Exploring the Role of Part-Time AAC Users: Bridging Gaps in

Closing The Gap Solutions e-Magazine, Dec 2024 / Janurary 2025 Volume 43 - Number 5 Exploring the Role of Part-Time AAC Users: Bridging Gaps in Communication

Exploring the Role of Part-Time AAC Users: Bridging Gaps in Communication alternative augmentative communication (AAC) Summary: The article "Exploring the Role of Part-Time AAC Users: Bridging Gaps in Communication" will examine the challenges and benefits faced by part-time AAC users. It will begin by sharing an example of a part-time AAC user and explore reasons to con- sider part-time AAC. The article will address barriers to AAC access, ableism in implementation, and strategies for supporting users, concluding with advocacy efforts to ensure accessibility for those who would benefit from part-time AAC use.

When Major was 3 years old, he received his first speech-gen- erating device. His parents took him to speech therapy because his speech was highly unintelligible. After beginning traditional therapy techniques, his speech therapist didn’t want to delay his language development any further and recommended an aug- mentative and alternative communication (AAC) device. At first, Major’s parents weren’t thrilled about the device. They wanted him to communicate with spoken language. Over time, they learned more and accepted the device as an alternate means for Major to communicate. However, by the time he was 9 years old, Major no longer wanted to use the device. He was

frustrated when others couldn’t understand his speech, but he still wanted to communicate with that modality. His parents sent him to a week of AAC camp to see if being around peer models might help him appreciate his device. After the first day of camp, Major came home to his parents and said, “I found my people!” He was thrilled to be around so many other AAC users. Major loved to show off his device, which had been programmed with phrases from a game he played, casting spells on his friends with words from the device. Al- though Major communicates with spoken language part of the time, he needs his AAC device to be able to interact with others,

CICI FRITTS, M.S., CCC-SLP, started her career in education as a Speech-Language Pathologist working in schools with children aged 3 to 21. She brought her love for technology and passion for complex commu- nication disorders to her role as an Assistive Technology Facilitator for Leander ISD in Leander, TX. Cici trains parents, teachers, and students across the country and is passionate about collaboration for all elements of Assistive Technology. She also is an adjunct instructor for a graduate AAC course for the University of St. Augustine for Health Sciences. Cici is always looking for ways to learn more about literacy, digital accessibility, teamwork, and AAC implementation. Cici is a licensed Speech-Language Pathologist in the state of Texas and ASHA certified. CANDACE HAYDEN, M.A., CCC-SLP, is a Clinical Assistant Professor for the Department of Speech, Language, and Hearing Sciences at the University of Texas at Austin. Candace specializes in AAC for complex communicators and related topics including supporting literacy, neurodiversity, assistive technology and acces- sibility, and caregiver coaching. She has presented on these topics at professional development and confer- ences at the local, state, and national level. With a special interest in innovation, she pursues technology-based solutions including efficiency tools and 3d printed assistive technology. Candace is a licensed Speech-Lan - guage Pathologist in the state of Texas and ASHA certified.

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especially when using some of his favorite, decontextualized language. Major represents a more traditional view of part-time of AAC use held by many speech therapists, serving individuals with severe articulation or phonological impairments. More recently, there has been a growing voice coming from Autistic individuals who also see a benefit of part-time AAC use for times of dysreg- ulation when their speech is not accessible. There is a growing recognition of the needs of part-time AAC users—individuals who may speak but find AAC beneficial or necessary in certain situations. Understanding and supporting these users requires a nuanced approach, considering their unique challenges and the educational strategies that can en- hance their communication. WHO ARE PART-TIME AAC USERS? Part-time AAC users might be able to speak clearly in certain environments or situations but struggle significantly in other conditions due to factors such as stress, sensory overload, fa- tigue, or the complexity of the conversation. In particular, Au- tistic adult researchers have described spoken language as sit- uationally insufficient, meaning the communicator is not able to express everything they wish to. Speech may be intermittent, meaning that the communicator can speak, but not always, depending on the topic or environment. Individuals have de- scribed their speech as unreliable, or find themselves expressing a message that does not convey their true intent (Zisk & Dalton, 2019). THE COMPLEXITY OF COMMUNICATION NEEDS The communication needs of part-time AAC users are com- plex and varied. Unlike full-time AAC users who rely on their devices for all communication, part-time users may switch be- tween verbal speech and AAC depending on the situation. This switching is not always straightforward and can depend on nu- merous factors such as the user's emotional state, physical con- dition, the environment, or the nature of the conversation. For instance, sensory overload is a common trigger that can make verbal communication difficult or impossible for some individuals. In noisy or chaotic environments, a person might find that their ability to speak becomes unreliable, and they may need to rely on AAC to communicate effectively. Similarly, during times of extreme stress or fatigue, speech may become less accessible, requiring the individual to turn to their AAC de- vice. Moreover, there are individuals whose communication needs vary depending on the topic of conversation. For example, a person might be able to speak fluently about everyday topics but struggle with more complex or abstract discussions. In such cases, AAC can provide the support needed to express thoughts and ideas that might be difficult to articulate verbally.

The variability in communication needs poses a unique chal- lenge for educators and speech-language pathologists (SLPs) working with part-time AAC users. It requires a deep under- standing of each individual's triggers and communication pat- terns, as well as a flexible approach to AAC implementation. This also means that the AAC system must be highly customized and responsive to the user’s immediate needs, providing seamless transitions between verbal speech and AAC use. BARRIERS TO AAC ACCESS FOR PART-TIME USERS One of the significant barriers to AAC access for part-time us- ers is the prevailing belief that those who can speak do not need AAC. This misconception can lead to delays in providing neces- sary support, leaving individuals without the tools they need to communicate effectively in all situations. Additionally, there is often resistance from various stakeholders—parents, educators, and even AAC users themselves—may prioritize verbal speech over AAC, viewing the latter as a last resort rather than a com- plementary tool. This barrier is often rooted in deep-seated beliefs about com- munication and disability. For many, the ability to speak is seen as the ultimate goal of communication therapy, and the use of AAC is sometimes viewed as an admission of failure in achieving that goal. This perspective can lead to a "wait and see" approach, where AAC is withheld in the hope that speech will improve suf- ficiently to make it unnecessary. However, this approach can be detrimental to part-time AAC users, who might be left without the support they need during critical moments when speech fails them. Moreover, integrating AAC into general education environ- ments presents another significant barrier. Students may feel self-conscious about using AAC devices, fearing that it sets them apart from their peers. This concern is compounded by the dif- ficulty in motivating both students and educators to fully em- brace AAC as part of the communication repertoire, especially when verbal speech is still possible. The challenge is not only technical—ensuring that the devices are available and function- ing—but also cultural, requiring a shift in how communication is perceived and valued within the educational setting. Another barrier is the lack of awareness and understanding among educators and professionals. Many teachers and even some SLPs may not be fully aware of the benefits of AAC for part- time users or may not know how to effectively implement these tools in a classroom setting. This can lead to missed opportuni- ties for support and intervention, leaving part-time AAC users without the resources they need to succeed. THE ROLE OF ABLEISM IN AAC IMPLEMENTATION The reluctance to provide AAC to part-time users is often in- tertwined with ableism, discrimination, or prejudice against in- dividuals with disabilities. Ableism can manifest in the assump- tion that verbal speech is inherently superior to other forms of

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communication. This belief can lead to the marginalization of AAC as a less desirable option, even when it could significantly improve an individual's quality of life. For part-time AAC users, this ableism can be particularly harmful. It may lead to a situation where their need for AAC is dismissed or downplayed, especially if they can speak reason- ably well most of the time. This can result in these individuals being forced to rely on speech in situations where it is not ef- fective, leading to frustration, communication breakdowns, and social isolation. Ableism can also be seen in the attitudes of some educators and professionals who may prioritize speech over AAC, even when it is clear that AAC would benefit the user (Donaldson, et al., 2019). This can create a situation where part-time AAC users are not allowed to fully explore and utilize AAC, limiting their ability to communicate effectively in all situations Challenging these ableist assumptions is crucial in ensuring that part-time AAC users receive the support they need. This involves recognizing that all forms of communication are valid and that the ultimate goal should be successful communication, not necessarily speech. It also requires a broader societal shift in how we view disability and communication, moving away from a deficit model that focuses on what individuals cannot do, to- wards an inclusive model that values all forms of expression. EDUCATIONAL STRATEGIES FOR SUPPORTING PART- TIME AAC USERS To support part-time AAC users, it is essential to develop strategies that address their unique needs. These strategies should begin with a thorough evaluation process that involves the potential AAC user, their family, educators, and SLPs. The evaluation should identify communication breakdowns and de- termine when and where AAC is most beneficial. This collabo- rative approach ensures that the AAC system is tailored to the individual's needs and that all stakeholders are on board. A key component of this evaluation involves referring to the Communication Bill of Rights (Brady et. al, 2016). Any rights that the individual does not have access to should be identified as an area of need. SLPs should continue to support communicators to consider AAC whether they need support to “request desired objects, actions, events, and people,” or if they demonstrate dif- ficulty with “clear, meaningful, and culturally and linguistically appropriate communications. ” Both are rights. Neither should be weighted over the other as a means to provide AAC or not provide AAC. If someone can ask for chips, but can not com- municate with the world around them for pleasure, education, or business then SLPs and educators should support the speak- er for possible AAC use. A recent study showed it is possible to have insurance fund an AAC device for a part-time AAC user based on their need to access those rights (Koerner, et al., 2023).

Stakeholders must identify the specific contexts in which AAC is most needed. For instance, some users may find that their need for AAC is situational, such as in noisy environments or during times of stress. Others may require AAC primarily for certain types of communication, such as discussing complex or abstract topics. By identifying these specific needs, educators and SLPs can design an AAC system that is both effective and unobtrusive, allowing the user to switch between speech and AAC as seamlessly as possible. Incorporating AAC into daily activities across all environ- ments is crucial for reducing stigma and promoting acceptance. Light-tech AAC options and text-to-speech tools should be made available to all students, not just those who are not speak- ing. By normalizing the use of AAC in various settings, educators can create an inclusive environment that supports all communi- cators. This can be achieved by integrating AAC into classroom activities, encouraging all students to use AAC devices or apps during certain lessons, and modeling AAC use as a natural part of communication. Furthermore, modeling AAC use is a vital part of the imple- mentation process. Educators, parents, and peers should be trained to model AAC in a variety of contexts, demonstrating how it can be used effectively alongside verbal speech. This modeling should be done in a way that is responsive to the user's needs, particularly when they are feeling regulated and receptive. For example, during a classroom discussion, a teach- er might model how to use an AAC device to ask a question or make a comment, showing students that AAC is a valid and valu- able tool for communication. THE IMPORTANCE OF FAMILY BUY-IN AND CONTINUOUS SUPPORT Family buy-in is critical to the success of AAC implementa- tion for part-time users. Educators and SLPs must work closely with families to address any concerns and to provide ongoing support as the AAC system is integrated into the user's life. This support includes teaching literacy and spelling skills, offering opportunities for interaction with other AAC users, and ensur- ing that the AAC system is personalized with vocabulary that is meaningful to the user. One of the challenges in achieving family buy-in is address- ing concerns about the impact of AAC on speech development. Many parents worry that introducing AAC might discourage their child from speaking or lead to a reliance on the device. However, research has consistently shown that AAC does not impede speech development; in fact, it can often support and enhance verbal communication by reducing the pressure to speak and providing a means of communication when speech is difficult or impossible. In addition, advocates for AAC can con- tinue to ensure that all modes of communication are honored and oral speech is not valued above communication with AAC.

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ADVOCACY AND POLICY: SUPPORTING PART-TIME AAC USERS Advocacy plays a critical role in ensuring that part-time AAC users receive the support they need. This advocacy can take many forms, from raising awareness about the importance of AAC in the general population to pushing for policy changes that make AAC more accessible and affordable. At the individual level, advocacy often involves educating families, educators, and healthcare providers about the benefits of AAC and dispelling common myths and misconceptions. For instance, advocates might work to challenge the belief that AAC is only for non-speaking individuals or that it hinders speech development. They may also provide resources and training to help families and educators feel more comfortable with AAC and understand how to use it effectively. At the policy level, advocacy efforts might focus on increas- ing funding for AAC devices and services, ensuring that all indi- viduals who could benefit from AAC have access to it. This could involve lobbying for changes to insurance policies, government programs, and educational mandates to make AAC more widely available and affordable. Additionally, advocates might work to ensure that AAC is included in broader disability rights legisla- tion, recognizing it as a fundamental tool for communication and inclusion. Another important area of advocacy is the promotion of re- search on AAC, particularly for part-time users. While there is a growing body of research on AAC, much of it has focused on full-time users, with less attention given to the unique needs and experiences of part-time AAC users. By advocating for more research in this area, we can develop a deeper understanding of how to best support these individuals and ensure that they have access to the tools and resources they need to communi- cate effectively. Advocacy can also take the form of professional develop- ment and training for educators, SLPs, and other professionals who work with part-time AAC users. By providing training on the latest AAC technologies, best practices, and strategies for sup- porting part-time users, we can ensure that these professionals are well-equipped to meet the needs of this population. MOVING TOWARD A MORE INCLUSIVE FUTURE Part-time AAC users represent a unique group within the AAC community, one that requires thoughtful consideration and tai- lored support. By overcoming barriers, implementing effective educational strategies, and fostering family and community buy- in, we can close the communication gap for these individuals, ensuring they have access to the tools they need to thrive in all aspects of their lives. As the field of AAC continues to evolve, we must expand our understanding and support of these part-time users, recognizing that successful communication is about more than just speech—it's about ensuring everyone has a voice.

Continuous support is also essential in ensuring the long- term success of AAC use. This includes regular check-ins with the AAC user and their family to assess how the system is working and make any necessary adjustments. As the user's needs evolve, the AAC system should be updated to reflect these changes, en- suring that it remains a relevant and effective tool. Additionally, providing ongoing training and resources for families can help them feel more confident and capable in supporting their loved one’s AAC use. Another important aspect of family support is involving them in the customization and updating of the AAC system. Families can provide valuable insights into the vocabulary and phrases that are most relevant to the user's daily life, ensuring that the AAC system remains practical and useful. By involving families in this process, educators and SLPs can help build a sense of own- ership and investment in the AAC system, increasing the likeli- hood of successful long-term use. EXPANDING THE ROLE OF TECHNOLOGY IN AAC Technology plays a crucial role in AAC, and recent advance- ments have made AAC devices more accessible and versatile than ever before. With the rise of smartphones, tablets, and oth- er portable devices like smartwatches, AAC is no longer limit- ed to specialized equipment; it can be integrated into everyday technology that users are already familiar. This has significant implications for part-time AAC users, who may benefit from hav- ing AAC tools readily available on their personal devices. One of the key advantages of modern AAC technology is its flexibility. Many AAC apps allow for extensive customization, en- abling users to create a system that reflects their unique com- munication needs. For instance, a part-time AAC user might configure their device to include specific phrases or vocabulary that they find difficult to articulate verbally, or they might set up different profiles for different environments, such as school, home, or social settings. Another promising development in AAC technology is the integration of artificial intelligence (AI) and machine learning. These technologies can enhance AAC systems by predicting the user's needs and suggesting relevant vocabulary or phras- es based on the context. For example, if an AAC user frequently uses certain phrases during mealtime, the device might auto- matically suggest these phrases when it detects that the user is at the dinner table. This kind of smart technology can make AAC use more intuitive and efficient, particularly for part-time users who need to switch between speech and AAC quickly and seamlessly. The integration of AAC with other assistive technologies, such as environmental control systems or smart home devices, can further enhance the independence and quality of life for AAC users. For instance, a part-time AAC user might use their device to control lights, appliances, or security systems in their home, making it easier to manage daily tasks and communicate needs without relying on verbal speech.

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REFERENCES Brady, N. C., Bruce, S., Goldman, A., Erickson, K., Mineo, B., Ogle- tree, B. T., Paul, D., Romski, M., Sevcik, R., Siegel, E., Schoonover, J., Snell, M., Sylvester, L., & Wilkinson, K. (2016). Communication services and supports for individuals with severe disabilities: Guidance for assessment and intervention. American Journal on Intellectual and Developmental Disabilities, 121 (2), 121–138. Donaldson, A., endever*, c.., & McCoy, J. (2021). "'Everyone De- serves AAC;: Preliminary Study of the Experiences of Speaking Autistic Adults Who Use Augmentative and Alternative Commu- nication" Perspectives of the ASHA Special Interest Groups. Vol. 6. 315-326. https://doi.org/10.1044/2021_PERSP-20-00220 Koerner, S., Glaser, S., & Kropkowski, K. (2023). Perspectives of Part-Time Augmentative and Alternative Communication Use in Adults and Implications for Pediatric Service Delivery. Per- spectives of the ASHA Special Interest Groups. Vol. 8, 747-760. https://doi.org/10.1044/2023_PERSP-22-00200 Zisk, A.H. & Dalton, E. (2019). Augmentative and alternative com- munication for speaking autistic adults: Overview and recom- mendations. Autism in Adulthood (1) 93-100. https://doi.org/10.1089/aut.2018.0007

In moving toward a more inclusive future, it is essential to challenge ableist assumptions and prioritize the communica- tion needs of all individuals, regardless of how they communi- cate. By embracing a more flexible, responsive approach to AAC, we can empower part-time users to communicate more effec- tively, build stronger social connections, and participate fully in their communities. This requires a commitment to ongoing research, advocacy, and education, as well as a willingness to listen to the voices of part-time AAC users themselves. Only by working together can we create a world where everyone has the opportunity to express themselves fully and be heard. CALL TO ACTION: SUPPORTING PART-TIME AAC USERS What can you do to support part-time AAC users in your com- munity? Here are a few steps you can take: 1. Educate Yourself and Others: Learn more about AAC and the needs of part-time users. Share this knowledge with others in your community, including educators, healthcare providers, and policymakers. 2. Advocate for Change: Support policies and initiatives that make AAC more accessible and affordable. This might include lobbying for insurance coverage, funding for AAC devices and services, and the inclusion of AAC in disability rights legislation. 3. Support Research: Encourage and support research on part-time AAC use, particularly studies that explore the unique needs and experiences of this population. This re- search is essential for developing evidence-based practices that can improve outcomes for part-time users. 4. Listen to AAC Users: The most important voices in the conversation about AAC are those of the users themselves. Listen to their experiences, challenges, and successes, and use this information to guide your advocacy and support efforts. By taking these steps, you can help ensure that part-time AAC users have the tools and support they need to communicate ef- fectively, build meaningful relationships, and participate fully in their communities.

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