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children have access to appropriate AAC systemsas a means to communicate, but also that theyreceive appropriate instruction to learn thelinguistic, operational, social, and strategic skillsrequired to communicate effectively and ensurethat children have appropriate opportunities andsupport from their partners to communicate(Light, 2003).
RESEARCH ON THE USE OF AACSYSTEMS BY YOUNG CHILDREN
The selection and development of appropriateAAC systems is one key component in interven-tion for young children with complex commu-nication needs to ensure that they have aneffective means to communicate. What do weknow specifically about the use of AAC systemsby young children with complex communicationneeds?
Use of Multiple Modes of Communication
One of the most robust findings in AAC researchis that individuals with complex communicationneeds typically rely on multiple modes to meettheir needs (Blackstone & Hunt Berg, 2003).Young children with a wide range of develop-mental disabilities typically use a variety of means(either simultaneously or sequentially) to com-municate with others in daily situations, includingspeech and speech approximations, signs, none-lectronic systems (e.g., communication boards),and AAC technologies (e.g., Binger & Light,2006; Light, Collier, & Parnes, 1985; Light &Drager, 2005). Choices of modes often relate tothe child’s skills as well as the communicationcontext, partners, tasks, and intent (Blackstone &Hunt Berg, 2003; Light et al., 1985).
Impact of AAC on Natural Speech Development
Despite the documented benefits of AAC inter-ventions on communication, many clinicians andparents still hesitate to adopt AAC for fear that itwill impede the development of natural speech(Romski & Sevcik, 2005). However, the evidencesuggests that this fear is unwarranted. Results of ameta-analysis by Millar, Light, and Schlosser(2006) indicated the following: (a) none of the 27cases demonstrated decreases in speech produc-tion as a result of AAC intervention; (b) the vastmajority (89%) demonstrated gains in speechafter AAC intervention. For the most part, thegains observed were modest (i.e.,
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20 spokenwords or less); however, in more than half of thecases, ceiling effects were observed in the speechmeasures, suggesting that these data may under-estimate the effects. The majority of the partici-pants (aged 2–60 years) had mental retardationor autism, and the AAC interventions involvedmanual signs or nonelectronic aided systems.Future research is required to delineate the effectsof AAC technologies on natural speech acrosschildren with a wide range of disabilities. Romski,Sevcik, Adamson, and Cheslock (2006) arecurrently engaged in such research with toddlerswith complex communication needs; results of their investigation will make an important con-tribution to the field.
Comparative Effectiveness of AAC Systems
There is evidence that many different types of AAC systems can have a positive impact on thecommunication skills of young children, includingunaided systems such as signs and gestures(e.g., Bartman & Freeman, 2003; Sigafoos et al.,2004) and aided systems, both nonelectronic(e.g., Charlop-Christy, Carpenter, LeBlanc, &Kellet, 2002; Johnston, McDonnell, Nelson, &Magnavito, 2003); and electronic technologies(e.g., DiCarlo & Banajee, 2000; Romski et al.,2006).To date, there is limited evidence of thecomparative effectiveness of various types of AAC systems. For example, Mirenda (2003,2005) conducted a narrative review of the researchto determine the comparative effectiveness of unaided and aided AAC systems with childrenwith autism spectrum disorders and concludedthat manual signs, graphic symbols, and AACtechnologies ‘‘... all have potential as commu-nication aids for individuals with autism’’ (2005,p. 52). It seems doubtful that there will be aunilateral answer to the question of the compara-tiveeffectiveness ofAAC systems.Insteadit seemsthat effectiveness will be determined by a complexinteraction between various factors, includingfactors intrinsic to the child, extrinsic factorssuch as communication partners and social con-text, as well as the overall purpose of theinteraction. Mirenda (2005) concluded: ‘‘WhichAAC technique is ‘best’ for a given individualdepends on: the learning/developmental prioritiesfor the person; the person’s existing skills andabilities; the person’s and family’s preferences; theperson’scurrentandfuture communicationneeds;and the environments in which and the peoplewith whom the person is likely to interact’’ (p. 52).It is highly unlikely that a single system will meetthe needs of all children with complex com-munication needs across all daily interactions.Despite the limited evidence of the relativeeffectiveness of different AAC systems, it seems
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