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 interaction Expression of wants/needs Information transfer Social closeness Social Etiquette Characteristics of Interaction Characteristics of interaction (Light, 1988) described according to: Goals of interaction Rate of communication Focus of interaction Tolerance for breakdowns Duration of interaction Number of participants Content of communication Independence of communicator Predictability of communication Partners: familiar/unfamiliar Scope of communication 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 Participants Individual interactions with 12 AAC interventionists in Indiana 8 Interviews and 4 email responses Demographic description ID Age Sex Years AAC Experience US 32 F 6 1 US 32 F 8 2 US 34 F 9 3 US 63 F 30 4 (as parent) US 58 F 22 5 US 51 F 10 6 US 50 F 9 7 US 37 F 10 8 US 31 F 7 9 US 52 F 28 10 US 29 F 6 11 US 50 M 15 12 Overall Experience Education in the Field 6 MA ccc 2006 Indiana University 8 MA ccc 2006 Indiana University 10 MA ccc 2004 Indiana University 18 MA Special Education 1997 Indiana University 23 MA ccc 1991 Indiana University 17 MA ccc 1992 Indiana University 24 MA ccc 1990 Indiana University 12 MA ccc 2001 Indiana University 7 MA Behavioral Analysis 2007 Indiana University 28 MA ccc 1985 Ball State 6 MA ccc 2008 Ball State 23 MA ccc 1991 Purdue Training in AAC No coursework, AAC diagnostics lab AAC covered as topic in course, Clinical supervision of AAC users, Vendor training, Self-training No coursework, On-the-job training in low-tech AAC, In-service training in AAC No coursework, Training by child’s SLPs and vendors, Self-training AAC course, CE in AAC and Hearing, Vendor training, Self-training No coursework, CE in AAC, On-the-job training, Self-training No coursework, CE in AAC, Clinical supervision of AAC users, Self-training No coursework, CE in AAC, On-the-job training, In-service training No coursework, Clinical supervision of AAC users, Self-training AAC course, CE in AAC, Self-training No coursework, CE in AAC, Mentored by expert in AAC, Self-training 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 Example Category Content Code 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 9 7 2 2 6 2 4 3 4 2 2 2 A A A A A F F A F F S S Code Express wants and needs Express thoughts and ideas Multiple language functions Repair communication breakdowns Self-initiates, independent use, novel utterances Listen to others/observe/ take turns Others are able to understand what is said Combine different modalities Communicate in more than one context/ environment Communicate with different communication partners Enjoys their device/ good use of their system 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 4 4 3 1 3 1 2 2 2 3 5 4 6 3 3 5 1 4 3 Construct A A A S A A A F F A F F S S S S F S S Code Rich broad vocabulary Use of core vocabulary Expand & grow with individual Access to full sentences not just words Meet needs of individual Repair communication breakdowns Self-initiates, independent use Others need to be able to understand Turn-taking: master exchanges- getting something from others Combine different modalities/ voice/ speech Communicate in more than one context/ activity Well-trained partners/ Expect communication Accessible motorically, visually, & across contexts Easy to manipulate vocabulary Consistency of system over time/ Motor Planning Easy to use/ efficiency/ speed Minimal intrusion & distraction/ Reliable Motivated and able to use 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 3 8 4 4 3 2 Construct F F F F F F 1 S 3 2 S F 1 2 2 F F S 2 1 3 1 S F S S Code Use across contexts – school, home, community, activities Patience of partners: don’t interrupt or guess messages, ask yes/no questions Partner attitudes: expect AAC user has something to communicate Uncomfortableness of partners with system Observation skills of partner: scanning, reading expressions Trust that partners will be patient and listen and allow AAC user to initiate not just respond AAC users want to show they are cognitively able – want to spell out everything AAC users’ lack of interest in others (autism). Going beyond just responding Recognize need for AAC in all environments, see device as not necessary throughout day Partners are distracted/ overly fascinated by device Needs to be used to communicate not just to participate in activities How to use a teachable moment without predicting what the person would say Balance device training & use Accommodating parents –lower own expectations Lack of training of SLPs, teachers and aides in schools 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 1 2 5 1 4 4 1 3 1 2 1 3 Construct Code F Awareness that communication is all the time/ create opportunities F Importance of advocacy and modeling in the community for unfamiliar communication partners F Attitudes and Dispositions – Patience, observant of AAC user expressions F Expectation of Communication F Encourage typical speakers to use AAC user’s system - fosters acceptance S Modeling communication on device to teach unfamiliar utterances S Comfort of AAC user with the communication system, Persistence F Desire for facilitating authentic communication to build relationships F Observe communication between familiar communication partners (i.e. with family at home) A Use of an activity or topic to ground conversation S Teaching Self-Instruction 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 5 2 10 3 3 6 4 2 1 1 1 1 1 1 1 Construct Code S Natural dispositions (patience, friendliness, honesty, persistence) vs. what can be taught S Age appropriate communication F Patience – willingness to listen, observe, give enough space to communicate F Honesty – willing to admit when you don’t understand A Strategies to repair communication breakdowns F Interest in what the AAC user is communicating/ maintaining attention. Interest in device/strategy F Understanding of AAC user’s experience of using communication system/ device/ model use of device A Acceptance of all modes of communication/behavior as communication A Peers as therapists/teachers instead of friends and communication partners F Importance of authentic communication to build relationships F Importance of facilitating shared experiences and fun for building camaraderie F Desire to work with SLP/teachers/ parents A Partner “ownership”/ empowerment in the intervention process A Advocate use of AAC device A Communication opportunities through day Construct Total Comments Sufficiency of Knowledge & Skills 7 Adequacy of Communication 9 Functionality of Communication 26 Summary Analysis Competent AAC User Features of AAC System Challenges Facilitators Partner Skills Total Sufficiency of Knowledge and Skills Adequacy of Communication Functionality of Communication Total 4 25 14 6 7 56 29 20 0 2 9 60 12 14 31 20 26 103 45 59 45 28 42 219 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 interaction Perspective-taking Emotional resonance Understanding 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. Communication Environments Transmission Environments exogenous feedback Sender/Encoder with endogenous feedback or Receiver/Decoder Transmission/Signal Channels Receiver/Decoder or Sender/Receiver with endogenous feedback Communication Contexts (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 using augmentative 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.