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 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.

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 (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 Characteristics of Interaction

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

13. IDAgeSex Years AAC Experience Overall Experience in the Field EducationTraining in AAC US 1 32F66 MA ccc 2006 Indiana University No coursework, AAC diagnostics lab US 2 32F88 MA ccc 2006 Indiana University AAC covered as topic in course, Clinical supervision of AAC users, Vendor training, Self-training US 3 34F910 MA ccc 2004 Indiana University No coursework, On-the-job training in low-tech AAC, In-service training in AAC US 4 63F 30 (as parent) 18 MA Special Education 1997 Indiana University No coursework, Training by child’s SLPs and vendors, Self-training US 5 58F2223 MA ccc 1991 Indiana University AAC course, CE in AAC and Hearing, Vendor training, Self-training US 6 51F1017 MA ccc 1992 Indiana University No coursework, CE in AAC, On-the-job training, Self-training US 7 50F924 MA ccc 1990 Indiana University No coursework, CE in AAC, Clinical supervision of AAC users, Self-training US 8 37F1012 MA ccc 2001 Indiana University No coursework, CE in AAC, On-the-job training, In-service training US 9 31F77 MA Behavioral Analysis 2007 Indiana University No coursework, Clinical supervision of AAC users, Self-training US 10 52F28 MA ccc 1985 Ball State AAC course, CE in AAC, Self-training US 11 29F66 MA ccc 2008 Ball State No coursework, CE in AAC, Mentored by expert in AAC, Self-training US 12 50M1523MA ccc 1991 Purdue AAC course, Clinical supervision of AAC users, Presented at conferences and workshops on AAC

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 CategoryCode ContentExpress wants and needs Express thoughts and ideas Different functionsMultiple language functions Repair communication breakdowns Self-initiates, independent use, novel utterances Sensitive to othersListen 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

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? TotalConstructCode 9AExpress wants and needs 7AExpress thoughts and ideas 2AMultiple language functions 2ARepair communication breakdowns 6ASelf-initiates, independent use, novel utterances 2FListen to others/observe/ take turns 4FOthers are able to understand what is said 3ACombine different modalities 4FCommunicate in more than one context/ environment 2FCommunicate with different communication partners 2SEnjoys their device/ good use of their system 2SUnderstand and learn language like others ConstructTotal Comments Sufficiency of Knowledge & Skills 4 Adequacy of Communication 29 Functionality of Communication 12

18. What are the features of an effective AAC system? TotalConstructCode 4ARich broad vocabulary 4AUse of core vocabulary 3AExpand & grow with individual 1SAccess to full sentences not just words 3AMeet needs of individual 1ARepair communication breakdowns 2ASelf-initiates, independent use 2FOthers need to be able to understand 2FTurn-taking: master exchanges- getting something from others 3ACombine different modalities/ voice/ speech 5FCommunicate in more than one context/ activity 4FWell-trained partners/ Expect communication 6SAccessible motorically, visually, & across contexts 3SEasy to manipulate vocabulary 3SConsistency of system over time/ Motor Planning 5SEasy to use/ efficiency/ speed 1FMinimal intrusion & distraction/ Reliable 4SMotivated and able to use 3SSufficient rate for communication ConstructTotal Comments Sufficiency of Knowledge & Skills 25 Adequacy of Communication 20 Functionality of Communication 14

19. What are the biggest challenges for AAC users to interact with typically developing communication partners? TotalConstructCode 3FUse across contexts – school, home, community, activities 8FPatience of partners: don’t interrupt or guess messages, ask yes/no questions 4FPartner attitudes: expect AAC user has something to communicate 4FUncomfortableness of partners with system 3FObservation skills of partner: scanning, reading expressions 2F Trust that partners will be patient and listen and allow AAC user to initiate not just respond 1S AAC users want to show they are cognitively able – want to spell out everything 3SAAC users’ lack of interest in others (autism). Going beyond just responding 2F Recognize need for AAC in all environments, see device as not necessary throughout day 1FPartners are distracted/ overly fascinated by device 2FNeeds to be used to communicate not just to participate in activities 2S How to use a teachable moment without predicting what the person would say 2SBalance device training & use 1FAccommodating parents –lower own expectations 3SLack of training of SLPs, teachers and aides in schools 1SSuccessful assessment in AAC ConstructTotal Comments Sufficiency of Knowledge & Skills 14 Adequacy of Communication 0 Functionality of Communication 31

20. What are the main facilitators for AAC users to interact with typically developing communication partners? TotalConstructCode 1FAwareness that communication is all the time/ create opportunities 2F Importance of advocacy and modeling in the community for unfamiliar communication partners 5FAttitudes and Dispositions – Patience, observant of AAC user expressions 1FExpectation of Communication 4FEncourage typical speakers to use AAC user’s system - fosters acceptance 4SModeling communication on device to teach unfamiliar utterances 1SComfort of AAC user with the communication system, Persistence 3FDesire for facilitating authentic communication to build relationships 1F Observe communication between familiar communication partners (i.e. with family at home) 2AUse of an activity or topic to ground conversation 1STeaching Self-Instruction 3FCollaboration with colleagues and families ConstructTotal Comments Sufficiency of Knowledge & Skills 6 Adequacy of Communication 2 Functionality of Communication 20

21. What skills do you think communication partners need to interact with people with little or no functional speech? TotalConstructCode 5S Natural dispositions (patience, friendliness, honesty, persistence) vs. what can be taught 2SAge appropriate communication 10FPatience – willingness to listen, observe, give enough space to communicate 3FHonesty – willing to admit when you don’t understand 3AStrategies to repair communication breakdowns 6F Interest in what the AAC user is communicating/ maintaining attention. Interest in device/strategy 4F Understanding of AAC user’s experience of using communication system/ device/ model use of device 2AAcceptance of all modes of communication/behavior as communication 1APeers as therapists/teachers instead of friends and communication partners 1FImportance of authentic communication to build relationships 1FImportance of facilitating shared experiences and fun for building camaraderie 1FDesire to work with SLP/teachers/ parents 1APartner “ownership”/ empowerment in the intervention process 1AAdvocate use of AAC device 1ACommunication opportunities through day ConstructTotal Comments Sufficiency of Knowledge & Skills 7 Adequacy of Communication 9 Functionality of Communication 26

22. Summary Analysis Sufficiency of Knowledge and Skills Adequacy of Communication Functionality of Communication Total Competent AAC User4291245 Features of AAC System25201459 Challenges1403145 Facilitators622028 Partner Skills792642 Total5660103219

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. Transmission Environments Sender/Encoder with endogenous feedback Receiver/Decoder Transmission/Signal Channels Communication Environments Communication Contexts or Receiver/Decoder or Sender/Receiver with endogenous feedback exogenous feedback (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.