Avoiding Insanity: AAC & the Pace of Change
Although the field of AAC emerged only in the last few decades, the notion of communicating in alternative ways is centuries old. In classical times, the use of manual communication by deaf individuals was referred to by Plato and documented in Europe during the Middle Ages. In North America, American Indian Hand Talk evolved over generations to allow cross-cultural communication between speakers of diverse languages.
As a clinical/educational field, AAC has been described as evolving through a “bottom-up” mechanism. Individuals with congenital conditions that prevented the development of intelligible speech invented their own communication systems long before teachers, therapists, and clinicians formalized instruction in alternative modes of expression. AAC users growing up in the forties and fifties tell of communicating through grunts, vocalizations, “air writing,” and eye movements, which, though effective in some contexts, were maddening in their limitations.
Individuals who were fortunate enough to have access to habilitative and therapeutic services did not fare much better than those left to their own creativity. With few exceptions, even the most well-intentioned professionals had little to offer, working on cognitive prerequisites to communication or oral motor and articulation skills that failed to improve noticeably despite years of therapy. Respite and solutions sometimes came from unexpected sources. Michael Williams, editor of the periodical Alternatively Speaking (no longer in publication), reflected on his own situation.
“I used air writing to communicate with people outside my family until I was well out of college. All this changed very dramatically one day when I was working at my job as a volunteer news writer for a radio station in Los Angeles. One of my coworkers became extremely irritated with my mode of communication. He found it extremely slow and tedious. He walked in the next day and threw a checkbook cover at me. I opened it and found the letters of the alphabet pasted inside. My friend had given me what all these professionals I had seen over the years had not given me: an alternative means of communication.” (1995, p. 3)
There were a few pioneers who did, in fact, try implementing nonspeech modes of communication with their clients with aphasia and cerebral palsy. Although these early efforts were successful, information on these strategies and tools was slow to trickle down to the average clinician. In essence, the service delivery profile for individuals with severe communication disabilities improved little until the mid-late 1970’s.
In the US, three factors catalyzed changes in our approach to intervention with individuals with severe communication impairments. The first was the passage of several pieces of legislation. The Rehabilitation Act of 1973 prohibited discrimination against people with disabilities, helping to create an environment in which disabled individuals participated more actively in mainstream society. In 1975, P.L. 94-142 mandated change in the educational system. For the first time, all children with significant disabilities were legally entitled to a free, appropriate education, thus attracting the attention of school-based speech-language pathologists. The second factor was an expansion of our knowledge base in the areas of linguistics and language development. In the early seventies, researchers such as Bates and Dore were investigating the function rather than the form of language. This broadened our scope from one that was speech-focused to one that was communication-focused, creating an environment more conducive to exploration of less conventional means of expression. Finally, microprocessor and switch technology began to be applied to individuals with communication disorders.
By the late seventies, alternative means of communication were beginning to be seen as a viable approach for some individuals who failed to develop or regain intelligible speech. In 1981, ASHA developed a position paper on AAC services, and delineated competencies for professionals interested in providing these services. Although recognized as a legitimate approach with this population, AAC intervention was still far from commonplace. The first AAC courses and workshops began to be taught, but most practicing clinicians had little awareness or direct knowledge of how to implement these new strategies and techniques.
During the past 30 years, the AAC field experienced explosive growth with the development of the International Society for Augmentative and Alternative Communication (ISAAC), the AAC Journal (1985), and a proliferation of textbooks, continuing education workshops, conference presentations, and pre-professional coursework.
And yet, we still have a population of individuals whose need for AAC goes unmet. Earlier this year, many of us read a white paper developed through the joint effort of an AT/AAC company and two university professors, which shared findings of a questionnaire circulated online to AAC stakeholders. A summary of their results included these findings:
Less than 10% of adult AAC users report receiving professional support to effectively implement AAC.
Close to 20% of the professionals consider the practitioner charged with supporting the person with AAC needs as being not knowledgeable or only slightly knowledgeable about AAC.
At a meeting last night, there were many families of adolescents with significant communication difficulties and several of their teachers. In the entire room, it seemed that only one child had an appropriate AAC system. Just one.
Clearly, something isn’t working in the AAC field. With all the our research, our writing, our teaching, our therapy, our conferences, and our advocacy, something isn’t working. What we are doing to give communication access to this population is just not working. Or not working well enough.
Einstein is credited with defining insanity as doing the same thing over and over and expecting a different result. Well, we’re not crazy. Really, we’re not. We are all good thinkers. We’re creative problem-solvers. We all work way too hard. And we all have big dreams and goals and expectations for people who have yet to access real language and communication development. So why are we doing the same thing over and over and expecting a different result?
There has to be a better way. Anyone want to open a dialogue to what we in the speech-language profession can do differently so that the pace of change gets accelerated? We need better solutions. Not complaints, not rants, both of which we (Robin and I) do far too often. The AAC field needs new, fresh ideas for things to try. Really, there has to be a better way.
What can we do differently to accelerate the pace of change in AAC?
Ideas, please. Big ones, small ones. Logical thoughts and off-the-wall sparks. Ideas for researchers, practitioners, administrators, clinical educators, bloggers, presenters. Share your thoughts. We’re listening.
Filed under: PrAACtical Thinking
This post was written by Carole Zangari