What is a competent AAC user? Perspectives from AAC interventionists

1. 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

2. 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 OttingFoundation • 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.

3. 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?

4. 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.

5. 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

6. 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

7. Characteristics of Interaction 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

8. 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

9. 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.

10. 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

11. 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

12. Methodology Participants • Individual interactions with 12 AAC interventionists in Indiana • 8 Interviews and 4 email responses • Demographic description

14. 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)

15. Analysis of Data – Categorical Coding Example

16. 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?

17. What is a competent AAC user?

18. What are the features of an effective AAC system?

19. What are the biggest challenges for AAC users to interact with typically developing communication partners?

20. What are the main facilitators for AAC users to interact with typically developing communication partners?

21. What skills do you think communication partners need to interact with people with little or no functional speech?

22. Summary Analysis

23. 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

24. 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

25. 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.”

26. 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?”

27. 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.”

28. 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.

29. Communication Environments Development of Meaning between individuals Transmission Environments exogenous feedback Receiver/Decoder Sender/Encoder with endogenous feedback or Sender/Receiver with endogenous feedback Transmission/Signal Channels or Receiver/Decoder Communication Contexts (taken from Lloyd et al., 1997, p. 7, Fig. 1.1)

30. 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.