Guidelines in selecting an AAC system

After the initial assessment, one of the first tasks is to choose which AAC devices or systems will be given to the child. The following are general guidelines to use in the selection process.

• It is initially easiest to eliminate systems that are obviously inappropriate. Once the possibilities have been narrowed down, it is highly recommended that the child try out one or more AAC systems that seem promising. This is particularly true of expensive devices such as computers and voice output communication devices (VOCAs). (In many cases, the child will have already tried one or more devices during the assessment.)

  Usually, a system or device must be tested by the child for a period of several weeks in order to get a full picture of how well the child is able use it, how it fits into the settings and activities that make up a typical day, and whether or not the child and his or her family like it or not. Unexpected problems or issues may arise when a system is actually being learned and used by the child in regular environments. It is important to note that children often do not know how, or will even resist using AAC because it is unfamiliar and may feel intrusive. Thus, if a child does not meet expectations during a trial period, this does not necessarily mean that the system is not the right one, or that the child will never use it.

• A good rule of thumb in selecting the various modes of communication that will make up a child’s AAC system is to always choose the method that is the quickest and most efficient, and does not cause negative side effects such as fatigue or harmful reflexes. Since communication requirements vary in different situations, multimodal communication is the best way to achieve these goals (Reichle, 1997).

• In selecting AAC it is easy to get distracted by equipment and systems, and forget that technology is not what teaches a child to communicate, people do. It is important, therefore, to keep in mind what the child’s communication goals are, and to have already begun thinking about teaching methods (Blackstone, 1989; Udwin & Yule, 1987).

• While the entire AAC team is involved in the decision-making process, the child’s and family’s desires and opinions must be given the greatest weight. Without the support of the family, AAC systems are likely to go unused in the home which is where a young child spends a great deal of time. In addition, it is the child and his or her family who will be using the AAC system long after specific teachers, therapists and other team members have left the picture. (See When family and professionals disagree. )

• There are several interactive database programs that can be of great help to team members trying to select the right AAC system for a child. Typically, these programs will ask a variety of questions regarding the child’s communication-related abilities and needs, and then, based on the answers, suggest one or more specific AAC devices or systems. It is important to be aware that some of these programs may focus only on electronic devices and are not programmed, therefore, to suggest an unaided approach such as sign language or a no-technology approach such as a communication board. Nevertheless, these programs can be very useful to an AAC team with relatively little experience, or team members who are unable to keep up with the proliferation of AAC devices that have come onto the market in recent years. While they should never be expected to provide the magic answer to a child’s AAC needs, they can be useful in helping the team identify potential devices for further evaluation or tryouts. One way of evaluating the quality of one of these programs is by the sheer number of devices listed in its database.

OTHER RESOURCES:

• Some AAC manufacturers have rental programs for potential customers.

• The Alliance for Technology Access (ATA) operates centers in most states which lend AAC equipment for trial periods. A listing of their centers is at www.ataccess.org/atacenters.html.

  Help me—and everyone who reads this site—by mailing your suggestions, criticisms and personal experiences to Ruth Ballinger at yaack@iname.com

• United Cerebral Palsy (UCP) spearheads a project called Tech Tots which maintains lending libraries of toys, computers, peripherals, software, and other assistive technology devices. For more information, go to www.ucpa.org/html/innovative/
  techtots/index.html.

• Needs First: AugCom System Search Tool, developed by Barbara Couse Adams and Cindy L. George, at www.augcomm.com/needsfirst.html.

• AAC Feature Match Software by Doug Dodgen and Associates is at www.dougdodgen.com/fm/Introduction.html.

Whether to focus mainly on a high technology AAC solution such as a computer or voice output communication aid (VOCA), as opposed to a nonelectronic system like a communication board used with finger-pointing or eye gaze depends, at least in part, on the following:

• What the child and his or her family want.

• The cost of the system.

• Flexibility of the system and its ability to keep up with the child’s communication growth. One rule of thumb is that an electronic device for a youngster should be expected to last about three years (Bizot, 1998).

• Whether partners (family members, peers, strangers, etc.) can understand it or will have to learn it (i.e. a VOCA can be readily understood; sign language would likely have to be learned).

• Whether teachers are already familiar with the system or have already taught it.

• It is hoped, or even expected, that the child will eventually speak. (See When does a child need AAC? and Does AAC impede natural speech?—and other fears.)

• Cost of the system.

OTHER RESOURCES:

• Cynthia Cress's Sept. 22, 1997 e-mail response under the heading "2 years old & best early AAC systems" discusses some of the issues to consider regarding a high tech AAC system for a two-year-old. It is on the ACOLUG listserv archives at listserv.temple.edu/cgi-bin/wa?A2=ind9709&L=acolug
  &F=&S=&P=20234.