I-ASC: Identifying Appropriate Symbol Communication

Child characteristics

Child characteristics
Child characteristics

The breakdown of the I-ASC explanatory model shows a range of factors that should be considered in decision making. These child characteristics include physical abilities, intrinsic traits, and factors related to the child’s experiences with AAC over time.

Age

The child’s chronological age. These findings suggest the age of the child or young person is often used as a frame to consider both existing and expected future progress.

Implications
girl with a wheelchair mounted aid
girl with a wheelchair mounted aid
  • A comprehensive criterion-referenced assessment of language and communicative abilities is an essential part of the recommendation process.
  • For some children and young people, it is important to consider both their chronological age and their developmental age in making AAC recommendations. When differences between these ages exist, acknowledgement of one may enhance the other. For example, by making language experience opportunities developmentally appropriate may support the young person to get closer to skills expected for their chronological age.
  • Consider the child’s age when choosing the vocabulary system. It may be helpful to take a developmental perspective where you choose a system that offers a level of language that suits current abilities but also promotes the young person’s development towards increased language complexity.
  • Very young children require their AAC systems to be available across the day. Ensuring this availability may require creative problem solving when mounting the system is not possible (e.g., because of concerns mounting may impact social development).
  • All children but especially very young children need an intervention plan to support skill development in using their AAC systems. A strong focus on highly motivating communication opportunities to build their resilience in using demanding AAC systems is a good place to start.
  • When making recommendations for adolescents, consider the young person’s personal development to date, and aspirations. Take particular consideration of their age and stage when choosing new vocabulary.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more

Murray, J., Lynch, Y., Meredith, S., Moulam, L., Goldbart, J., Smith, M., Randall, N., Judge, S., (2019) Professionals’ decision making in recommending communication aids in the UK: Competing considerations Augmentative and Alternative Communication.

Smith, M. M. (2015). Adolescence and AAC: Intervention Challenges and Possible Solutions. Communication Disorders Quarterly, 36(2), 112–118. Doi: 10.1177/1525740114539001

Assumed abilities

Where assumptions have been made about the child’s level of functioning.

Implications
boy using direct access on a mounted communication aid
boy using direct access on a mounted communication aid
  • Be careful to collect all relevant information before making judgements about abilities (in particular language comprehension) rather than relying on informally reported information.
  • If information is missing, it is important to identify the potential implications of these gaps within the decision making process.
  • Be mindful of roles and responsibilities, clearly signposting expectations of each other.
  • Provide opportunities to discuss expectations to ensure all pertinent information is collected and considered before making a recommendation.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more
  • Murray, J., Lynch, Y., Meredith, S., Moulam, L., Goldbart, J., Smith, M., Randall, N., and Judge, S., (2019) Professionals’ decision making in recommending communication aids in the UK: Competing considerations Augmentative and Alternative Communication.

Child’s preference

This characteristic refers to the child’s views regarding options of communication system or way of communicating.

Implications
Image of communication aids and a person pointing to the one they prefer
Expressing choices
  • Incorporate child and young person preferences and perspectives in the AAC assessment and ensure they are reflected in decision making.  
  • Identify what motivates the child to use the technology, or to communicate more, or in different ways.
  • Check with the child or young person that your understanding of their preferences are the same as theirs, and work out how to support differences in opinion.
  • Ensure aid trials are evaluated objectively so that child preferences are fully understood and inform decisions effectively.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more

Atkinson, J., Hayward, C., Sheridan, J., and Williams, R. (2011) GOAL! Creating a resource to facilitate client input in goal setting Communication Matters Journal 26:2 35-37

Judge, S. and Townend, G. (2013), Perceptions of the design of voice output communication aids. International Journal of Language & Communication Disorders, 48: 366-381. doi:10.1111/1460-6984.12012

Murray, J., Lynch, Y., Meredith, S., Moulam, L., Goldbart, J., Smith, M., Randall, N., and Judge, S., (2019) Professionals’ decision making in recommending communication aids in the UK: Competing considerations Augmentative and Alternative Communication.

Cognitive skills

Information about the child’s general cognitive skills including attention, memory, focus, learning style, and insight. The child’s perceived cognitive abilities shaped the views of what communication supports should be offered and when. Findings suggest the need to consider different aspects of cognition.

Implications
girl using a communication book with direct access
girl using a communication book with direct access
  • Introduce AAC as early as possible to support understanding and expressive communication.
  • Use a criterion-referenced assessment of children’s cognitive abilities to accurately determine the level of functioning. This is especially important where cognitive skills determine service access.
  • Offer AAC scaffolding supports with lower operational demands to promote language and communicative development while children are learning how to use AAC systems with higher cognitive loads.
  • Give sufficient consideration to the selection of the first graphic representation.
  • Stick to one type of graphic representation to retain learning. Changing the graphic representation used should only be done to suit the individual child’s need. Changes for reasons external to the child should be avoided if possible.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

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Murray, J., Lynch, Y., Meredith, S., Moulam, L., Goldbart, J., Smith, M., Randall, N., Judge, S., (in press) Professionals’ decision making in recommending communication aids in the UK: Competing considerations Augmentative and Alternative Communication.  

Murray, J., & Goldbart, J. (2011) Emergence of working memory in children using aided communication. Journal of Assistive Technologies, 5, 213-232.

Murray, J., Lynch, Y., Meredith, S., Moulam, L., Goldbart, J., Smith, M., Randall, N., & Judge, S., (2019) Professionals’ decision making in recommending communication aids in the UK: Competing considerations Augmentative and Alternative Communication.

Thistle, J. J., & Wilkinson, K. M., (2015) Building Evidence-based Practice in AAC Display Design for Young Children: Current Practices and Future Directions. Augmentative and Alternative Communication, 31(2), pp. 124-136.

Stadskliev, K., Batorowicz, B., Massaro, M., van Balkom, H., von Tetzchner, S. (2018) Visual-spatial cognition in children using aided communication Augmentative and Alternative Communication 34 68-78. doi: 10.1080/07434618.2017.1422017

Communication ability

This considers the view of the child’s level of communication ability, both aided and unaided. Findings suggest that communication ability needs to be described across different contexts and related to differing people’s views of the child.

Implications
Young lady with her communication aid and parents
  • Identify how communication abilities are viewed in different locations, e.g., home, school, and elsewhere. It is important to ensure aid recommendations are made in a way that complements existing family communication systems.
  • Identify what communication opportunities exist for the child or young person to learn how to use their recommended AAC system, and support them to achieve agreed goals.
  • Identify the aspects of multimodal communication that are used and how they are prioritised in different locations, e.g., unaided communication is used more at home or aided communication is used more in school.
  • Promote the child or young person’s desire to communicate through highly motivating communication activities.
  • Plan carefully during vocabulary transitions to support children’s range of communicative functions.
  • Support families to see the potential communication development possible with appropriate AAC supports.
  • Consider using multiple communication modalities (e.g. voice, manual sign, aided AAC) to support immediate (quickfire) communication solutions for social interaction.
  • Do not require children to demonstrate communication ability before an AAC system is recommended as doing so may limit the potential of some children.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more

Lynch, Y., Goldbart, J., Dada, S., Moulam, L., Randall, N., Judge, S. Meredith, S., & Murray, J. (2018). A literature review on the language abilities of children and young adults who use aided AAC during language development. Communication Matters Journal, 32(3), 16-20.

Murray, J., Lynch, Y., Meredith, S., Moulam, L., Goldbart, J., Smith, M., Randall, N., Judge, S., (2019) Professionals’ decision making in recommending communication aids in the UK: Competing considerations Augmentative and Alternative Communication.

Wolf Nelson, N., (1992) Performance is the prize: Language competence and performance among AAC users, Augmentative and Alternative Communication, 8:1, 3-18, DOI: 10.1080/07434619212331276003

Diagnosis

This refers to any medical or speech and language diagnosis for the child or young person. The child’s diagnoses filters expectations and choices for some members of the team about access to services, system selection, access methods and even vocabulary organization.

Implications
Girl with her communication aid and communication partner
  • Consider characteristics related to speech, language and communication abilities. These considerations should include the available information on the young person’s diagnosis to shape the decision making process. For example, looking at social communication skills in children with autism spectrum conditions.
  • Consider the impact that other characteristics related to diagnoses may have. These characteristics may include physical abilities and physical function, sensory abilities, and (medically related) reflex responses.
  • Consider the impact of referral and diagnostic information to help plan which team members will be needed for the AAC symbol communication assessment.
I-ASC Resources
Other Resources
  • Please email i-asc@mmu.ac.uk if you know of resources that should be included here
Learn more

Lund, S. K., Quach, W., Weissling, K., McKelvey, M. & Dietz, A. (2017) Assessment With Children Who Need Augmentative and Alternative Communication (AAC): Clinical Decisions of AAC Specialists. Language, Speech and Hearing Services in Schools, 48, 56-68.

Murray, J., Lynch, Y., Meredith, S., Moulam, L., Goldbart, J., Smith, M., Randall, N., Judge, S., (2019) Professionals’ decision making in recommending communication aids in the UK: Competing considerations Augmentative and Alternative Communication.

Expectations and aspirations

This describes the child’s future journey with AAC. It includes predicted needs, and goals for AAC, hopes, and expectations. Findings suggest that the child’s expected future pathway shaped decisions for the current recommendation. 

Implications
A young boy in a communication aid assessment
  • Choose an AAC system that supports current needs but also allows for future development.
  • Hold high expectations for all children and young people.
  • For children who have not progressed quickly, consider the communication opportunities they have received to date and identify how future opportunities could be enhanced rather than judging the child’s progress and potentially limiting expectations.
  • Support AAC recommendations with goal setting that aims to build communication skills across communication and learning contexts.
  • Include sufficient discussion and consensus building during the AAC assessment to ensure a common understanding and agreement of the goals for the child or young person with AAC.
  • Interventions plans should include many communication opportunities with different communication partners to support young people achieving their language and communication potential.
  • Provide children with AAC role models to shape their expectations of themselves. Facilitate aspirational thinking to create and maintain high expectations.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more

Atkinson, J., Hayward, C., Sheridan, J., Williams, R. (2011) GOAL! Creating a resource to facilitate client input in goal setting Communication Matters Journal 26:2 35-37

Bryen, D. N. (2012). Daring to Dream: Turning Dreams into Future Realities. Amazon, Kindle Edition, http://www.amazon.com/dp/B008O5BKHU

Bryen, D.N., Sleseransky, G. & Baker, D. (1995). Augmentative Communication and Empowerment Supports: A Look at Outcomes. Augmentative and Alternative Communication, 11 (2).

Judge, S. and Townend, G. (2013), Perceptions of the design of voice output communication aids. International Journal of Language & Communication Disorders, 48: 366-381. doi:10.1111/1460-6984.12012

Lynch, Y., Goldbart, J., Dada, S., Moulam, L., Randall, N., Judge, S. Meredith, S., & Murray, J. (2018). A literature review on the language abilities of children and young adults who use aided AAC during language development. Communication Matters Journal, 32(3), 16-20.

Murray, J., Lynch, Y., Meredith, S., Moulam, L., Goldbart, J., Smith, M., Randall, N., Judge, S., (2019) Professionals’ decision making in recommending communication aids in the UK: Competing considerations Augmentative and Alternative Communication.

Linguistic level

This described the child or young person’s existing level of language, literacy and graphic symbol knowledge. Findings suggest that often insufficient detail is provided at the time of a communication aid assessment to accurately describe the child’s current receptive and expressive language abilities.

Implications
boy switch access to aid mounted on wheelchair
A boy using switch access to access a communication aid mounted on wheelchair
  • All AAC symbol communication aid assessments should include informal summaries of language skills. These summaries should be founded in observational evidence, e.g., describe, with examples from the child, their level of language comprehension in terms of average information carrying words comprehended within a sentence, or, expressively, what concepts can be produced within a sequence of related ideas, or can be expressed through a low-tech symbol communication system.
  • If possible use formal (standardised) language assessment data either completed as specified in the standardisation protocols or adapted standardised assessments to provide specific descriptive data of the child’s comprehension and expressive language abilities.
    Working collegiately, this information can be generated, e.g., the local and specialised providers working collaboratively, rather than assuming responsibility to one or other provider.
  • Where children’s physical challenges impact on access to AAC vocabularies, ensure specific communication opportunities with lower physical access demands. For example, providing opportunities to use repeated line Social Scripts for social conversation or use partner assisted scanning. 
  • Support children in developing the strategic competence needed to select different ways of communicating as appropriate for the context and communication partner.
  • Ensure intervention plans include AAC goals that address both language and communication development to address these complementary but separate goals. 
  • Provide drill and practice opportunities to develop language and communication skills as well as real-time opportunities to apply skills learned.
  • Provide AAC supports and strategies to facilitate literacy development.
    Maintain high expectations of children’s language potential and avoid requiring children to demonstrate ability before being able to access AAC learning opportunities.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more

Lynch, Y., Goldbart, J., Dada, S., Moulam, L., Randall, N., Judge, S. Meredith, S., and Murray, J. (2018). A literature review on the language abilities of children and young adults who use aided AAC during language development. Communication Matters Journal, 32(3), 16-20.

Lynch, Y., McCleary, M., and Smith, M. (2018). Instructional strategies used in direct AAC interventions with children to support graphic symbol learning: A systematic review. Child Language Teaching and Therapy, 34(1), 23-36. doi:10.1177/0265659018755524.

Murray, J., Lynch, Y., Meredith, S., Moulam, L., Goldbart, J., Smith, M., Randall, N., and Judge, S., (2019) Professionals’ decision making in recommending communication aids in the UK: Competing considerations Augmentative and Alternative Communication.

Webb, E.J.D., Meads, D., Lynch, Y., Randall, N., Judge, S., Goldbart, J., Meredith, S., Moulam, L., Hess, S., and Murray, J. (2019) What’s important in AAC decision making for children? Evidence from a best-worst scaling survey, Augmentative and Alternative Communication, doi: 10.1080/07434618.2018.1561750

Motor abilities and operational competence

This section includes consideration of physical skills, mobility, and speech intelligibility. Findings suggest challenges related to children’s motor and operational abilities influence the communication aid recommendation process.

Implications
girl using eye gaze
A girl using eye gaze
  • Provide more time within learning opportunities for children with physical limitations so that they can actively participate.
  • Be mindful of the impact of slower access on the final message delivery on motivation for the child and their communication partner.
  • Provide other communication opportunities that are fast and place lower levels of demands on children.
  • Be aware of balancing the longer term goal of independent communication with the operational demands required to use more autonomous systems. Assisted and scaffolded communication opportunities may be an interim goal.
  • Where access is a significant consideration, aim to include the relevant professionals in decision making and ensure language development and communication achievement remain paramount in the recommendation process.
  • Be mindful of team member preferences and aim to achieve consensus when choosing a selection method.
  • Provide specific opportunities to develop access skills and provide separate language and communication learning opportunities.
  • Aim to gather as much information related to physical and visual skills as possible to avoid making decisions with information gaps.
  • Where setting up the AAC system takes time (e.g. such as with eye gaze systems), provide other AAC supports for spontaneous communication.
  • Provide offline navigation learning opportunities to allow children to concentrate on the linguistic/communicative demands in communicative contexts.
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more

Murray, J., Lynch, Y., Meredith, S., Moulam, L., Goldbart, J., Smith, M., Randall, N., and Judge, S., (2019) Professionals’ decision making in recommending communication aids in the UK: Competing considerations Augmentative and Alternative Communication.

Webb, E.J.D., Meads, D., Lynch, Y., Randall, N., Judge, S., Goldbart, J., Meredith, S., Moulam, L., Hess, S., and Murray, J. (2019) What’s important in AAC decision making for children? Evidence from a best-worst scaling survey, Augmentative and Alternative Communication, doi: 10.1080/07434618.2018.1561750

Personality and temperament

This includes references to the child’s personality, temperament and includes motivation and frustration. Findings suggest that a child’s personality and temperament were considered during the communication aid recommendation process, with the potential to have both a positive and negative influence.

Implications
Young girl in front of photos of her playing different sports
  • Consider ways of enhancing a child’s confidence and willingness to persevere with AAC.
  • Minimise frustration by building AAC related demands slowly and build motivation by providing early communication success.
  • Ensure early intervention focuses on building positive communication experiences and the child’s desire to communicate.
  • Take time in the assessment to support the child to express their personality and use this information to inform recommendations and design personalised communication systems.
I-ASC Resources
Other Resources

B-DI is a project website dedicated to scientific work and professional applications in the area of temperament https://www.b-di.com/

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more
  • Murray, J., Lynch, Y., Meredith, S., Moulam, L., Goldbart, J., Smith, M., Randall, N., and Judge, S., (2019) Professionals’ decision making in recommending communication aids in the UK: Competing considerations Augmentative and Alternative Communication.

Progress and communication opportunities

Simply having a communication aid can open up new communication opportunities as other people’s perceptions of the child with the communication aid change. The findings suggest for many children a lengthy process of trialling a communication aid should be part of the recommendation process. This process allows time for the skills needed to use a communication aid to develop. It also offers opportunities to use the aid in real interactions which supports informed recommendations based on sufficient practice and learning opportunities. These opportunities can be used to better understand each child’s learning trajectories.

Implications
A girl using a communication aid
A girl using a communication aid
  • Trialling should be informed by substantial amounts of formal and informal assessment.
  • Make the communication aid available at all times. Do not limit the child or young person’s opportunities to experiment and practice using their communication aid. Be aware of the influence of service structures on the availability of the communication aid, e.g., only used in group activities in school.
  • Offer communication opportunities (with AAC) irrespective of the child or young person’s level of proficiency. Some will take longer to become effective AAC users and need your continuous enthusiasm and scaffolding to support AAC use.
  • Communication opportunities help children to develop communication skills. Introduce AAC as early as possible and provide planned and structured communication opportunities, especially with familiar communication partners.
  • Using clear objective measures to identify goals for a communication aid loan period is critical. This should include goals that recognise the child’s own learning styles and needs.
  • Be mindful of established ways of working and their influence on the choices of AAC system offered individual children and young people.
  • Where possible, offer peer AAC mentoring support to the child and young person.
  • Give the child off-line practice to develop their linguistic competence skills, e.g., rehearsing sentence structure production with their communication aid, and offer on-line strategic competence skills in real-time interactions, e.g., including multiple ways of communication (through a combination of speech, gesture, symbol book and communication aid). Approaching communication opportunities in these different ways will help you accommodate the need to move on with getting a message across and onto the next thing in the day.
  • Provide a range of communication opportunities, e.g., asking questions, describing, telling jokes, telling stories.
  • Let children make mistakes when practising to use their AAC system. These mistakes could look like they have poor memory for symbols or symbol locations but it is important that children have the opportunity to explore and learn. Be patient and give scaffolds if appropriate. We can all learn from our mistakes.
  • Plan ahead – will this system be available in five years’ time? Can this system grow in linguistic complexity over time? Can this system be accessed in various ways?
  • Be clear about who has the expertise to support the child and young person’s on-going communication opportunities, and who might like to learn skills that could be
I-ASC Resources
Other Resources

Please email i-asc@mmu.ac.uk if you know of resources that should be included here

Learn more

Bryen, D., Chung, Y., and Lever, S. (2010). What you might not find in a typical transition plan! Some important lessons from adults who rely on augmentative and alternative communication. Perspectives on Augmentative and Alternative Communication19, 32-40. Doi:10.1044/aac19.2.32

Light, J., and McNaughton, D. (2012). Supporting the communication, language, and literacy development of children with complex communication needs: State of the science and future research priorities. Assistive Technology, 24, 34-44.  Doi:10.1080/10400435.2011.648717

Lynch, Y., Goldbart, J., Dada, S., Moulam, L., Randall, N., Judge, S. Meredith, S., & Murray, J. (2018). A literature review on the language abilities of children and young adults who use aided AAC during language development. Communication Matters Journal, 32(3), 16-20.

Murray, J., Lynch, Y., Meredith, S., Moulam, L., Goldbart, J., Smith, M., Randall, N., and Judge, S., (2019) Professionals’ decision making in recommending communication aids in the UK: Competing considerations Augmentative and Alternative Communication.

Smith, M. (2015). Language development of individuals who require aided communication: Reflections on state of the science and future research directions. Augmentative and Alternative Communication, 31, 215-233. Doi: 10.3109/07434618.2015.1062553