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Infants & Young Children

Vol. 18, No. 3, pp. 174185

c 2005 Lippincott Williams & Wilkins, Inc.

Augmentative Communication
and Early Intervention
Myths and Realities
MaryAnn Romski, PhD, CCC-SLP; Rose A. Sevcik, PhD
The use of augmentative and alternative communication (AAC) services and supports with infants
and young children has been limited, owing to a number of myths about the appropriateness of
AAC use with this population. This article will provide an overview of some of the myths that
have hampered the inclusion of AAC into early intervention service delivery and refutes them. It
will then examine some of the realities that must be considered when delivering AAC services
and supports to young children. Key words: augmentative communication, severe disabilities,
speech and language intervention

F OR more than 3 decades now, the field

known as augmentative and alternative
communication (AAC) has addressed the com-
Despite these advances, the inclusion of
AAC services and supports into early interven-
tion service delivery for young children has
munication needs of children and adults who been hampered primarily by myths about the
cannot consistently rely on speech for func- specific types of roles AAC plays. The pur-
tional communication (e.g., Beukelman & pose of this article is to examine these myths,
Mirenda, 2005). Numerous developments in in light of the current literature on the early
the hardware and software options available language development period, and to provide
to an individual using AAC, including speech arguments and data to refute them. To meet
output capabilities, have occurred from the this goal, we will provide an overview of how
1980s to the present. The capacities of the de- language and communication skills emerge in
vices and the intelligibility of the voices have young typically developing children and the
improved substantially. (See the Communica- roles AAC may play in facilitating the develop-
tion Aids Manufacturers Association Web site, ment of young children with significant com-
http://www.aacproducts.org, for the range of munication disabilities. Next, we will exam-
technology available.) Simultaneously, there ine some of the myths and then discuss the
also have been important developments in the issues that contribute to the successful deliv-
empirical knowledge base to support decision ery of AAC services and supports for young
making for successful clinical assessment and children.
intervention.
TYPICAL PATTERNS OF EARLY
LANGUAGE DEVELOPMENT
From the Georgia State University, Atlanta, Georgia.
Young children use language for many
The preparation of this article was funded in part
by grant DC03799 from the National Institutes of purposes, including to meet their wants and
Health and a Research Program Enhancement Grant needs, to gain knowledge about the world
from Georgia State University. The authors contributed around them, to develop and maintain social
equally to the preparation of this article.
relationships, and to exchange information
Corresponding author: MaryAnn Romski, PhD, with others. In order for young children to
CCC-SLP, Department of Communication, Georgia State
University, PO Box 4000, Atlanta, GA 30302 (e-mail: develop functional language and communica-
mromski@gsu.edu). tion skills, they must be able to comprehend
174
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Augmentative Communication and Early Intervention 175

and produce language so that they can take object names to actions and from present to
on the reciprocal roles of both listener and absent person and object names. The most
speaker in conversational exchanges (Sevcik common compositions of the first 50 recep-
& Romski, 2002). Sevcik and Romski (2002) tive words include people, games and rou-
defined language comprehension as the tines, familiar objects, animals, body parts,
ability to understand what is said to us so that and actions (Fenson et al., 1994). Recently re-
we can function as a listener in communi- ported methodologies suggest that from the
cative exchanges. Conversely, they char- outset the young child relies on comprehen-
acterized language production as the abil- sion to build a foundation for later productive
ity to express oneself so that one can word use (Hollich, Hirsh Pasek, & Golinkoff,
function as a speaker in conversational 2000).
exchanges. As children move through their second
year of life, the character of their under-
standing of words changes. By 24 months,
Language comprehension they rely more on social cues than on per-
Spoken language comprehension skills as- ceptual cues (Hollich et al., 2000). They
sume an extremely important role in the early also quickly expand their understanding from
communication development of typically de- single words to relational commands, such
veloping children (Adamson, 1996). From as Give daddy a kiss, and can carry out
birth on, young, typically developing, chil- such instructions (Goldin-Meadow, Seligman,
dren hear spoken language during rich social- & Gelman, 1976; Hirsh-Pasek & Golinkoff,
communicative interactions that include reoc- 1996; Roberts, 1983). Golinkoff, Hirsh-Pasek,
curring familiar situations or events (Bruner, Cauley, and Gordon (1987) reported that
1983; Nelson, 1985). Well-established rou- typically developing children as young as
tines draw the young childs attention to 17 months of age, who were characterized
word forms and their referents in the environ- as productively one-word communicators and
ment. Word input from the caregiver to the not producing word order, actually compre-
child also permits the caregiver to create new hended word order (e.g., Big bird tickle
learning opportunities by capitalizing on well- Ernie. Ernie tickle big bird.) when a video-
established routines and the childs under- based preferential looking paradigm was em-
standing of them (Oviatt, 1985). These social ployed to assess their skills.
and environmental contexts converge with Interestingly, Fenson and his colleagues
the available linguistic information to produce (1994) reported overlap between the words
understandings (Huttenlocher, 1974). Con- young children comprehended and pro-
textual, or situational, speech comprehension duced, although comprehension was shown
begins to emerge as early as 9 months of to have a developmental advantage in the ma-
age and by 1215 months the child under- jority of the children they studied. Young typ-
stands, on average, about 50 words without ically developing children quickly move on
contextual supports (Benedict, 1979; Miller, to word production, and the childs ability to
Chapman, Branston, & Reichle, 1980; Snyder, comprehend words, and even sentences, is
Bates, & Bretherton, 1981). This type of com- assumed by the adults in the childs environ-
prehension means that children first learn ments. Since word production skills emerge
to respond to words in highly contextual- so quickly in typical children, they may mask
ized routines that include situational supports and overshadow the continuing role speech
(Platt & Coggins, 1990). For example, a child comprehension plays in the early language de-
touches the blocks after her mother says velopment process. Comprehension may play
go get the blocks and simultaneously points a particularly important role for the young
to them. The understanding of these words child who is encountering great difficulty
progress developmentally from person and with this process.
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176 INFANTS & YOUNG CHILDREN/JULYSEPTEMBER 2005

Language Production YOUNG CHILDREN WITH

Young children typically begin to speak be- DEVELOPMENTAL DISABILITIES
fore 2 years of age. From birth to approxi-
mately 1821 months of age, the young typ- Every day, children who cannot speak face
ically developing child advances through the social and educational isolation as well as sig-
stages of intentional communication devel- nificant frustration because they are unable
opment (perlocutionary or preintentional, il- to communicate their necessities, desires,
locutionary or intentional) learning that he knowledge, and emotions to their parents, sib-
or she can control the world through com- lings, extended family members, peers, and
munication. (See Brady & McLean, 2000, for teachers. These limitations may be due to
a review.) Somewhere between 12 and 15 some type of congenital disability that hinders
months the young child begins to produce their development of speech or having experi-
first word approximations and slowly starts to enced an injury or illness very early in life that
develop a vocabulary. At about the same time substantially limits the speech and language
that the young typically developing child at- abilities they are developing. Autism, cerebral
tains a 50-word productive vocabulary (18 palsy, cognitive disabilities, dual sensory im-
21 months) and experiences a spurt in vo- pairments, genetic syndromes, multiple dis-
cabulary size, he or she is also beginning to abilities (including hearing impairment), or
combine words. So, prior to the time a child even a stroke at or near birth are congenital
has a 50-word vocabulary, the focus of com- disabilities that may impede the development
munication development is on learning about of speech and language skills. A young child
the social functions and the meaning of lan- also may encounter difficulty communicating
guage rather than on its grammatical dimen- via speech through a traumatic brain injury as
sions. The child who is not yet talking may use a result of an accident, stroke, or, in rare in-
comprehension skills as a way to break into stances, even severe psychological trauma.
language. Most children with developmental disabil-
ities do develop functional spoken com-
munication skills during their childhood
Overview (Abbeduto, 2003); thus children who do not
The beginning period of language develop- eventually speak form a relatively low inci-
ment is rich with opportunities for the young dence population. There are certainly indi-
child to develop a firm language foundation vidual differences in communication patterns.
even though he or she is not yet talking. This Not every child presenting with one of these
foundation includes opportunities to develop disorders is, or will be, nonspeaking across
comprehension skills and to communicate via his or her entire life span, but children within
vocalizations, gestures, and other means even this broad range of disabilities may use AAC at
before he or she uses a conventional out- some point during their early development to
put mode such as speech, manual signs, or augment natural speech so that they can com-
symbols. The literature on typically develop- municate and develop language skills.
ing childrens language development strongly
suggests then that these early types of expe- WHAT IS AUGMENTATIVE AND
riences are important for later language de- ALTERNATIVE COMMUNICATION?
velopment. It also illustrates the development
of communication, language, and speech3 Communication is defined in the broadest
distinct but related processes. Early language sense as any act by which one person gives
interventions must consider how these recep- to or receives from another person informa-
tive and expressive experiences can be in- tion about that persons needs, desires, per-
corporated into intervention strategies during ceptions, knowledge, or affective states (Na-
the beginning developmental period through tional Joint Committee [NJC], 1992; http://
the means of AAC. www.asha.org/njc). Language is an arbitrary
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Augmentative Communication and Early Intervention 177

code that we use to communicate with one of natural communication (including gestures
another and speech is an output mode that and facial expressions) as well as manual signs
uses the oral mechanism. and the American Sign Language (ASL), and
By definition, AAC is an intervention ap- can be employed by children who are able to
proach (Glennen, 2000) that uses manual use their hands and have adequate fine-motor
signs, communication boards with symbols, coordination skills to make fine-grained pro-
and computerized devices that speak and duction distinctions between hand-shapes. Of
incorporate the childs full communication course, communication partners too must be
abilities. These abilities may include any able to understand the signs for communica-
existing speech or vocalizations, gestures, tion to take place.
manual signs, communication boards and Aided forms of communication consist of
speech-output communication devices. (See those approaches that require some addi-
American Speech-Language-Hearing Asocia- tional external support, such as a commu-
tion [ASHA], 2002, for a comprehensive defi- nication board with symbols (i.e., pictures,
nition of AAC.) In this sense, then, AAC is truly photographs, line drawings, symbols, printed
multimodal, permitting a child to use every words) or a computer that speaks for its
mode possible to communicate messages and user (also known as a speech-generating de-
ideas. AAC abilities may change over time, al- vice) via either synthetically produced speech
though sometimes very slowly, and thus the or recorded natural (digitized) speech. From
AAC system selected for use at one age may laptop computers that talk and can perform
need to be modified as a young child grows a wide range of other operations (e.g., word
and develops (Beukelman & Mirenda, 2005). processing, World Wide Web access) to com-
A child can communicate using a range puterized devices dedicated to communica-
of representational mediums from symbolic tion, technological advances have produced
(e.g., speech or spoken words, manual signs, a range of opportunities for communication.
arbitrary visual-graphic symbols, printed These boards and devices typically display
words) to iconic (e.g., actual objects, photo- visual-graphic symbols that stand for, or rep-
graphs, line drawings, pictographic visual- resent, what the child wants to express.
graphic symbols) to nonsymbolic (e.g., signals Some children create messages using printed
such as crying or physical movement). (See English words or letters of the alphabet. Ac-
Mineo Mollica, 2003, and Sevcik, Romski, cess to aided forms of communication can
& Wilkinson, 1991, for discussions of visual- be via direct selection or scanning. Direct se-
graphic representational systems.) In addi- lection techniques include pointing with, for
tion to the vocalizations and gestures that example, finger, hand, head (through a head
some young children use, they may benefit stick), eyes, or feet. Scanning is a technique
from other dimensions of AAC when com- in which the message elements are presented
municating with familiar and unfamiliar to the child in a sequence either by a person
partners across multiple environments. Some or the device. The child specifies his or her
young children have no conventional way to choice by responding yes or no to the person
communicate and may express their commu- or the device after each element is presented.
nicative wants and needs in socially unac- Scanning can be, for example, linear, circu-
ceptable ways, such as through aggressive or lar, or row-column and encoding (e.g., Morse
destructive, self-stimulatory, and/or persever- Code; see Beukelman & Mirenda, 2005, for a
ative means. AAC systems can replace these detailed description of these techniques).
unacceptable means with conventional forms AAC can play at least four different roles in
of communication. early intervention. The role(s) an AAC system
Typically, forms of AAC are divided into 2 plays will vary depending on an individual
broad groups, known as unaided and aided childs needs. These roles are as follows: aug-
forms of communication. Unaided forms of menting existing natural speech, providing
communication consist of nonverbal means a primary output mode for communication,
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178 INFANTS & YOUNG CHILDREN/JULYSEPTEMBER 2005

providing an input and an output mode for are derived from individual professionals be-
language and communication and serving as liefs or assumptions sometimes without any
a language intervention strategy. The most empirical support. Sometimes myths are per-
common and well-known role is to pro- petuated despite empirical evidence to the
vide an output mode for communication. For contrary. A limited research base along with
example, Janie is a 24-month-old girl with the immediate demands of providing clini-
spastic cerebral palsy and quadraplegia whose cal services have fostered practice that re-
attempts at speech are unintelligible to every- lies more on a professionals clinical intuition
one other than her family members owing to than on current data (Cress, 2003; NJC, 2002).
severe dysarthria. She understands almost ev- There are at least 6 myths, listed in Table 1,
erything that is said to her. Janie could use an that have developed about the use of AAC.
AAC system as a primary communication out- Each myth has grown out of information ex-
put mode in her interactions with adults and pressed in clinical literature but has not neces-
other children across a variety of settings. The sarily been backed up by empirical evidence
other roles, however, can be equally impor- to support or refute its use. Unfortunately,
tant, especially for the very young child just the myths remain and have become inte-
beginning to develop communication skills. grated into clinical practice. Their use in clin-
David is 36 months old, has some challeng- ical practice may result in young children
ing behavior (i.e., head banging) and a very re- being inappropriately excluded from AAC
cent diagnosis of autism. He understands less supports and services (AT/AAC EnablesWeb
than 20 words and has just a few undifferen- site (http://depts.washington.edu/enables/);
tiated vocalizations. He is learning to use AAC Cress & Marvin, 2003; NJC, 2002).
to indicate his wants and needs to his family
and teachers. In this case, AAC serves a very
different role than it did for Janie functioning Myth 1: AAC is a last resort in
as an input-output mode and a language inter- speech-language intervention
vention strategy. Using a developmental per- When AAC was first emerging as an in-
spective, AAC interventions (i.e., gestures, de- tervention strategy, it was considered a last
vices, switches) can be viewed as a tool that resort, to be employed only when every
aids or fosters the development of early lan- other option for the successful development
guage skills and sets the stage for later vocabu- of speech had been exhausted. In 1980, Miller
lary development and combinatorial language and Chapman argued for a set of decision
skills regardless of whether the child eventu- rules that indicated AAC was to be consid-
ally talks or not. ered when speech had not developed by age
8 years (Miller & Chapman, 1980). Since that
MYTHS ABOUT AAC time, additional information has emerged to
change the use of decision rules such as these.
A myth is defined as a widely held but The use of AAC interventions should not be
false belief (Oxford, 2002). Clinical myths contingent on failure to develop speech skills

Table 1. Myths about AAC use

Myth 1 AAC is a last resort in speech-language intervention.

Myth 2 AAC hinders or stops further speech development.
Myth 3 Children must have a certain set of skills to be able to benefit from AAC.
Myth 4 Speech-generating AAC devices are only for children with intact cognition.
Myth 5 Children have to be a certain age to be able to benefit from AAC.
Myth 6 There is a representational hierarchy of symbols from objects to written words (traditional
orthography).
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Augmentative Communication and Early Intervention 179

or considered a last resort because AAC can a temporary or permanent opening for the
play many roles in early communication de- child to breathe) who used manual signs to
velopment as described earlier (e.g., Cress & communicate. When the tracheostomy tube
Marvin, 2003; Reichle, Buekelman, & Light, was removed, she immediately attempted to
2002). In fact, it is critical that AAC be intro- speak and quickly used speech as her primary
duced before communication failure occurs. means of communication. Romski, Sevcik,
This change means that AAC is not only for and Adamson (1997) evaluated the effects of
the older child who has failed at speech de- AAC on the language and communication de-
velopment but also for a young child during velopment of toddlers with established devel-
the period when he or she is just develop- opmental disabilities who were not speaking
ing communication and language skills, to pre- at the onset of the study. Although the families
vent failure in communication and language of these very young children were much more
development. receptive to using AAC than the investigators
initially thought they would be, they were
quick to focus exclusively on speech when
Myth 2: AAC hinders or stops further their child produced his or her first word ap-
speech development proximation. For very young children, the use
The myth that AAC is a last resort goes of AAC does not appear to hinder speech de-
hand in hand with another myth about AAC. velopment (Cress, 2003). In fact, it may en-
It is the impression that AAC will become hance the development of spoken communi-
the childs primary communication mode and cation, which should be a simultaneous goal
take away the childs motivation to speak. In for intervention.
fact, the fear many parents, and some practi-
tioners, have is simply not supported by the
available empirical data. The literature actu- Myth 3: Children must have a certain set
ally suggests just the opposite outcome. There of skills to be able to benefit from AAC
are a modest number of empirical studies that In the past, young children with some de-
report improvement in speech skills after AAC gree of cognitive disability were frequently ex-
intervention experience (see Beukelman & cluded from AAC intervention because their
Mirenda, 1998; Romski & Sevcik, 1996, for re- assessed levels of intelligence and their sen-
views). Sedey, Rosin, and Miller (1991), for ex- sorimotor development were not commen-
ample, reported that manual signs had been surate with cognitive/sensorimotor skills that
taught to 80% of the 46 young children with had been linked to early language develop-
Down Syndrome (mean chronological age ment (Miller & Chapman, 1980; Mirenda &
3 years, 11 months) that they surveyed. The Locke, 1989; Romski & Sevcik, 1988). While
families of these children also reported that one may argue that some basic cognitive skills
they discontinued the use of the manual signs are essential for language to develop, the ex-
when the child began talking or when the act relationship between language and cogni-
childs speech became easier to understand. tion have not been specified clearly (see Rice,
Miller, Sedey, Miolo, Rosin, and Murray-Branch 1983; Rice & Kemper, 1984, for reviews).
(1991) also reported that when sign vocab- Investigators have argued against excluding
ularies were included, the initial vocabular- children from AAC interventions based upon
ies of a group of children with Down Syn- intellectual performance and/or prerequisite
drome were not significantly different from sensorimotor skills (Kangas & Lloyd, 1988;
those of mental-agematched typically devel- Reichle & Karlan, 1988; Romski & Sevcik,
oping children. Adamson and Dunbar (1991) 1988). Given the overall impact language ex-
described the communication development erts on cognitive development, a lack of ex-
of a 2-year-old girl with a long-term hospi- pressive language skills may put an individ-
talization and a tracheostomy (i.e., an inci- ual at a distinct developmental disadvantage
sion into the trachea [windpipe] that forms (Rice & Kemper, 1984). Some individuals
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180 INFANTS & YOUNG CHILDREN/JULYSEPTEMBER 2005

with severe sensori-motor disabilities cannot self. Having a voice at a young age can facili-
demonstrate their cognitive abilities without tate self-identity as well as communication.
a means by which to communicate so we can-
not insist on evidence of those abilities before Myth 5: Children have to be a certain
providing AAC services and supports. There age to be able to benefit from AAC
is also some evidence that severe physical dis- There is no evidence suggesting that chil-
abilities and limited communication skills may dren must be a certain chronological age
interfere with the course of early cognitive to optimally benefit from AAC interventions.
development, in particular the development Chronological age is often mentioned as an ar-
of object permanence and means-ends skills. gument against the provision of AAC services
Thus, developing language skills through AAC to young children. Specifically, some parents
may be of critical importance if the individual and professionals believe that the introduc-
is to make functional cognitive gains as well. tion of an AAC mode at an early age will pre-
clude the child from ever developing speech
Myth 4: Speech-generating AAC as his or her primary mode of communication.
devices are only for children with Current research clearly documents the effi-
intact cognition cacy of communication services and supports
The cognitive skills a young child brings to provided to infants, toddlers, and preschool-
the intervention task can vary from no evi- ers with a variety of severe disabilities (Bondy
dence of cognitive disabilities to that of severe & Frost, 1998; Cress, 2003; Pinder & Olswang,
cognitive disabilities. Another myth related to 1995; Romski, Sevcik, & Forrest, 2001;
Myth 3 relates to the use of speech-generating Rowland & Schweigert, 2000). Studies also
devices. In the past, computer-based AAC de- have demonstrated that the use of AAC
vices were often limited to children who had does not interfere with speech development
intact cognition by clinicians for 2 main rea- (Romski, Sevcik, & Hyatt, 2003, for a review)
sons. First, the devices were expensive and and actually has been shown to support such
thus it was argued that the money should only development (see Millar, Light, & Schlosser,
be spent on children who could truly bene- 2000, for a review of research demonstrating
fit from the device (Turner, 1986). Second, this effect; Romski & Sevcik, 1996; Romski,
early computer-based devices often required Sevcik, & Pate, 1988).
a fairly sophisticated set of cognitive skills in
order to operate them and thus were pro- Myth 6: There is a representational
vided only to those children who had such a hierarchy of symbols from objects to
level of skill. Neither of these 2 reasons are written words (traditional orthography)
true today. The technological developments This myth suggests that a child can only
in AAC devices have made a broad range of learn symbols in a representational hierarchy.
options available to young children. There are The hierarchy begins with real objects to
now many choices of AAC devices that speak photographs, to line drawings, to more
from simple inexpensive technology (like sin- abstract representations, and then to written
gle switches) to complex systems that per- English words (traditional orthorgraphy).
mit access to sophisticated language and liter- Namy, Campbell, and Tomasello (2004)
acy skills. This broad range of options include suggested that 13- to 18-month-olds early de-
devices that are modestly priced (<$100.00) velopment of word learning is not specific to
to expensive ($10,000.00 or more). These a predetermined mode of symbolic reference
newer devices sometimes require little skill because their comprehension of referents in
and can provide a place of introduction to their environments is in the developmental
AAC for the young child. The AAC device is stage. Iconicity did not impact the ability to
simply a tool, a means to an endlanguage learn symbol-referent relationships at the on-
and communication skillsnot the end in it- set of language development but did make a
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Augmentative Communication and Early Intervention 181

difference by the time the typically devel- intervention is begun early in life, at least 2
oping child was 26 months old. The childs additional issues need to be considered by
expectation about the relationship between professionals and families (Berry, 1987). First,
a symbol and its environmental referent may families are still coming to terms with their
change throughout their development. By the young childs disability (Wright, Granger, &
time children are 4 years old, they may have Sameroff, 1984) and often seek a broad va-
developed a greater awareness of symbolic riety of interventions (e.g., speech-language
function, have a larger vocabulary, and may therapy, occupational therapy, physical ther-
be more open to using various symbolic apy, educational therapy) to help their child
modes. This empirical evidence from the overcome his or her limitations. These inter-
literature on typical language development ventions may include highly publicized inter-
suggests that this myth is not based on ventions (e.g., direct instruction, floor-time)
evidence about how young children learn. or multiple types of speech-language ther-
In fact, during early phases of development, apy (e.g., therapy focused on feeding issues,
it may not matter if the child uses abstract therapy focused on speech-language develop-
or iconic symbols because to the child they ment). Second, there appear to be fewer struc-
all function the same. The choice of symbol tured routines outside the home in which to
set may be complicated by what families place AAC intervention, than in the school
perceive as appropriate for young children. childs day, including opportunities for com-
munication with others during the young
ISSUES IN DELIVERING AAC SERVICES childs day. Thus, the toddlers family may take
AND SUPPORTS TO YOUNG CHILDREN a primary role in the intervention process
in addition to their other parenting respon-
These 6 myths grew out of early thinking sibilities (Crutcher, 1993). Fulfilling this pri-
about how to use AAC services and supports. mary interventionist role may require differ-
None of these myths are supported by the ent external supports and organization than
current literature on early intervention and is the case when a child is school-aged. Kaiser
AAC. However, they are often discussed when and Hancock (2003) reported that parent-
AAC is considered as part of the intervention implemented language intervention is a com-
plan for a young child. The delivery of AAC plex phenomena that requires a multicompo-
services and supports must be accomplished nent intervention approach. Romski, Sevcik,
in the broader context of early intervention and Adamsons (1997) preliminary findings re-
services. There is a growing recognition of garding initial choice about AAC suggest that
the merits of implementing AAC interventions engaging in early augmented language inter-
with young children (Cress & Marvin, 2003; vention may be a more complex decision than
Culp, 2003). First, the use of AAC is mandated professionals initially anticipate. Parent per-
as part of the implementation of Part C of the ception about communication and parental
Individuals With Disabilities Education Act. stress may play roles in augmented language
And, second, AAC technologies are becoming intervention. In general, todays parents may
increasingly available at a reasonable cost. Im- not be afraid of the use of technology be-
plementing AAC raises a number of issues that cause of extensive parent education about the
are only beginning to be explored. These is- importance of getting communication started
sues include, though are not limited to, fami- and the increased use of computers in daily
lies as partners, assessment issues, transitions, life. Understanding how to arrange early aug-
and training for professionals. mented language intervention to be able to
capitalize on the communicative roles fam-
Families as partners ily members may typically play has not been
There are a number of important issues re- examined to date. In addition, sometimes,
lated to the family and the child. When AAC parental knowledge about AAC device choice
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182 INFANTS & YOUNG CHILDREN/JULYSEPTEMBER 2005

exceeds professional knowledge and experi- Transitions

ence with AAC devices because parents read- The young child can make a number of tran-
ily use the Internet to gain information. Such sitions during this early period. Over a pe-
discrepancies in knowledge and experience riod of 3 years, the child must transition from
can serve to create challenges for teams in de- early intervention services that are usually de-
termining and providing services. livered in the family or home environment to
One of the difficulties families face is that a preschool classroom. This type of transition
they want their young children to talk. Their is complex and includes many different as-
expectations for production may lead to a pects. It is important to stress that parents are
competition between a focus on developing a source of expertise about how a child com-
a way to communicate and a focus on hav- municates when service providers change. In-
ing the child speak, even if the speech the corporating AAC during early communication
child produces is imitative in nature. Thus, development requires a focus on language
interventions that do not confuse the par- and communication development within the
ents or children but instead permit them to context of the AAC mode. Sometimes school-
focus their energies on a specific goal are based clinicians are not open to the use of
needed. AAC because it is not readily available or they
Assessment Tools are constrained by 1 or more of the 6 myths. It
is particularly important that communication
For young children who present with sig- be a focus during the transition process.
nificant communication disabilities, there are
also limited tools available that can provide Training for professionals and families
an adequate assessment of the young childs
communication strengths and weaknesses. To ensure that AAC services and supports
The more challenging the childs disabilities, can be provided to children receiving early in-
the more difficult it can be to assess the tervention services, training about AAC must
childs language and communication skills. be included for professionals and families.
One particularly important, yet challenging, When serving young children, instruction
area of research need is that of language and for the early intervention team must include
communication measurement tools (Sevcik, information about the philosophy of com-
Romski, & Adamson, 1999). Attention must munication, technology, and assessment and
be focused on the development of assessment intervention strategies, with particular em-
tools that provide a fine-grained analysis of phasis on the role of the speech-language
the childs language and communication skills pathologist. Assessment must include infor-
across modes and that measure a range of in- mation about test adaptations, standardized
tervention outcomes over time. Sevcik and and informal or experimental measures, and
Romski (2002) reviewed assessment options parental report. Intervention strategies must
available for the examination of early com- discuss linking speech and language therapy
prehension skills during the childs commu- with AAC, as the goal is language and commu-
nication assessment. Some outcomes of using nication development.
AAC go beyond the development of specific
comprehension and production vocabulary, CONCLUSIONS
and even grammatical skills, and have been
somewhat elusive to quantitative measure- The reality is that it is never too early to in-
ment. Communication access can also pre- corporate AAC into language and communica-
vent the emergence of secondary disabilities tion intervention for the young child with a
(e.g., challenging behaviors). Tools that per- significant communication disability. The AAC
mit measurement of these elusive outcomes devices and strategies are a tool, a means
are important to develop. to an endlanguage and communication
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Augmentative Communication and Early Intervention 183

skillsnot the end. Incorporating AAC during draw on as clinicians make practice decisions
early communication development requires a about intervention strategies for early com-
focus on language and communication devel- munication development. Clinical decisions
opment within the context of the AAC mode. must be guided by empirical data in the con-
AAC is sometimes thought of as a separate area text of clinical judgment not just by beliefs
of practice, and thus clinicians do not always (Romski, Sevcik, Hyatt, & Cheslock, 2002).
incorporate the information they know about AAC is not a last resort but rather a first line of
language and communication development intervention that can provide a firm founda-
as they consider AAC assessment and inter- tion for the development of spoken language
vention. Often speech-language pathologists comprehension and production. It can set the
think that someone else will provide AAC stage for further language and communication
services for the children on their caseloads. development during the childs preschool
It is imperative that AAC be linked to early and early school years. It also can open the
language and communication development. door for the childs overall developmental
There is a strong history of empirical data to progression.

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