliterators, and Translators, Speech Sound Disorders: Articulation and Phonology, Evaluating and Treating Communication and Cognitive Disorders: Approaches to Referral and Collaboration for Speech-Language Pathology and Clinical Neuropsychology, Interprofessional Education/Interprofessional Practice (IPE/IPP), National Joint Committee for the Communication Needs of Persons With Severe Disabilities (NJC), End-of-Life Issues in Speech-Language Pathology, National Assistive Technology Act Technical Assistance and Training (AT3) Center - Program Directory, National Assistive Technology Act Technical Assistance and Training (AT3) Center - AT Act Information, Local Coverage Determinations by State Index, Medicare Coverage Policy on Speech-Generating Devices, TEDPA Telecommunications Equipment Distribution Program Association, Health Care Common Procedure Coding System (HCPCS) Level II Codes: AAC and Other Speech-Language Pathology Related Devices, An Overview of the AAC Assessment Process, International Society for Augmentative and Alternative Communication, National Parent Center on Transition and Employment, Association of Assistive Technology Act Programs, Communication Supports InventoryChildren & Youth (CSI-CY), Family Impact of Assistive Technology Scale for Augmentative and Alternative Communication Systems (FIATS-AAC), Dynamic Learning Maps Professional Development, Pennsylvania Training and Technical Assistance Network (PaTTAN), American Association on Intellectual and Developmental Disabilities (AAIDD), Assistive Technology Industry Association (ATIA), Rehabilitation Engineering and Assistive Technology Society of America (RESNA), Rehabilitation Engineering Research Center on AAC, Boston Childrens Hospital Augmentative Communication Program Handouts and Resources. flexibility of access method as physical abilities change or decline; vocabulary selection to ensure that the individual will be able to express their wishes, desires, and feelings; basic needs; and issues related to medical care; and. Important considerations for this population include, Challenges noted above can be overcome or prevented by. Evaluation of the Language Acquisition through Motor Planning (LAMP) program with children with autism spectrum disorders (ASD). Several AAC companies offer devices or software that includes multilingual functionality. providing training as necessary and documenting need for/use of AAC. These other modes of communication are used to support or supplement what the person can say verbally. Visual prompting strategies use visual cues (e.g., pointing or gesturing) to help individuals maintain attention, understand spoken language, sequence events, organize environments, or increase independence with task completion (Hodgdon, 1995). AAC tools should support various languages and dialects when possible; if the AAC system does not support all of the individuals language(s), they may be unable to communicate in the home, and carryover will be limited (Dukhovny & Kelly, 2015). Preferred practice for AAC intervention incorporates multiple communication modalities so that the user is not restricted to aided or unaided approaches but can use a combination of communication modalities, depending on the environment, listener, and intent of the message. AAC is augmentative when used to supplement existing speech and https://doi.org/10.1080/17518423.2017.1339133, Angelo, D., Jones, S., & Kokoska, S. (1995). (2019). In the United Kingdom, Creer et al. International Classification of Functioning, Disability and Health. Augmentative and Alternative Communication, 35(2), 120131. (2003). Effects of AAC interventions on communication and language for young children with complex communication needs. SGDs should also have customization/individualization options for users to select icons, vocabulary, and languages/dialects that meet their unique needs. (2019). the availability of system components to be trialed for both the clinician and the client; the availability of not only a facilitator but also instruction and training for this individual to set up the device prior to evaluation; access to cameras (e.g., document cameras, smartphones, tablets) or other methods, which allow the clinician to observe the clients interaction with the device (e.g., camera placement over the clients shoulder to show the device from above, allowing the clinician to see the device screen and the clients selection); proper audio/amplification for the clinician to hear selections; the need for interdisciplinary collaboration with physical and/or occupational therapy to establish optimal positioning for access prior to or during the evaluation process; and. https://doi.org/10.3109/07434618.2015.1064163. It provides the means to achieve personal, educational, vocational, and social goals (Calculator, 2009; Light & McNaughton, 2014; Lund & Light, 2007). The shaping of individual meanings assigned to assistive technology: A review of personal factors. In G. Soto & C. Zangari (Eds. Unaided forms require some degree of motor control. There are two main selection techniques. Journal of Autism and Developmental Disorders, 21(3), 329340. Assessment should include elements of dynamic assessment and other informal assessments (e.g., direct observation of language use in a variety of natural contexts) to supplement standardized assessment data. Combining core and fringe vocabulary can increase the frequency of AAC use (Beukelman et al., 1991; van Tilborg & Deckers, 2016; Yorkston et al., 1988). The symbols used in an AAC system should allow for the same changes and flexibility. Appropriate roles for medical/clinical SLPs include the following: Appropriate roles for school-based SLPs include the following: As indicated in the ASHA Code of Ethics, SLPs shall engage in only those aspects of the profession that are within the scope of their professional practice and competence, considering their level of education, training, and experience. Its the opposite. Organization strategies may change over time based on changes in skills and contexts. https://www.asha.org/policy/ps2018-00351/, Andzik, N. R., Schaefer, J. M., Nichols, R. T., & Chung, Y.-C. (2018). 5996). 108-364, 118 Stat. Brookes. 265286). Overall, the more severe an individuals communication deficit, the more likely the individual would benefit from AAC support (Brown et al., 2021; Funke et al., 2018; Iacono et al., 2016; Kristoffersson et al., 2020). ), The efficacy of augmentative and alternative communication: Toward evidence-based practice (pp. Communicative competence is an individuals ability to freely express ideas, thoughts, and feelings to a variety of listeners across contexts. https://doi.org/10.1044/jshr.3506.1333, American Speech-Language-Hearing Association. https://doi.org/10.1080/07434619112331275913, Funke, A., Spittel, S., Grehl, T., Grosskreutz, J., Kettemann, D., Petri, S., Weyen, U., Weydt, P., Dorst, J., Ludolph, A. C., Baum, P., Oberstadt, M., Jordan, B., Hermann, A., Wolf, J., Boentert, M., Walter, B., Gajewski, N., Maier, A., Meyer, T. (2018). Augmented inputalso called natural aided language, aided language stimulation, or aided language modelingis a receptive language training approach in which the communication partner provides spoken words along with AAC symbols during communication tasks (e.g., partner points to the AAC symbols while simultaneously talking). accessibility due to physical limitations. Core vocabulary consists of high-frequency words that make up about 80% of the words used by most people every day (Quick et al., 2019). The SLP must justify that the device being ordered is medically necessary in order to receive third-party funding. Symbols are not universal across cultures. Symbol organization should be appropriate to the users language level and address the users needs and capabilities as well as those of the communication partners (Beukelman & Light, 2020). A listing of these programs is available at TEDPA Telecommunications Equipment Distribution Program Association. Augmentative and Alternative Communication, 23(4), 288299. Potential AAC users may believe that AAC reduces motivation to improve natural speech and delays language development. Blockberger, S., & Sutton, A. Augmentative and Alternative Communication, 23(1), 3043. Augmentative and Alternative Communication, 11(3), 193201. PODD can help increase communication because of the focus on the communication partner to work with the client to maneuver the PODD book. cerebrovascular accidents (i.e., stroke); disability following surgeries (e.g., glossectomy, laryngectomy); and, patients in critical care settings (e.g., intubated patients) and, communication apps, such as AAC software that enables dynamic symbol/language representation, single-message devices and recordable/digitized devices, Hearing Assistive Technology Systems (HATS), voice amplifiers and artificial phonation devices, speech valves (for individuals with tracheostomies or ventilators), orthography (i.e., alphabet-based symbols). A review of medical records at the University of Iowa Hospitals & Clinics found that 33% of intensive care unit (ICU) patients met the AAC candidacy criterion, whereas 3% of non-ICU patients met the AAC candidacy criterion (Zubow & Hurtig, 2013). https://doi.org/10.1044/2020_PERSP-20-00041, Mindel, M., & John, J. Effective AAC assessment via telepractice is a complex process. In K. A. Quill (Ed. Video recordings of such a behavior (e.g., appropriate use of an AAC device) are watched and imitated by a learner. Unaideddo not require an external tool. B., Angell, M. E., & Carroll, K. (2006). See The Participation Model for Augmentative and Alternative Communication [PDF] (Beukelman & Mirenda, 2013). https://doi.org/10.3109/17483107.2014.913715, McGee, G. G., Morrier, M. J., & Daly, T. (1999). For more details about visual scene displays and an example, see Tuthill (2014). Electronicselection of one symbol automatically activates change in symbol set. Conduct a comprehensive, transdisciplinary, culturally and linguistically relevant AAC assessment. Augmentative and Alternative Communication, 7(3), 171185. Symbols are laid out according to spoken word order and print orientation, and they are adaptable to languages that follow different semantic rules than English (e.g., left-to-right or right-to-left, adjectivenoun, nounadjective). Lack of literacy development restricts AAC users to nonorthographic symbols and limits their ability for novel message generation (Millar et al., 2004). Complete the comprehensive speech-language evaluation. Erickson, K. A., Koppenhaver, D. A., & Cunningham, J. W. (2006). https://doi.org/10.1080/09638280412331280334. These devices are considered AT but do not fall under AAC, because they do not require skilled SLP intervention prior to use. Augmentative and alterative communication systems. ), Treatment of language disorders in children (pp. Involving families and caregivers in the assessment process may involve working with an interpreter or a translator. The assessment should be conducted in the language(s) needed by the AAC user. https://doi.org/10.1044/aac24.4.142, Hart, J. E., & Whalon, K. J. However, early AAC use can help develop speech and language (Lke, 2014; Romski et al., 2010; Wright et al., 2013) and can increase vocabulary for children with developmental delays aged 3 years and younger (Romski et al., 2015). Augmentative and alternative communication (AAC) advances: A review of configurations for individuals with a speech disability. TC has also been used with populations such as individuals with ASD (e.g., Nunes, 2008; Wong & Wong, 1991). SLPs often assist individuals with reduced or impaired communication when nearing the end of life. Light, J. C., & McNaughton, D. (2012). https://doi.org/10.1080/07434618.2017.1347960. Autism Spectrum Australia. Australian Critical Care, 32(5), 373377. It allows for changes to vocabulary and mode of access as the individuals language and physical needs change over time. Provide trial periods with AAC systems and collect data. (2013). See the Assessment section of Social Communication Disorder. American Journal of Speech-Language Pathology, 19(2), 178195. The goal of intervention is to maximize the efficiency and effectiveness of communication for individuals who are unable to communicate via verbal speech. Individuals with Disabilities Education Act of 2004, 20 U.S.C. having the motor movements needed for unaided approaches. Guidelines for meeting the communication needs of persons with severe disabilities [Guidelines]. Total communication (TC) is a holistic approach to communication that promotes the use of all modes of communication, including sign language, spoken language, gestures, facial expressions, and environmental cues such as pictures and sounds. 143172). Varied types of devices are used to help speakers get their messages across. negative attitudes toward persons with disabilities and the stigma associated with AAC. Iconicity directly affects the communicators efficiency and effectiveness, especially with untrained or unfamiliar communication partners. This includes building both receptive and expressive vocabulary (including both spoken words and AAC symbols). https://doi.org/10.1044/1058-0360(2006/012), Dukhovny, E., & Kelly, E. B. Language Acquisition Through Motor Planning (LAMP) is a therapeutic approach based on neurological and motor learning principles that uses a high-tech AAC system to provide the child with opportunities to initiate activity, engage in communication around activities of their choice, and access consistent motor plans to locate vocabulary (Potts & Satterfield, 2013). Books can vary depending on the communication needs communicate via verbal speech,,... And reflected in assessment and treatment plans nurses, doctors, case managers, and skills., for example and vision evaluations or make referrals as appropriate AAC companies offer devices or software that multilingual! Needed by the AAC device of functional AAC use Fuller, D. ( 2012 ) powered communication in... Slps should obtain documentation of hearing and vision evaluations or make referrals as appropriate aids in the of... 5 ( 6 ), 207225 third-party funding treatment plans the end of life with complex communication such. Words, depending on premorbid and current literacy level for those with acquired needs... Necessary and documenting need for/use of AAC intervention is to facilitate communication between the individual and their.. & Sutton, A. augmentative and Alternative communication, 13 ( 4,. Diagnosed with autism spectrum disorders 11 ( 3 ), the efficacy of augmentative and Alternative communication, (! Of access as the individuals language and physical needs change over time on... To accommodate vision or hearing deficits and any other physical difficulties,,! Either unable to be understood or have limited speaking ability based on in! 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And their communities details about visual scene displays and an example, see (. Hearing Research, 49 ( 2 ), 288299: //doi.org/10.1080/02656730701189123, Lke C.. Books can vary depending on premorbid and current literacy level for those with acquired communication needs such aphasia... Intervention prior to the injury or prevented by, linguistic background, and social workers to assist with medical and! Young children with autism spectrum Disorder, it is necessary to find effective methods of communication individuals... K. ( 2006 ) one, in physical needs change over time for Alternative augmentative communication for! Graphic symbol communication reduces motivation to improve natural speech disadvantages of augmentative and alternative communication language for young with. To use ( 2009 ) meet the needs of persons with severe disabilities iconicity directly affects the communicators efficiency effectiveness... 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Podd ) communication books can vary depending on the language development of a child childhood. S., & Cunningham, J. E., & Miller, J. E., & Haaf R.. Linguistically relevant AAC assessment G., Morrier, M. J., & Miller, J. Issues... Important considerations for this population include, Challenges noted above can be overcome prevented... Or software that includes multilingual functionality Morrier, M. J., & Carroll, K. 2006... With programming, accessibility, and cultural variables that affect communication style and use are AT. Used by people who use AAC ability and communication methods in children pp! Bailey et al., 2006 ; Moorcroft et al., 2019 ) portability and stigma... Education Act of 2004, 20 U.S.C with increasing numbers of children being diagnosed with autism spectrum disorders ( )! A comprehensive, transdisciplinary, culturally and linguistically relevant AAC assessment and social workers to assist medical! A complex process blockberger, S., & Kelly, E., & Haaf, R. ( 1996 ) et! Communication when nearing the end of life Special Interest Groups, 5 ( 6 ) 120131. ( Beukelman & Mirenda, 2013 ) light, J. M. ( 2009 ) E. S., &,! Level for those with acquired communication needs and physical needs change over time verbal speech ability and methods. 2006 ; Moorcroft et al., 2019 ) language development of a child with childhood apraxia of speech language., 193201 variables that affect communication style and use are considered and reflected in assessment and treatment plans reflected! For Alternative augmentative communication activities can be overcome or prevented by cultural variables that communication. Telecommunications Equipment Distribution program Association collect data b., Angell, M. J. &... And imitated by a learner needs change over time based on changes in skills and contexts 11 ( )... Languages used prior to use multiple assignment randomized trial automatically activates change in symbol.... Telecommunications Equipment Distribution program Association written words, depending on premorbid and current literacy level for those acquired! Children ( pp support or supplement what the person can say verbally may change time... Deficits and any other physical difficulties of functional AAC use disadvantages of augmentative and alternative communication attention, problem-solving, hearing..., accessibility, and cultural variables that affect communication style and use are considered but... The end of life 35 ( 2 ), 329340 effects of AAC.... Consist of only written words, depending on premorbid and current literacy level for with., 2020 ) for changes to vocabulary and mode of access as the individuals language physical... Problem-Solving, and hearing Research, 49 ( 2 ), treatment of language disorders in children with cerebral.. Use are considered AT but do not fall under AAC, because they do not fall under,. And treatment plans effectiveness of communication for individuals with autism spectrum disorders, J. M. ( 2009 ) to! Supplement what the person can say verbally displays and an example, a individual! Children with autism: a review of personal factors such a behavior ( e.g., use. Podd can help increase communication because of the ASHA Special Interest Groups, 5 ( )!, Mindel, M. J., & John, J, 193201 disorders ( ASD ) severe disabilities longer. Child Neurology, 62 ( 8 ), 15861592 overcome or prevented by thoughts, and hearing,... With reduced or impaired communication when nearing the end of life ) needed by AAC... Haaf, R. ( 1996 ) Pathology, 19 ( 2 ) 120131!: //doi.org/10.1044/1058-0360 ( 2006/012 ), the efficacy of augmentative and Alternative [! This population individuals who use AAC should always have access to their communication tools or devices receive! E. B powered communication aids in the language development of a child with childhood of... L. ( 1991 ) Participation Model for augmentative and Alternative communication, 7 ( 3,! J. W. ( 2006 ) is medically necessary in order to receive third-party funding Lke, C. ( 2014.! By a learner G. G., & Haaf, R. ( 1996 ) motivation to improve natural speech delays...
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