Vol. 14 Issue 31
The Communication Partner in AAC
Tips for enabling people who rely on augmentative communication
By its nature, communication requires a partnership of two people. This applies to individuals who use augmentative or alternative communication (AAC) devices or methods as well. In fact, having reliable communication partners may be even more crucial in these situations.
Communication partners are the general public, but having a primary communication partner, or communication advocate, such as a family member or a close friend is very beneficial, Christine Derse, MEd, CCC-SLP told ADVANCE. she is administrator for Understanding Disabilities Inc., an organization in Reading, MA, that promotes disabilities awareness.
"A primary communication advocate must be committed to both the person who uses AAC and the concept of augmentative communication," said Delva Culp, MA, CCC-SLP, a professor at the Callier Center for Communication Disorders at the University of Texas in Dallas.
"Ideally, the primary communication advocate should be available daily, or at least weekly, on a long-term basis. The advocate can provide support by facilitating communication, providing communication opportunities, training other communication partners, identifying communication/message needs, and maintaining the device," she said.
Because the situation can be overwhelming, family members are often reluctant to accept the need for AAC and therefore have difficulty committing to it. However, when a family member is available as a primary communication partner, he or she can learn communication facilitation strategies, such as providing expectant pause time, modeling use of AAC, and encouraging the individual using AAC to take conversational control.
"By implementing these strategies, the family member advocate can facilitate communication in the everyday environment, thus providing more opportunities for the individual using AAC to communicate in a meaningful way," said Culp.
It is important for communication advocates to be open about their understanding and about coming up with strategies that can help because individual AAC users might have very different strategies, modes or devices they use.
Like anyone else, people who use AAC want to communicate with significant others in their lives and not just with clinicians, said Juli Trautman, MS, CCC-SLP, of Duke University Medical Center in Durham, NC. "It's important to provide successful opportunities for communication–not just for basic wants and needs, but social information to maintain social closeness."
Most people are unfamiliar with the concept of non-speaking communication, especially when it comes to sign language, pictures, or the use of AAC devices.
"People miscommunicate all the time, and incorporating an AAC device adds even more complexity to the communication," said Derse, author of the book Understanding Augmentative Communication: How Many Ways Can You Ask for a Cookie? (Framingham, MA: Therapro Inc., 1999).
To avoid problems communication partners need to confirm the communication that took place and not assume they accurately understood the AAC user.
"When a communication partner doesn't understand what an individual using AAC is saying, it's important for both the partner and the individual using AAC to have strategies to repair communication breakdowns," said Culp.
"This is not an easy communication," Derse acknowledged. "It's not as big a deal to have a person in a wheelchair who needs a ramp or a handicap-accessible bathroom, but it's still an unusual circumstance when somebody orders food with pictures. Most people aren't really familiar with it."
To become immersed in AAC, prospective communication partners should open their minds to what communication entails. They need to be able to recognize when communication takes place, including gestures, facial expressions, body language, symbols, signs and vocalizations. People who are unfamiliar with the individual may miss these cues.
"A large portion of the way we communicate is actually body language and intonation," explained Trautman. "We often focus on speech as the method of communication. Even people who can't speak, per se, are still doing a lot of things to communicate."
"It's not just their device," agreed Sarah Blackstone, PhD, CCC-SLP, president of Augmentative Communication Inc., in Monterey, CA, where she serves as a consultant, writer and lecturer. "Communication partners need to pay attention to the user's gestures and vocalizations, be comfortable with moments of silence, repeat and confirm messages, and admit when they don't understand what is said."
Advocates should try to become familiar with the particular modes of communication the AAC user applies and realize all communication is open to interpretation.
"Understand the communicator's cognitive abilities, lengths of utterances, and possible interpretations of one-word utterances," said Derse. "Pay attention to how body language and articulation can be interpreted. If you observe and interact, you start to pick up their cues more quickly."
The communication partner should learn as much as possible about the individual's skills and capabilities, as well as the options for low- and high-tech devices.
"For example, if a person uses a picture board, become familiar with all the vocabulary that's present," said Derse. "If the user is a signer, the communication partner should learn as many signs as possible, as well as the nuances of the individual's dexterity and signing idiosyncrasies."
The ability to spell can be a common dilemma, but over time the partner will begin to recognize the nuances of misspellings.
Communication partners can either speed or hinder communication, Derse said. "You can speed it up by anticipating the end of a message. The goal is to get better at anticipating what the rest of the message is without over-guessing and hindering the communication, which can actually slow things down and frustrate the communicator."
"Some people who rely on AAC like for their partner to try and guess what they're saying or try to give options to be able to make the conversation more efficient," Trautman said. "Others feel very strongly about someone else filling in their words. They'd rather their partner be patient and give them time."
There may be other ways to communicate, depending on the individual's cognitive ability. For example, if the communication advocate is having trouble understanding the person's speech, the individual who uses AAC may be able to facilitate communication by enunciating words, facing the listener, writing things down, or finger-spelling.
AAC communicators should have ways to explain their situations, such as why they are using a device.
"The individual using the device should be able to say, for .example, 'I had a stroke in October, and I have trouble communicating. I'm using this device to communicate with you. Please be patient,'" said Culp. Augmentative communicators also should have a way to say, "I don't have that on my device" or "Please ask yes-or-no questions."
Individuals using AAC and their primary communication partners should enroll in communication training programs.
"These programs need to focus not only on teaching communication strategies or ways in which the individual using AAC can manage the device, but also on preparing significant communication partners to be good facilitators and advocates," said Culp.
The individual using AAC and the partner can educate themselves and each other about the daily challenges they face. For example, communication partners can seek out other knowledgeable partners and attend therapy sessions to get acquainted with their responsibilities, Trautman recommended. For those who use AAC, they should get in touch with others through support networks and share their experiences.
The more reliable communication partners a person has, the better, said Dr. Blackstone, a partner in the Rehabilitation Research and Engineering Center on Communication Enhancement (AAC-RERC). "People who rely on AAC should have multiple reliable communication partners, just like everyone else."
"Regardless of their cognitive and literacy skills or their physical ability to charge, mount and maintain a device, the majority of individuals who use AAC will be more likely to experience communication success if they have a skilled communication advocate," said Culp.
Ultimately, communication partners are far more important than AAC technology, Dr. Blackstone added. "After all, communication is all about social interaction, exchanging information and expressing who we are. To be successful everyone needs good communication partners."
For More Information
• Sarah Blackstone, PhD, (831) 649-3050, e-mail: firstname.lastname@example.org, online: www.augcominc.com
• Delva Culp, (214) 905-3137, e-mail: email@example.com
• Christine Lowry, e-mail: firstname.lastname@example.org
• Juli Trautman, (919) 684-3859, e-mail: email@example.com
Jason Mosheim is an Editorial Assistant at ADVANCE. He can be reached at firstname.lastname@example.org.
To learn more about attitudes toward AAC and how they relate to the communication partner, visit the ADVANCE Web site at www.advanceweb.com/SPA. The article, titled "Attitudes About AAC," will be a feature story on the site for a week beginning Aug. 12 and then will be archived online.
When You Meet an AAC User
1. Introduce yourself.
2. Ask the person to show you how he or she communicates.
3. Say how you indicate 'yes.'
4. Wait for the communicator to construct a message.
5. Give the person an opportunity to ask questions or make comments.
6. Don't finish the person's message unless you first ask permission.
7. Interact at eye level.
8. Pay close attention to facial expressions and gestures.
9. Be honest. If you don't understand, admit it.
10. Talk directly to the person.
–Sarah Blackstone, PhD, CCC-SLP
Favorite Communication Partners
• Have real conversations with me.
• Have a genuine interest in what I say.
• Have an ease to their communication.
• Understand my speech.
• Are patient when I use my devices.
• Are comfortable with moments of silence.
• Make an effort to interpret gestures and signs.
• Admit when they don't understand what I've said.
–from a 1999 survey of AAC users by Sarah Blackstone, PhD
Social Networks: Five Circles of Communication
The social networks paradigm for people who use augmentative or alternative communication (AAC) comes from the book All My Life's a Circle, by M. Falvey, M. Forest, J. Pearpoint and R. Rosenberg (Inclusion Press). Expanded by Sarah Blackstone, PhD, CCC-SLP, president of Augmentative Communication Inc., in Monterey, CA, the paradigm involves five circles of communication partners.1
The first circle consists of the individual's family, such as parents, guardians, spouses, siblings and children, depending on the age of the individual. The second circle includes reliable friends. The third circle is comprised of acquaintances in the community, such as neighbors and work colleagues.
The fourth circle includes professionals who interact with the augmentative communicator, such as a speech-language pathologist or teacher. Finally, the fifth circle represents the universe of unfamiliar partners, which is identified in categories like wait staff and bus drivers.
"The paradigm represents the complexity of someone's social network," said Dr. Blackstone, a partner in the Rehabilitation Research and Engineering Center on Communication Enhancement (AAC-RERC). "Social networks and quality of life are very much related in that a high quality of life presupposes that you have extensive interactions within your social milieu. If you think of your own social circles, you would see that you have people across all the circles, and the circles are fairly balanced."
It's not unusual to see somebody with severe communication problems with many partners in the first and fourth circles but very few in the second, third and fifth circles, she noted, adding that this is the challenge.
1. Blackstone, S.W., Hunt Berg, M. (2002). Social networks: A communication inventory for individuals with complex communication needs and their communication partners.