Feb/March Closing The Gap Resource Directory 2025 Volume 43 - #6
augmentative and alternative communication (AAC)
Preventing AAC Device Abandonment in Adults with Developmental Disabilities Summary: Discover strategies to prevent AAC device abandonment in adults with developmental disabilities. This article will address common challenges like inadequate training and poor device fit, exploring their impact on communication and daily partici- pation. Readers will learn practical solutions, including personalized assessments, customized training, device personaliza- tion, and community integration. Backed by evidence-based insights and realworld examples, the article will empower assis-
Augmentative and Alternative Communication (AAC) devices play a crucial role in supporting adults with developmental disabilities by providing a reliable means of communication. These devices empower users to express their needs, engage in social interactions, and fully participate in their communities. Despite their potential, many AAC devices are discontinued due to various challenges. Factors such as mismatched devices, inadequate training, and systemic barriers often contribute to this ongoing issue. Addressing this issue requires a comprehensive, person- centered approach focusing on the user’s communication needs and their support network. Evidence-based practices in AAC emphasize the critical role of person-centered planning in supporting adults with developmental disabilities. Person- centered planning ensures that interventions align with indi- vidual needs, preferences, and goals rather than imposing generalized solutions. This approach integrates the user’s voice into every process stage, from device selection to training and community integration. By emphasizing personal agency and collaboration with caregivers, professionals, and the broader support network, person-centered planning enhances the usability of AAC devices and fosters meaningful participation in daily life. Research consistently demonstrates that tailoring AAC interventions to reflect individual priorities leads to better
communication outcomes, greater device retention, and improved quality of life. This article explores the common barriers to AAC device retention, outlines evidence-based strategies for preventing abandonment, and provides actionable insights for assistive technology professionals and paraprofessionals. UNDERSTANDING DEVICE ABANDONMENT Device abandonment occurs when users discontinue using their AAC assistive technology due to personal, systemic, or environmental factors. Understanding these barriers is the first step in addressing the problem. AAC device abandonment is often linked to issues like inad- equate system maintenance, negative attitudes, insufficient training, lack of support, poor device fit, and environmental or social barriers. Devices that are not regularly updated to align with the user’s changing needs can become irrelevant, resulting in disuse. Negative attitudes or misconceptions from caregivers, professionals, or the broader community—such as believing natural speech is the only valid form of commu- nication—further discourage AAC use. Moreover, insufficient training for users and support networks leads to improper use, frustration, and eventual abandonment. Environments that fail to support AAC use consistently across settings, combined
CELESTE R. HELLING, M.A., CCC-SLP, ATP is a speech-language pathologist specializing in augmentative communication and assistive technology service delivery for children and adults with developmental and acquired disabilities. Her background includes assistive technology service delivery for children and adults with developmental and acquired disabilities. Celeste is employed by the North Carolina Assistive Technology Program in Charlotte, NC.
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with mismatches in cognitive, sensory, or physical capabilities, increase the likelihood of device abandonment. Social stigma and the absence of caregiver support compound the problem. The consequences of AAC abandonment are severe. Users lose a critical tool for communication, leading to increased isolation and decreased participation in daily activities. Finan- cially, thousands of dollars invested in technology and training go to waste. STRATEGIES FOR PREVENTION Comprehensive and Dynamic Assessments Effective AAC use begins with a thorough assessment that considers the individual’s unique needs and circumstances. Comprehensive assessments evaluate the user’s communica- tion goals, such as whether the device will be used for social, functional, or a combination of purposes. Key stakeholders, including caregivers, educators, and healthcare providers, must be involved to provide holistic perspectives. Environmental factors are also assessed to ensure that the device is practical across various settings, from home to work and community spaces. Frameworks like the Participation Model are employed to identify barriers and provide actionable solutions to support meaningful communication. For example, Michael, a 45-year-old with cerebral palsy, was referred to identify an augmentative communication solution tailored to accommodate his limited fine motor skills. A compre- hensive assessment was conducted to determine an appro- priate AAC solution. Michael expressed a desire to communicate independently at home and during social events. His family, an occupational therapist, and a speech-language patholo- gist collaborated to identify his specific needs. The device was customized with vocabulary for personal care routines, social interactions, and navigating public spaces. Using the Partici- pation Model, the team addressed barriers such as fine motor challenges and trained caregivers to reinforce effective AAC use. This personalized approach empowered Michael to engage actively in familiar and new environments. Tailored Training Programs Training programs are critical for the success and retention of AAC devices, bridging the gap between acquiring the assis- tive technology and using it effectively in everyday life. These programs must be personalized, practical, and dynamic to address the unique needs of each user and their communica- tion partners. Hands-on practice is a cornerstone of effective training, allowing users and their caregivers the opportunity to familiarize themselves with the device in real-life scenarios. For example, users can practice ordering food at a restaurant, asking for assistance at a store, or participating in discussions during family gatherings. These activities build operational
competence and reinforce the practical value of AAC in daily interactions. Caregivers and support networks play a vital role in AAC training. They must be equipped with the knowledge and skills to model effective device use during interactions, demon- strating its functionality and purpose. For instance, a caregiver might use the AAC device to initiate a conversation, guiding the user to respond using the same technology. Observing and practicing makes the user more confident and consis- tent in their device usage. Additionally, caregivers can create supportive environments by encouraging AAC use in a variety of contexts, ensuring that communication opportunities are plentiful and meaningful. Training programs should also focus on skill maintenance and growth. Regular refresher sessions help users, and their support teams stay proficient as device features evolve or as communication goals shift. For example, as a user transitions from requesting basic needs to engaging in complex social exchanges, the training program should adapt to introduce new vocabulary and interaction strategies. Effective AAC training is an ongoing process, evolving with the user’s needs and goals. By prioritizing hands-on practice, caregiver involvement, interdisciplinary collaboration, and continuous adaptation, tailored training programs empower AAC users to achieve meaningful and sustained communica- tion success. Device Customization and Personalization Personalization ensures that the AAC device reflects the user’s personality, preferences, and communication needs. Vocabulary sets are tailored to include commonly used phrases and words related to the user’s life. Voice output should match the user’s age, gender, and cultural background, and the inter- face should be intuitive and logical. Ben, a 37-year-old with autism, was considered to be at risk for AAC device abandonment. Ben’s team focused on device customization and personalization, tailoring the system to reflect his unique interests, daily routines, and unique needs. His team included words related to his favorite activities, such as swimming and attending Monster Jam events. Functional phrases like “Can we go to the pool?” and “When is the next Monster Jam?” were added to empower him to participate in conversations. The interface was designed with visuals paired with text to make navigation easier, and regular training sessions reinforced effective device use. Ben’s team ensured long-term engagement and use by embedding AAC into his daily routines and updating the system to align with evolving interests.
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Community Integration AAC devices are most effective when users participate actively in their communities. Encouraging involvement in inclusive recreational programs, volunteering opportunities, or public events can reinforce AAC use and reduce stigma. For example, users can join local community centers, contribute to food bank efforts, or attend advocacy events to raise awareness about AAC. Continuous Monitoring and Feedback Ongoing support is essential for addressing challenges and adapting devices to evolving needs. Regular follow-ups with AAC specialists ensure technical issues are resolved, and feedback mechanisms allow users and caregivers to share experiences and request adjustments. Scheduled check-ins help maintain the device’s functionality and relevance, while routine updates align the technology with the user’s changing circumstances. CONCLUSION AAC devices have the potential to transform lives, but their success depends on thoughtful planning, training, and sustained support. Preventing abandonment requires collabo- ration among families, professionals, and communities. By advocating for comprehensive assessments, personalized interventions, and inclusive environments, assistive technology professionals can ensure that every AAC user has the tools and confidence to communicate effectively and fully participate in all daily activities and environments. REFERENCES Beukelman, D., & Mirenda, P. (2020). Augmentative and Alter- native Communication: Supporting Children and Adults with Complex Communication Needs (5th Edition). Baxter, S., Enderby, P., Evans, P., & Judge, S. (2012). Barriers and facilitators to the use of high-technology augmentative and alternative communication devices: A systematic review and qualitative synthesis. International Journal of Language & Communication Disorders, 47(2), 115–129. Helling, C., & Minga, J. (2014). Developing an Effective Frame- work for the Augmentative and Alternative Communication Evaluation Process. Perspectives on Augmentative and Alterna- tive Communication. 23 (2), pp.91-98 Johnson, J. M., Inglebret, E., Jones, C., & Ray, J. (2006). Perspec- tives of speech-language pathologists regarding success versus abandonment of AAC. Augmentative and Alternative Commu- nication, 22(2), 85–99.
Light, J. (1989). Toward a Definition of Communicative Compe- tence for Individuals Using Augmentative and Alternative Communication Systems. AAC Journal.
Phillips, B., & Zhao, H. (1993). Predictors of assistive technology abandonment. Assistive Technology, 5(1), 36–45.
Rush, E. & Helling, C. (2013). AAC Assessment: Merging Personal And Clinical Evidence To Support Quality Outcomes. Session presented at the 2013 ASHA Convention, Chicago, IL
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