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Collaboration Corner: AAC & AT: 5 Tips, Myths and Truisms

by Kerry Davis
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Look around at every stop light and you will see the soft addictive glow of smartphones. Minivans off for a family vacation are burgeoning with tablets and some other thumb-numbing form of entertainment.  For more particular consumers, any technology prefaced with an “i” will do.

For people with complex communication needs, tools for learning and speaking have become more affordable and accessible.  But this easy access is not without its challenges.

It’s true that augmentative and alternative communication (AAC) platforms have made it into the cool kid circles, but this can make it more confusing for families and therapists to make informed decisions. Beyond You Tube and Candy Crush, it is important to remember the why and how of AAC and assistive technology (AT). Here are some points to ponder before getting too bedazzled.

  1. “AT and AAC are the same thing.” Not so much. While AAC falls under the umbrella of assistive technology, it requires a specific skill-set. Just as “related service provider” or “allied health services” includes SLP services, I would not assume the job of my physical therapy colleagues and start recommending orthotic devices. Same with AAC and AT; both tools aid and assist, and include low tech (such as a pencil grip, picture schedules) and high-tech interventions (anything that plugs in). The difference here is who is involved: AT includes a wide range of professionals well-versed in making recommendations, from special education teachers to AT certificate holders. AAC does not. In AAC, the “C” stands for communication. It is within our scope of practice per ASHA guidelines. As far as I know, it’s not under the domain of other disciplines. Period.
  2. “I don’t get it, he has an ipad, he should be able to (fill in your random ability here).” A large reason for device “abandonment” is a mismatch between the tool and the user. As SLPs your job is to consult with other experts to make sure it fits the child’s needs in terms of accessibility; fine motor, vision, and positioning are just a few considerations. AT, particularly high-tech AT, requires additional considerations, with the primary focus being, does it aide and assist?
  3. “Everybody has one.” ‘Nuff said. Social pressure should not guide recommendations. AAC is prescriptive. I know it can be difficult, but stay strong and focused on what is appropriate and effective.
  4. “He is so good at using technology, so then why can’t he…?”  My 10 year-old can use keys to unlock the door, but I wouldn’t give him the keys to drive to the store and pick up milk. Technology is a tool. AAC is a tool that requires explicit teaching. SLPs and parents are teachers that guide the process. Here is where it is important for us to educate, model and educate some more. As evidence-based practitioners, we need to take data. Data guides us on what’s working to guide what needs to be changed. For my students with autism spectrum disorder, it has been so helpful working with, and learning from, certified behavioral specialists, and come up with a system that everyone can use.
  5. “She uses it at school, and home is a time to relax, not work.” Consider the social circles of communication partners described by Deanna Wagner and colleagues (2003):
    diagram(adopted from Wagner, Daswick & Musselwhite, 2003)Becoming a confident communicator means practice: practice at home, practice with friends and friendly acquaintances, familiar and unfamiliar people, and within the context of different places. Don’t aim for perfection. Just aim for opportunities to practice!

Kerry Davis EdD, CCC-SLP,is a speech-language pathologist in the Boston area, working with children who have significant communication challenges. She conducts trainings and workshops, and serves as a volunteer speech pathologist and consultant for Step by Step Guyana, a school for children with autism in South America. The opinions expressed in this blog are her own, and not those of her employer.

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8 comments

Rachael October 21, 2014 - 10:18 pm

I love this! I’m an SLP working as an AAC Specialist and I’m repeatedly explaining the differences (and overlap) between AT and AAC. Great points to consider when teams are searching for the best fit with AAC.

Kerry October 26, 2014 - 3:05 pm

Thank you! Often we get AT referrals when really the family/team means communication…then they are disappointed when the evaluation comes back, so it’s important to clarify.

Kim October 22, 2014 - 12:21 pm

Hi Kerry. Great article. I appreciate your differentiating AT and AAC in your first section. As an OT working in both AT and AAC for many, many years, I know this can be confusing. I would like to point out that indeed, functional “C”ommunication is an area covered under the scope of practice for Occupational Therapy however. Having a team in place to support an AAC user is crucial to success and I wish OT would embrace this functional role more consistently. As you say, practice, practice, practice!

Kerry October 26, 2014 - 2:48 pm

Hi Kim, I agree with you…the OT plays a crucial part in AAC success, so much has to do with education and awareness on how are skillet compliment one another. Thank you!

Kerry October 26, 2014 - 3:03 pm

Lol auto correct! Skills!

Kate October 22, 2014 - 11:44 pm

You realize that some of the best and brightest in the low incidence AAC field are NOT SLPs. Linda Burkhart, Kelly Fonner and others. It is just plain insulting to those who aren’t SLPs to imply these and other ground breakers aren’t as capable as someone with CCCs. Honestly ASHA should focus on getting their members up to speed in AAC before it goes knocking those who are making a difference everyday in the field but don’t happen to have the same credentials.

Kerry October 26, 2014 - 3:02 pm

Hi Kate,
You are correct, there are many experts who contribute the field of AAC. My intention in the article, and my daily professional experience, (unfortunately) includes well-intended people who decide to pick a piece of technology because they have heard its useful, when it really needs to be a thoughtful evaluation process, and include the SLP who is the language/communication expert. I worry that because AAC is so available now, people just pick them up without relying on experts to guide the process. I have seen this time and time again. In public schools it seems to happen all the time.Because it is within our scope of practice, it is our obligation to learn and guide…this is not to say we are not learning from other people knowledgeable in AAC…we most certainly should look to all available resources. Thanks for your feedback!

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