Every individual has a fundamental right to communicate and access equal opportunities to fully participate in society. However, this right may not be fully manifested for individuals with communication access needs especially those from underrepresented groups. This project had two aims, to determine 1) the specific experiences, challenges, and aspirations related to the cultural identities of people of color (POC) who use augmentative and alternative communication (AAC) and 2) how AAC service providers and manufacturers can support POC AAC users in a culturally and linguistically responsive manner. We conducted an online, asynchronous focus group with seven participants over eight weeks. The participants' responses were coded qualitatively. Seven major themes were identified: AAC is a Culture, AAC System Features, Self-Identity as a Person of Color who uses AAC, Experience with Service Providers, Improvements to the Field of AAC, Racial Inequities in AAC Support, and Future Research. Suggestions are provided regarding how service providers and manufacturers can serve as better allies to support POC who use AAC.

A multiple-probe across participants design was used to examine whether three young children diagnosed with autism spectrum disorder (ASD) could learn to use verb symbols presented on an AAC application to request actions. Using researcher coaching (involving joint planning, descriptive instructions, and guided practice) parents of participants were taught to (a) embed opportunities for children to request actions in daily home routines, (b) model AAC responses, (c) use a prompt hierarchy with a time delay, and (d) contingently reinforce correct aided AAC responses. Following intervention delivered by parents, all three participants increased their use of verb symbols to request actions and parents implemented procedures with high fidelity. There were, however, individualized differences in rate of acquisition, variability of responding, readiness for fading supports, and moving to more advanced skills. One of the three participants was able to master two-step responses involving navigation to a category folder. Generalization of requesting actions to labeling actions was limited.

This paper explores the intricate relationship between people who use Augmentative and Alternative Communication (AAC) and their AAC devices. Drawing upon insights from phenomenology, I conducted a modified systematic review to explore the enduring phenomenon of low AAC device adoption and as a means to unravel the moments of embodiment and disembodiment experienced by people who use AAC with their devices. The discussion begins with an introduction to phenomenology as a philosophical inquiry and the guiding principles I employed to explore the phenomenon, namely, and object embodiment. Subsequently, I analyze the hegemony of a device-centric approach within the AAC landscape and delve into the first-person experiences of people who use AAC in living with their devices. Lastly, I discuss the embodiment and disembodiment of people who use AAC with their devices, conceptualize the interrelationship between them, and provide future directions for a more holistic and participatory AAC development and investigation that centers on the lived experiences of people who use AAC.

Appropriate vocabulary selection for augmentative and alternative communication (AAC) intervention is crucial to support communication and language development in children with intellectual and developmental disabilities (IDD). Core vocabulary lists are commonly used to guide this process, and there is a need for language-specific consideration. This paper aimed to develop a wordlist for selecting the core vocabulary for AAC intervention for young Hebrew-speaking children with IDD. Five children (age 3;5-8;4) were audio-recorded in naturalistic interactions with an interviewer and family members. Using Levy's clinical corpus in the Child Language Data Exchange System (CHILDES) and Child Phonology Analyzer (CPA) tools and preestablished codes, wordlists with usage frequencies were extracted and coded for lexeme, lexical categories and functions or content. The percentages of the 20, 50, 100, and 200 most frequent lexemes were calculated for each child and for the five children combined. The top 200 most frequently used lexemes constituted 85% of the composite lexicon. A comparison was made between this study list and a previous list derived from language samples of typically developing (TD). Lexemes representing function words dominated, albeit with a slight preference for content words in children with IDD. Among the content words, children with IDD used more adverbs, while children with TD used more verbs. Implications for AAC core vocabulary are discussed.

This exploratory interpretative qualitative study aimed to investigate environmental factors influencing "in the moment" decisions about use of graphic symbols or spelling in face-to-face communicative interactions, by adolescents who use communication aids and are learning how to spell. The participants were six adolescents who used speech generating devices and their mothers. Data collection consisted of seven to eight communicative interactions between adolescents and their mothers and follow up interviews with the participants. Each dyad took part in three Zoom sessions. Researchers identified the communication mode shifts between graphic symbols and spelling during interactions and subsequently discussed with participants the reasons for these shifts. The interview data were analyzed using Charmaz's constructivist grounded theory approach to coding. The analysis revealed three themes explaining environmental factors relevant to choosing spelling or graphic symbols in communicative interactions, which were: (a) features of the communication aid; (b) communication partner's skills and their knowledge of the shared experience; and (c) opportunities to practice and use spelling. The findings provide insights into the importance of providing opportunities to practice and use spelling, communication partner's skills and knowledge of shared experience and communication aid technology design which can help to facilitate spelling during communicative interactions.

Most research about augmentative and alternative communication (AAC) has focused on improving use of and access to speech generating devices (SGDs). However, many adults with significant physical and developmental disabilities express a preference for unaided, embodied forms of communication. This study used conversation analysis (CA) techniques to analyze the forms and functions of embodied communication that occurred during interactions between a young man who used unaided, embodied communication and an SGD to communicate with a familiar communication partner. Close analysis revealed that embodied resources were required for both unaided and aided forms of communication. Furthermore, both participants used their bodies to establish interactional spaces with different focal points during interaction, which placed different demands on the aided speaker. Unfortunately, when the SGD was the focal point, problematic demands were placed on the aided speaker, which in turn resulted in increased embodied effort on his part. The forms and functions of the body, differences in the participants' interactions when communication did and did not involve the SGD, and implications for research and practice are all reported and discussed.

Eye tracking research technologies are often used to study how individuals attend visually to different types of AAC displays (e.g. visual scene displays, grid displays). The assumption is that efficiency of visual search may relate to efficiency of motor selection necessary for communication via aided AAC; however, this assumption has not received direct empirical study. We examined the relation between speed of visual search and speed of motor selection of symbols. Ten individuals on the autism spectrum (AS; Study 1) and nine with Down syndrome (DS; Study 2) participated in a search task using simulated AAC displays with a main visual scene display (VSD) and a navigation bar of thumbnail VSDs. Participants were given an auditory prompt to find one of four thumbnail VSDs in the navigation bar. Eye tracking technologies measured how long it took participants to fixate visually on the thumbnail VSD, and recorded how long it took participants to select the thumbnail VSD with a finger. A statistically significant relationship emerged between visual fixation and selection latencies, confirming the positive relationship between visual processing and motor selection for both groups of participants. Eye tracking data may serve as a useful proxy measure for evaluating how display design influences selection of AAC symbols, especially when individuals are unwilling or unable to comply with traditional behaviorally-based assessment tasks.

Since effective and successful AAC service delivery relies on the knowledge and competence of professionals in the field of AAC, sufficient training in AAC will equip professionals to provide quality AAC service delivery. However, many professionals lack training in AAC and structured opportunities for professional development are sorely needed. As there is no consensus on the amount, mode of delivery and content of AAC training, the purpose of this scoping review was to identify AAC training programs for professional development and to describe the characteristics and effects of such programs. A five-pronged search strategy was used to identify relevant studies. The certainty framework was used to appraise the quality of included studies. Charted data included general study characteristics; participant characteristics; training characteristics (i.e., training goals; instructional materials and strategies; training duration); quality appraisal; and reported effects of the training. The scoping review identified 34 studies for inclusion. The results showed the potential of AAC training programs for continuous professional development to increase professionals' skills in AAC intervention. A range of training characteristics was identified to guide the development of future training programs. Gaps in the research related to the training of AAC professionals were also identified to guide future research.

Smart Predict is a novel two-tablet application developed to improve conversational efficiency for people who use augmentative and alternative communication (AAC) devices. The Smart Predict system consists of two distinct applications that were built for use with two Android tablets and/or phones with Bluetooth capability. One application is referred to as the AAC User app and the second application is called the Partner app. Smart Predict integrates vocabulary supplementation from communication partners in real-time while persons who rely on AAC generate text and maintain full control to choose words within a word prediction line. Using single-case research designs with adapted alternating treatments under two counterbalanced treatment conditions (AAC User app alone versus AAC User app + Partner app), we examined message efficiency with persons who rely on switch scanning for on-screen keyboards. User experience questionnaires were administered to determine satisfaction and workload, and to provide feedback for future development efforts. Three adults with complex communication needs and motor impairments conversed with research staff about fourteen movie trailers. Characters per minute and switch selections per character produced by the person with complex communication needs and motor impairments were measured during 15-minute interviews to represent communication speed and effort. Results indicate that message efficiency increased with the dual-tablet Smart Predict, indicating faster message generation with the vocabulary supplementation system. User satisfaction increased and perceived effort decreased under the Smart Predict conditions. Given these results within a research and development framework, the Smart Predict concept is a viable feature that could be considered within smart AAC technologies.

Sharing personal stories with others is essential to human interaction and language development. To communicate, individuals use a variety of semiotic resources, including images, symbols, and written and spoken language. These modes are deployed in the co-construction of a daily face-to-face conversation. A self-created film can serve as a valuable resource to facilitate a deeper understanding of a personal experience, especially where spoken or written language may present a challenge, for example, for people who rely on augmentative and alternative communication (AAC). Although the AAC literature indicates that using videos delivers benefits for aided communicators, guidelines on how to self-create, use, and transcribe them are rare. The present paper, a tutorial, describes how people who use AAC can develop a personal-video-scene (PVS) via the Film as Observable Communication (FaOC) method to utilize self-created films in sharing their stories. The first part of this paper, the theoretical framework, describes theories, methods, and practices from the fields of AAC, social semiotics, and visual anthropology, on which the FaOC method is based. The second part provides a step-by-step tutorial delivering practical guidance on how to create, use, and transcribe the PVS as a resource in conversations.

A socio-neurocognitive approach to augmentative and alternative communication (AAC) shows several underlying domains of communicative competence: Attention, perception, cognition, memory, orientation, socio-emotional development, motor skills, and language. To determine developmental markers of these underlying core domains of communicative competence in children with communication support needs, we developed a new screening instrument. The present article consists of three consecutive studies. In study 1, we constructed the first version of the screening instrument based on a sample of both children without disabilities and children with Down syndrome. In study 2, we confirmed the reliability (i.e., internal consistency) of the screening instrument in a new group of young children with typical development and established concurrent validity with the Early Language Scale. In study 3, we established concurrent validity with the Communication Matrix in a clinical sample of children with communication support needs. The screening instrument can be used in clinical practice as part of AAC assessment to provide comprehensive insights into strengths and weaknesses in the underlying core domains of communicative competence of children with communication support needs.

The selection of high-tech AAC for children diagnosed with autism spectrum disorder can be a challenging process due to the vast array of options available. One of the decisions that clinicians need to make involves how vocabulary will be organized on the display. This study aimed to compare a visual scene display (VSD) with a grid display using a multiple-probe design across participants with an embedded adapted alternating treatment design. Four young children with autism spectrum disorder who were beginning communicators were recruited and taught to request preferred items using two display formats: VSD and grid layout on a mainstream tablet with an AAC app. Two of the participants achieved criterion with both displays, the other two participants failed to achieve criterion in either display. For all participants, progress was similar in both displays. The results are discussed through the lens of each participant's characteristics with suggestions for clinical decision-making.

It is well-known that children with expressive communication difficulties have the right to communicate, but they should also have the right to do so in whichever language they choose, with a voice that closely matches their age, gender, and dialect. This study aimed to develop naturalistic synthetic child speech, matching the vocal identity of three children with expressive communication difficulties, using Tacotron 2, for three under-resourced South African languages, namely South African English (SAE), Afrikaans, and isiXhosa. Due to the scarcity of child speech corpora, 2 hours of child speech data per child was collected from three 11- to 12-year-old children. Two adult models were used to "warm start" the child speech synthesis. To determine the naturalness of the synthetic voices, 124 listeners participated in a mean opinion score survey (Likert Score) and optionally gave qualitative feedback. Despite limited training data used in this study, we successfully developed a synthesized child voice of adequate quality in each language. This study highlights that with recent technological advancements, it is possible to develop synthetic child speech that matches the vocal identity of a child with expressive communication difficulties in different under-resourced languages.

This qualitative study aimed to describe speech-language pathologists' (SLPs') perspectives on augmentative and alternative communication (AAC) use for people with post-stroke aphasia focusing on: (a) current AAC practice, (b) factors that influence the use of AAC, and (c) the success and relevance of AAC interventions. Semi-structured interviews took place with ten South African SLPs with experience in aphasia intervention. The transcribed interviews were thematically analyzed using a six-phase process of inductive and deductive analysis within a phenomenological framework. All the participants use AAC with their clients, employing a variety of approaches that reflect their diverse settings, experiences, and perspectives on AAC. AAC use is complex, and SLPs make conscious choices considering multiple factors. Barriers to use were often associated with limited resources in the low- and middle-income country (LMIC) context, but most participants retained a positive view of AAC, actively working to circumvent barriers to use. Participants consistently emphasized the vital role of partners in communication interactions, linked to the importance of defining AAC broadly. It is necessary to advance the integration of AAC into rehabilitation plans to improve communication and social participation outcomes for people with post-stroke aphasia, especially in LMICs such as South Africa.

Key word signing (KWS) is an unaided form of augmentative and alternative communication (AAC) and is frequently used by children with cognitive impairments and their families. Successful implementation of KWS requires a family environment that provides aided language input by modeling the signs. However, families face challenges implementing the signs in their everyday lives. KWS requires effort and sustained parental commitment. Users may also struggle with finding good learning resources and stimulating and enjoyable shared contexts for communication. Signed videos of popular children's books may help to implement KWS and create a signing environment which exposes children and their families to KWS in meaningful ways. The aim of this study was to create videos of this type and investigate whether and how they might serve as an attractive medium of support for families' KWS experience. Three families tested the videos. A triangulated qualitative study incorporating interviews and participant observation explored the families' experience of using these videos as a context for shared communication. The findings suggest that picture book videos supplemented by KWS may be appropriate resources for the use of KWS in everyday family life. They serve as a child-centered activity involving KWS exposure, in which children and their families can participate joyfully and naturally.

Communication accessibility has been defined by many scholars and organizations, but it is generally described as clear communication that everyone can access and understand. The objective of this manuscript was to assess communication accessibility for people who use augmentative and alternative communication (AAC) within a variety of restaurant settings through interviewing five adults who utilize AAC as their primary form of communication. Interviews were qualitatively coded and revealed common communication accessibility themes restaurants and restaurant staff were not implementing, such as direct communication and increasing AAC awareness. The implications of the interview data include its potential usage in training restaurant staff and management to utilize communication accessibility tips and features to increase the communication accessibility of the restaurant patrons they serve, especially for individuals who use AAC. This could then lead researchers in creating a formal training schema for restaurants to implement into their businesses reliably and effectively.

The aim of this interpretive qualitative study was to explore how environmental factors influence the transition from relying solely on graphic symbols to using spelling in face-to-face communicative interactions, from the perspective of literate adults with speech and motor impairments who use augmentative and alternative communication (AAC). Fourteen adults either chose to submit a written story with weekly email follow-up, took part in interviews conducted via Zoom, or chose to communicate solely by email. Researchers analyzed data using Charmaz's (2014) constructivist grounded theory approach. The analysis yielded three themes explaining environmental factors relevant to the transition from using graphic symbols to spelling in communication: (a) access to AAC systems and services; b) knowledgeable and supportive communication partners who have high expectations; and (c) opportunities to learn reading, writing, and spelling. Supportive factors included providing sufficient time for spelling in communicative interactions, structured learning opportunities for practice and independence, opportunities to learn through socially meaningful interactions and having print-rich and language-rich activity settings. Slow speed in navigating graphic symbols and lack of ability to express an exact message were motivational reasons for participants to use spelling in communicative interactions. The interaction among environmental factors and person-related characteristics warrants further investigation.

The purpose of this study was to investigate the perceived symbol referent relationship for selected symbols in typical adults for two different symbol sets: Indian Picture Symbols for Communication (IPSC) and Picture Communication Symbols (PCS) to identify cultural influences on symbol recognition. A total of 240 typical adults, including 120 nonprofessionals, and 120 health professionals, from Kerala, a southern state in India, participated in the study. A guessability task involving IPSC and PCS symbols for 30 target referents was utilized. Guessability scores for each participant as well as each symbol stimuli across two symbol sets were determined. The guessability scores for IPSC were significantly ( <.001) higher than PCS. For both symbol sets, nouns were the most accurately guessed, followed by verbs, adjectives, and prepositions. The results also revealed that prompting and previous exposure to symbols tend to influence the transparency of symbols. Error analyses revealed that visual and conceptual cues within a symbol tend to influence guessability. The results indicate that cultural and linguistic factors play a role in symbol guessability. The study highlights the importance of investigating the iconicity of IPSC and PCS symbols across different populations within India, before using symbols for educational/clinical purposes.

The relationships between the use of nouns and verbs, and other word classes have been well established in the typical language development literature. However, questions remain as to whether the same relationships are seen in the language use of individuals who use graphic symbol-based augmentative and alternative communication (AAC). The aim of the study was to examine relationships between the use of verbs and nouns, and the use of prepositions, adverbs, and adjectives through a secondary analysis of language transcripts taken from 12 children and adolescents who used aided AAC in conversation with an adult. A series of multiple linear mixed-effect regression analyses showed a positive predictive association between the use of verbs and the use of prepositions and adverbs, as well as a positive predictive relationship between the use of nouns and the use of adjectives. The theoretical and practical implications of these findings are discussed.

The current study explored both the extent to which representation of augmentative and alternative communication (AAC) exists in young adult literature, as well as qualitative characteristics of that representation. A systematic search of multiple databases was conducted using standardized keywords and inclusion criteria. Descriptive statistics and literary content analysis were employed in order to analyze quantitative and qualitative information about each of the 32 novels that fit inclusion criteria. Results indicated that, while representation of AAC in young adult fiction largely aligned with existing statistics regarding types of AAC devices used, stories often differed from current information about the most common etiologies of AAC users. Analyses of character development revealed most featured AAC-using characters were multidimensional and expressed positive attitudes regarding their devices, although some characters also expressed frustration. These results indicated that representation of AAC in young adult literature was sparse. However, the representation that did exist at least partially reflected reality and may represent a positive portrayal of AAC use and users.

The selection of appropriate vocabulary is a crucial and challenging aspect of augmentative and alternative communication (AAC) intervention. Core vocabulary lists are frequently used to support vocabulary selection for children who require AAC. A vocabulary domain that has garnered limited attention within the AAC literature is relational basic concepts (RBCs). RBCs describe relationships between objects, persons, or situations, and play a pivotal role in language development, communication, and academic success. For the present study, we created a list of 156 RBCs, drawing primarily from assessments that measure basic concept knowledge in preschool and early elementary school students. We examined the overlap of these words on nine core vocabulary lists. We found that most concepts were not represented on any core lists. Additionally, there was relatively little overlap of RBCs between the core lists. These findings suggest that vocabulary selection resources created using exclusively a core vocabulary approach may have limited utility for identifying many concepts that preschool and early elementary students are expected to know and use. Implications for AAC research and practice are discussed with emphasis on the need for further consideration of RBCs within vocabulary selection practice and the field of AAC at large.