AAC Implementation & Communication Partner Strategies
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Four Competencies, One Goal
Light's model of communicative competence for people who use AAC names four skill areas that intervention must build together. Psychosocial factors such as motivation, confidence, and resilience, plus environmental supports and barriers, influence all four (Light and McNaughton, 2014). ASHA's Practice Portal lists psychosocial competence as a fifth competency, so an exam item may name five.
| Competence | What it covers | Example goal area |
|---|---|---|
| Linguistic | Vocabulary, grammar, and the symbol system; the home and community languages for multilingual users | Combining two symbols to comment |
| Operational | Powering on, navigating pages, adjusting volume, charging, clearing the message bar | Navigating to a second-level page |
| Social | Initiating, taking turns, maintaining topic, using many functions | Greeting a peer without a prompt |
| Strategic | Compensating for system limits: "I am still typing," a shortcut, asking a partner to wait | Using a stored phrase to hold a turn |
Aided Language Input
AAC users rarely see anyone else use their system. Aided language input (aided language stimulation, modeling) closes this gap: the partner points to or activates symbols on the user's system while speaking naturally.
- Model without expecting an immediate response; the goal is comprehensible input.
- Model one to two symbols beyond the user's current message length.
- Model many functions in real routines on the user's own system: comment, protest, ask, direct, joke.
- Accept every mode the user produces and respond to the meaning.
High-Yield: Aided language input is an evidence-based AAC implementation strategy, with gains in comprehension and expression across ages, disabilities, and language levels. Expect months of modeling before independent generative use, the same way a toddler listens for a year before talking.
Core Vocabulary and Consistent Motor Plans
Core words (roughly 200 to 400 high-frequency words such as go, more, stop, that, not, want, and different) make up about 80 percent of what anyone says. Fringe words are context specific. A robust system keeps core words on every page in the same location so the motor plan becomes automatic, and adds fringe by activity. Descriptive teaching (Van Tatenhove) lets a student answer curriculum questions with core words ("it is hot and wet") instead of needing every content noun preprogrammed.
Prompting Hierarchies and Wait Time
Prompt only as much as needed, and fade. Least-to-most prompting suits a partial skill. Most-to-least prompting starts with the most supportive prompt the client needs to succeed (for example, a full model or simultaneous production) and fades to less support as accuracy holds. It suits a brand-new motor plan and produces fewer errors, though learning can be slower.
| Level | Partner behavior |
|---|---|
| Environmental arrangement | Motivating item in view but out of reach; a reason to communicate |
| Expectant pause (time delay) | Look expectantly and wait at least 5 to 10 seconds, longer for motor or processing needs |
| Aided model | Show the symbol on the device while saying the word |
| Gestural cue | Point toward the location without activating it |
| Partial physical | Guide the elbow or wrist, hand-under-hand so the user leads |
| Full physical | Use sparingly and fade quickly (a planned exception is the physical prompter in PECS Phase 1); overuse risks prompt dependence and learned passivity |
Count spontaneous versus prompted productions. A goal met only "with hand-over-hand assistance" has not been met.
Beyond Requesting
Requesting is motivating and easy to elicit, but a person who can only request cannot refuse, comment, or build relationships. Plan explicit opportunities for protest ("no," "stop," "different"), commenting ("look," "funny," "yuck"), asking, directing others, sharing news, and social closeness.
High-Yield: An AAC user who says "no" or "all done" and is not honored learns that the system does not work. Refusal is communication and must be respected within safety limits.
Partner Training
Partners change faster than users when taught explicitly. Kent-Walsh and McNaughton's (2005) eight-step instructional model runs: (1) pretest and commitment, (2) strategy description, (3) strategy demonstration, (4) verbal practice of the strategy steps, (5) controlled practice and feedback, (6) advanced practice and feedback, (7) posttest and commitment to long-term use, and (8) generalization. The ImPAACT program applies it to strategies such as modeling, expectant pauses, and open-ended questions.
Implementation Across Populations
| Population | Considerations |
|---|---|
| Aphasia | Multimodal from the start: visual scene displays with personal photographs, communication books, written choice, and partner training (Supported Conversation for Adults with Aphasia); generative high-tech systems add load many cannot sustain |
| ALS | Introduce early while speech is functional; message banking and voice banking preserve the person's voice; plan progression from touch to eye gaze or partner-assisted scanning; keep a low-tech backup |
| Cerebral palsy | Positioning and seating first with OT and PT; the most reliable, least fatiguing access site; never limit vocabulary because access is slow |
| Autism | Robust core-based systems with aided modeling in routines; PECS is one starting option, not the endpoint; do not require eye contact or sitting before access |
| Pediatric feeding and medical settings | Children who are NPO, tube fed, tracheostomized, or in feeding therapy need words for pain, "more," "stop," "all done," and choices; honoring refusal builds trust; intubated adults need low-tech boards |
Abandonment Risk Factors
Device abandonment is common and rarely the user's fault. Watch for a slow or fatiguing access method, no trained partners so the user is spoken for, vocabulary that is too limited or reorganized so often that motor plans never form, no follow-up after delivery, long repair times with no backup, family values left out of selection, and stigma. Reassess when use drops; the fix is usually a partner or vocabulary change, not a new device.
Common Traps
- Trap: Wait for the child to point to symbols before modeling. Better: Model first, for months if needed, without requiring a response.
- Trap: Reward requests and add other functions later. Better: Build protest, comment, and social functions from the start.
- Trap: Full physical prompts get faster results. Better: Overused or unfaded, they produce prompt dependence; lead with expectant pauses and aided models.
- Trap: The device was delivered, so implementation is complete. Better: Implementation begins at delivery and needs scheduled follow-up.
Sources to Know
- ASHA Practice Portal: Augmentative and Alternative Communication
- Beukelman and Light, Augmentative and Alternative Communication (5th ed., 2020)
Key terms 8
- Aided language input
- Partner points to or activates symbols on the user's own AAC system while speaking naturally, providing input in the AAC modality without demanding a response
- Communicative competence (Light)
- Integration of linguistic, operational, social, and strategic competencies, shaped by psychosocial factors such as motivation and confidence
- Strategic competence
- Compensatory skills for system limits, such as signaling that a message is still being composed or asking a partner to wait
- Expectant pause (time delay)
- Waiting with an expectant look for at least 5 to 10 seconds to give the AAC user time to initiate before any prompt is added
- Prompt dependence
- Reliance on partner prompts, especially physical prompts, so communication occurs only when cued; avoided by least-to-most hierarchies and fading
- Descriptive teaching
- Van Tatenhove's approach of answering curriculum questions with core words that describe, rather than preprogramming every content noun
- Message banking
- Recording a person's own phrases in their own voice before speech declines, as in ALS, for later playback from a device
- Device abandonment
- Discontinued use of an AAC system, most often tied to poor feature match, untrained partners, limited vocabulary, or lack of follow-up
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