A recent online discussion on the ASHA Special Interest Group for AAC (SIG 12), got me thinking about the various resources that have fed into my collective sense of how to relate to the question: “Will speech be [negatively] impacted by AAC?” The following is my attempt to have some sense of organization to the range of materials which contribute to my own thought process when having this conversation with families or school teams. For the sake of ease/time/effort (always in limited supply), much of this is cut and pasted from other places — which sometimes results in odd formatting and abrupt font mixes. My apologies for that.
(1) Dr. Light and Dr. Drager at Penn State did extensive research on Early Intervention with kids as young as six months old who had developmental disabilities such as autism, cerebral palsy, Down Syndrome and others. Their work is profiled at their Early Intervention website with comprehensive discussions and video clips of the principles of intervention which fully incorporated the range of no tech (e.g., intonation, vocalizations, speech, gestures, sign language), low tech (e.g., print materials such as photos, picture symbols, communication boards and books), and high tech computer technologies. The FAQ page on the site goes into some discussion about the question of benefits of AAC and implications on talking, and specifically references an intensive review of the literature which found no evidence of negative impact:
–> Millar, D., Light, J., & Schlosser, R. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech Language Hearing Research, 49, 248-264.
I have sometimes found that using these video clips or those from the Literacy Intervention website can help illustrate that speech is always modeled, supported, and reinforced. Using case studies like these can sometimes add an objectivity or emotional distance from the conversation: I can talk about my thought process around the individual(s) profiled and how decision-making and/or priorities might be considered without it being quite as personal. In particular, the Success Story of Sandra on the Literacy website illustrates beautifully (and heartbreakingly) what access to multimodal instruction in literacy has meant to her as she speaks in her own words about being underestimated much of her life to that point. Her profile further explains that she uses speech, gestures and a communication book to communicate as well as a computer with speech output.
(2) The next two are from books or journals written for SLPs, so they may be pretty dense reading to someone less familiar with the jargon.
(5) Last, but absolutely not least, there may be a huge, huge value in first-person accounts from other parents.
Rob Rummel-Hudson, dad to Schuyler, writes the blog “Fighting Monsters with Rubber Swords”, as well as articles for Support for Special Needs and he has a presence on Facebook. Rob is unflinchingly honest about his emotions around Schuyler’s challenges, the value of AAC in her life, and how both he and Schuyler continue to fervently wish for a day when she will be able to “speak like her friends” even as they recently made the decision in her IEP to discontinue that as a target in favor of focusing on her fluency with multimodal communication. Rob is deeply eloquent in his discussions of family life, interacting with schools, and I rarely leave his writings without feeling deeply moved.
In April of 2013, Dana Nieder published “An Open Letter to the Parent of a Child with Speech Delays” on her family blog, “Uncommon Sense” about their family’s experience loving and supporting her daughter, Maya, and coming to terms with decisions around AAC. She is honest about the process — the importance of feature matching, the impact on family life — and provides resources parent-to-parent for others to reflect on what may be best in their own lives.
I imagine there are first-person accounts from the other side of parents/families out there who made the decision to focus entirely on speech, successfully…but I do not know of those. My ~guess~ is that these may be associated with specific interventions (and substantial investments financially, and in practice/focus both in and out of therapy). I don’t want to fall prey to a Bias of Fairness and assume that there always is an equally relevant, balanced other side to the argument — I think sometimes that the effort in seeking one out is a distraction from what could be authentic and functional change and/or feeds false hopes . But neither do I mean to be closed minded and beyond surprise — so I certainly acknowledge that there may be profiles/characteristics/indicators which could be of value to families and SLPs trying to make this judgment call of how to best allocate limited time, energy, and resources.
For now, for me: speech is always anchored solidly within a deep belief around Multimodal. From there, it is a process of the evidence, the family values, response to intervention, functional outcomes, and prognosis.
End blip.