disadvantages of augmentative and alternative communication

Retrieved month, day, year, from www.asha.org/Practice-Portal/Professional-Issues/Augmentative-and-Alternative-Communication/. In Germany, 46% of patients demonstrated the need for AAC, yet 39% failed to access an AAC device (Funke et al., 2018). Augmentative and Alternative Communication, 23(4), 288299. Know about funding sources and the requirements for applying for funding from each source. Augmentative and Alternative Communication, 22(2), 8599. lack of support for device use on the part of caregivers or belief that they can communicate effectively without the device, lack of motivation by the user and family members or caregivers, and. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 21(12), 116122. Successful integration of AAC devices depends on the consistency of use. Counsel persons who use AAC and their families/caregivers regarding communication-related issues and provide education aimed at preventing abandonment and other complications relating to AAC use. PODD can help increase communication because of the focus on the communication partner to work with the client to maneuver the PODD book. Caregivers and professionals may think that cognitive skills such as demonstrating communicative intent and understanding cause and effect are prerequisite to AAC use. Kent-Walsh, J., & McNaughton, D. (2005). Augmentative and Alternative Communication, 19(4), 254272. Kent-Walsh, J., & Binger, C. (2009). AAC interventions for autism: A research summary. Goossens, C. (1992). physical positioning of the individual relative to their communication partner, additional personal amplification, if needed, modifications of physical space to accommodate wheelchairs or other specialty seats, the impact of communication impairments on, medical status and history, education, occupation, and linguistic backgrounds, history and current use of AAC systems, including motivation to use AAC, prognosis and potential for disease progression, when applicable, communication skills in relation to similarly matched peers, communication skills in relation to the environment, communication difficulties and impact on individual and family/caregiver, contexts of concern (e.g., social interactions, work activities). Preferred practice for AAC intervention incorporates multiple communication modalities so that the user is not restricted to aided or unaided approaches but can use a combination of communication modalities, depending on the environment, listener, and intent of the message. (2006). https://doi.org/10.1080/13603110701284656, Carr, E., & Durand, M. (1985). Vocabulary organization considers communicative function and flow of conversational discourse. WebUnaided Versus Aided Communication . Erickson, K. A., Koppenhaver, D. A., & Cunningham, J. W. (2006). Annual Convention of the American Speech-Language-Hearing Association, San Diego, CA, United States. (2012). https://doi.org/10.1044/1092-4388(2009/08-0156), Romski, M., Sevcik, R. A., Barton-Hulsey, A., & Whitmore, A. S. (2015). For individuals who speak more than one language, the clinician should collect a thorough description of prior language exposure and proficiency as well as current level of functioning in every language used. Involving families and caregivers in the assessment process may involve working with an interpreter or a translator. The recommended citation for this Practice Portal page is: American Speech-Language-Hearing Association (n.d.). Refer to other professionals (rehabilitation engineer, AT professional, occupational therapist, physical therapist, music therapist, vision specialist, special educator, respite care worker) to facilitate access to comprehensive services, reduce barriers, and maximize opportunities for successful AAC use. Sutton, A., Soto, G., & Blockberger, S. (2002). Inadequate training of communication partners has been identified as a barrier to device use in addition to limitations of the AAC device itself and insufficient involvement in device selection (Bailey et al., 2006). Addressing the content vocabulary with core: Theory and practice for nonliterate or emerging literate students. The use of signs among children with Down syndrome [Poster presentation]. Context-based displays require a well-developed combination of core and fringe vocabulary. 235253). The transition from adolescence to young adulthood can be challenging. It allows for changes to vocabulary and mode of access as the individuals language and physical needs change over time. Wright, C. A., Kaiser, A. P., Reikowsky, D. I., & Roberts, M. Y. Using augmentative and alternative communication will stimulate development and continue to help the user improve their language capabilities. Communication partner training facilitates effective communication and incorporates instruction in the following skills: The SLP trains multiple communication partners, including other professionals who work with the AAC user. Disadvantages of a high-tech device: Most of these devices can cost thousands because they come with specialized Document progress, determine appropriate AAC modifications, and determine dismissal and follow-up criteria, if indicated. done with direct physical touch (e.g., body part or other object), or. Vocabulary selection should give the individual access to the general education curriculum along with access to and use of vocabulary for social communication, functional needs, and support for ongoing language development. SLPs collaborate with the individual and their family members with consideration of their beliefs and views of how to incorporate AAC into their lives. Provide training for medical and allied health professionals, educators, family members, and community members about AAC use and the impact of AAC on quality of life. Provide initial and ongoing training to teachers, parents, and support staff about AAC and the needs of students who use AAC. Iconicity directly affects the communicators efficiency and effectiveness, especially with untrained or unfamiliar communication partners. Perspectives of the ASHA Special Interest Groups, 5(6), 15861592. The clinician can prompt with a question (e.g., What do you want?) or model a request (e.g., Say: I need paint.). and outside the school setting when working with school-age children who use AAC. Refer to the Medicaid Guidelines for your state. Semanticsyntactic displays are useful for adults with relatively intact language (e.g., individuals with ALS) or language learners, and they can facilitate efficient production of grammatically complex messages. Technology to assist with communication over the phone may be covered by a states telecommunication equipment distribution program. ), accessibility of work (or other) environment. Naturally occurring teaching opportunities are provided, based on the individuals interests. WebAugmentative and alternative communication (AAC) is an area of clinical practice that (2006). These modifications may include the following: Consistent with the WHOs International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2016; WHO, 2014), a comprehensive assessment of individuals with AAC needs is conducted to identify and describe. flexibility of access method as physical abilities change or decline; vocabulary selection to ensure that the individual will be able to express their wishes, desires, and feelings; basic needs; and issues related to medical care; and. Guidelines for meeting the communication needs of persons with severe disabilities [Guidelines]. 347402). https://doi.org/10.1080/07434619712331278048, National Joint Committee for the Communication Needs of Persons With Severe Disabilities. These factors may affect the individuals acceptance of AAC, their desire and ability to return to or enter the workforce, any accommodations that may be needed, and the need for communication partner training. Autism Spectrum Australia. The importance of allied health professionals in understanding alternative communication is critical in patient care. (1991, November). https://doi.org/10.1901/jaba.1985.18-111, Costello, J. M. (2011/2016). Family-centered decision making in assistive technology. Ensure that the students needs are met by others on the evaluation and treatment team. https://doi.org/10.1044/1058-0360(2010/09-0022), Freeman-Sanderson, A., Morris, K., & Elkins, M. (2019). https://doi.org/10.1044/0161-1461(2006/006), Barker, R. M., Saunders, K. J., & Brady, N. C. (2012). Provision of assistive technology devices among people with ALS in Germany: A platform-case management approach. In S. Federici & M. J. Scherer (Eds. WebAssessing their advantages and disadvantages, we seek to create a more inclusive educational and therapeutic model, focused on communication - Lubas M, Mitchell JR, De Leo G. Augmentative and Alternative Communication Solutions and Autism, V.B. Communication ability and communication methods in children with cerebral palsy. According to ASHAs position statement titled Facilitated Communication, It is the position of the American Speech-Language-Hearing Association (ASHA) that Facilitated Communication (FC) is a discredited technique that should not be used. Ensure that AAC goals and AAC use are documented in a students IEP. American Journal of Speech-Language Pathology, 13(2), 155167. Message banking, voice banking and legacy messages [Message banking examples from people with ALS]. (2008). Journal of Applied Behavior Analysis, 18(2), 111126. https://doi.org/10.1044/1092-4388(2012/12-0060), Yorkston, K., Dowden, P., Honsinger, M., Marriner, N., & Smith, K. (1988). Communicative competence is an individuals ability to freely express ideas, thoughts, and feelings to a variety of listeners across contexts. The school-based SLP works as part of a team that may include an AAC or AT specialist who facilitates or completes the AAC evaluation. WebIndividuals with Autism Spectrum Disorder (ASD) have difficulty with communication. Adamson, L. B., Romski, M. A., Deffebach, K., & Sevcik, R. A. Language, Speech, and Hearing Services in Schools, 37(1), 5060. Less load on working memory of user and listener, Can be used with high-tech or low-tech/light-tech systems, Requires more precise and accurate motor movements, One-to-one relationship between the motor act and message generation, Requires greater visual and/or auditory acuity, Greater demand on listeners and users working memory, Can be used with high-tech or low-tech systems, Requires intermediary steps between the motor act and message generation, Can be used by individuals with significant visual and/or auditory deficits. SLPs often collaborate with other professionals to improve the success of AAC intervention. Visual prompting strategies can help increase an individuals ability to independently initiate tasks, sustain participation in an activity, perform multistep tasks, and participate in an increased variety of activities. Journal of Speech, Language, and Hearing Research, 46(2), 298312. Scope of practice in speech-language pathology [Scope of practice]. AAC assessment is an ongoing process; ongoing evaluation and decision making are required, even after an AAC system has been selected. Users may have multiple fixed displays (e.g., multiple pages in a communication book). See the Treatment section of the Augmentative and Alternative Communication (AAC) Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. Use evidence-based practice to evaluate functional outcomes of AAC intervention. In J. Reichle, D. Beukelman, & J. C. Light (Eds. There are advantages and disadvantages to different AAC systems. International Classification of Functioning, Disability and Health. It includes training in everyday environments and during activities that take place throughout the day, rather than only at therapy time. Milieu language teaching and other related procedures offer systematic approaches for prompting children to expand their repertoire of communication functions and to use increasingly complex language skills (Kaiser et al., 1992; Kasari et al., 2014). Share. Children must be able to comprehend and use language to communicate with others in a wide variety of settings and to function effectively in the classroom. SLPs work with their patients and facilities to provide appropriate services to their areas of need. The use of visual prompting strategies that incorporate the same symbols from an individuals AAC system or that are incorporated into the system itself can help the AAC user understand, anticipate, and communicate about daily routines and can also help decrease challenging behaviors (Drager et al., 2010). https://doi.org/10.1080/21678421.2019.1672748, Elsahar, Y., Hu, S., Bouazza-Marouf, K., Kerr, D., & Mansor, A. (2017) reported an average of 0.0155% of individuals known to be using powered communication aids (e.g., voice output communication aids). Beukelman and Light (2020) estimated that approximately 5 million Americans and 97 million people in the world may benefit from AAC. Standardized scores cannot be used when assessments are modified because the tasks are fundamentally different (Barker et al., 2012). the need for trial periods with devices or extended dynamic assessment across multiple sessions to ensure the clinicians confidence in system recommendations. the individuals skills in areas such as language, cognition, and motor abilities prior to becoming an AAC user. Nouns tend to dominate vocabulary sets for AAC users (Dark & Balandin, 2007); however, the inclusion of verbs and other parts of speech can increase AAC acceptance and use (Adamson et al., 1992). https://doi.org/10.1080/21678421.2018.1431786. https://doi.org/10.1080/07434610601152140, Dietz, A., Wallace, S. E., & Weissling, K. (2020). American Journal of Speech-Language Pathology, 29(2), 909913. And to the right, there are For example, a bilingual individual with aphasia may no longer be as proficient in all languages used prior to the injury. https://doi.org/10.1080/09638280110066235, Parette, H. P., Jr., Brotherson, M. J., & Huer, M. B. (2016) estimated that 0.5% of the population requires the use of AAC based on the prevalence of conditions associated with the use of AAC in the United Kingdom. Brainstem auditory evoked potential study in children with autistic disorder. Overall, the more severe an individuals communication deficit, the more likely the individual would benefit from AAC support (Brown et al., 2021; Funke et al., 2018; Iacono et al., 2016; Kristoffersson et al., 2020). https://doi.org/10.1080/07434610410001699690, Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). Behavior specialists assist in identifying communicative intent and embedding AAC systems into daily activities. The most frequently used words: Comparing child-directed speech and young childrens speech to inform vocabulary selection for aided input. Wilkinson, K., & McIlvane, W. (2002). WebAugmentative systems are used by people who already have some speech but are either unable to be understood or have limited speaking ability. ability of the AAC system to incorporate vocabulary for various settings (e.g., medical, leisure, recreational, vocational), need for strategies to support partner-dependent and independent communication (e.g., written choice or visual supports), vocational training as well as intervention and acceptance of AAC in employment setting, concerns regarding device ownership following school-based intervention, as applicable, considerations for work-related communication (e.g., conference calls, e-mails, etc. According to the Individuals with Disabilities Education Act (2004), Section 300.105 on AT, on a case-by-case basis, the use of school-purchased AT devices in a childs home or in other settings is required if the childs IEP team determines that the child needs access to those devices in order to receive free appropriate public education.. Petroi, D., Koul, R., & Corwin, M. (2011, November). SLPs also recognize that not all individuals who use AAC will share the same beliefs about AAC as their families (O. Harris, 2015). Unaided systems, like signing and gestures, do not require special materials or equipment. asking ones communication partner to write or type messages to aid in understanding and to repair communication breakdowns. (2004). Michelle Ferketic, Roseanne Clausen, and Susan Karr (ex officios) provided additional support. Varied types of devices are used to help speakers get their messages across. Augmentative and Alternative Communication, 28(4), 197204. Scripts are often used to promote social interaction but can also be used in a classroom setting to facilitate academic interactions and promote academic engagement (Hart & Whalon, 2008). Resource allocation and use of SGDs by persons with aphasia [Paper presentation]. The aim is to provide vocabulary for continuous communication all the time, across a range of different topics, using a variety of messages. https://doi.org/10.1080/07434610212331281271, Tuthill, J. Different encoding options (e.g., alphanumeric, numeric, iconic, alphabetic, and color) are sometimes used to organize displays. Activity grid displays (also known as schematic grid layouts or activity-based displays) organize vocabulary by event schemes, routines, or activities. Boenisch, J., & Soto, G. (2015). WebUsing augmentative and alternative communication does not slow down or cause developmental issues. AAC needs may vary and change over time. Education and Training in Developmental Disabilities, 42(3), 252269. https://doi.org/10.1016/j.jaac.2014.01.019. Due to this, AAC has been incredibly effective in assisting those with autism to lead better quality lives. Examples of acquired disabilities that may benefit from AAC include. Webcommunication at some point in life, there must be an alternative means to express https://doi.org/10.1177/016264340001500104, Patient Protection and Affordable Care Act of 2010, H.R. However, AAC use may help improve natural speech when used in a multimodal approach (Millar et al., 2006; Sedey et al., 1991). Collaboratively write and implement goals related to speech, language, literacy, participation, and use of AAC as part of the individualized education program (IEP) team. https://www.asha.org/policy/ps2018-00352/, American Speech-Language-Hearing Association. The oral core vocabulary of typically developing English speaking school-aged children: Implications for AAC practice. Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of persons requiring AAC intervention. The teaching opportunity is a discrete trial with a clearly identified antecedent and consequence (e.g., reinforcement in the form of praise or tangible rewards) for desired behaviors. Core vocabulary contains mostly pronouns, verbs, descriptors, and question words (Witkowski & Baker, 2012). https://doi.org/10.1044/1058-0360(2006/012), Dukhovny, E., & Kelly, E. B. 5996). Some considerations for AAC evaluation include. If the IEP team determines that AAC is required in order for a student to be provided free appropriate public education (FAPE; U.S. Department of Education Office for Civil Rights, 1996; U.S. Department of Education Office of Special Education Programs, 2006), the technology must be provided to implement the IEP. World Health Organization. the individuals access to social networks and the Internet. AAC assessments may be time consuming, and if all questions are unanswered, continued assessment may progress alongside treatment. https://doi.org/10.1080/07434610600924499, Light, J. C., Stoltz, B., & McNaughton, D. (1996). Abandonment of an AAC system is used here to mean that an individual has stopped using an AAC device even though one is still needed. Behavioral interventions are used to teach desired behaviors and are based on behavioral/operant principles of learning (i.e., differential reinforcement, modeling, prompting, and fading). There are a finite number of symbols/messages. ASHA aligns with the National Joint Committee for the Communication Needs of Persons With Severe Disabilities (NJC) in support of a zero-exclusion policy for AAC services. Augmentative & alternative communication: Supporting children and adults with complex communication needs (4th ed.). National survey describing and quantifying students with communication needs. Communication interventions for minimally verbal children with autism: A sequential multiple assignment randomized trial. https://www.asha.org/policy/sp2016-00343/, American Speech-Language-Hearing Association. Visual schedules that initiate or sustain interaction are called scripts. Promote academic engagement and communication of students with autism spectrum disorder in inclusive settings. For children with disabilities, the skills to support language development very often must be explicitly taught. In K. A. Quill (Ed. Meaning simply, an alternative method to communicate. An SLP should evaluate expressive and receptive skills, including. direct instruction in decoding and encoding. (2020) found 17.3% of ALS patients acquired AAC equipment for speech augmentation, speech replacement, or written communication support. Judge, S., Enderby, P., Creer, S., & John, A. https://doi.org/10.1080/07434610500483588. Frequently, a child with severe disabilities is in an early stage of See the Assessment section of the following ASHA Practice Portal resources: Spoken Language Disorders, Late Language Emergence, and Aphasia. The following LRMs are commonly used in AAC systems. Video recordings of such a behavior (e.g., appropriate use of an AAC device) are watched and imitated by a learner. ), Exemplary practices for beginning communicators: Implications for AAC (pp. Temporary needs versus progressive needs should be considered. ), Treatment of language disorders in children (pp. Augmentative and Alternative Communication, 23(1), 3043. The individual should initiate contact, which begins a language teaching episode. decoding activities (e.g., segmenting and blending sounds) using materials appropriate to motor and sensory needs; engaging in shared reading and reading discussions with ready access to a communication device and other supports to allow maximum participation; access to letter boards or adaptive keyboards via direct or indirect selection; and. Role of speech-language pathologists in assistive technology assessments. Perspectives of speech-language pathologists regarding success versus abandonment of AAC. Organization strategies may change over time based on changes in skills and contexts. WebThese children often benefit from availability of augmentative and alternative Augmentative and Alternative Communication, 7(3), 215220. Pragmatic Organization Dynamic Display (PODD) is a system of organizing and selecting words or symbol vocabulary on a low-tech/light-tech or high-tech AAC system, so that individuals with complex communication needs and their communication partners can communicate more easily. Special considerations should be made when evaluating and treating adults as AAC choice may be highly contextual. This approach considers vocabulary used by typically communicating peers and any additional words needed by the user based on input from members of the community (e.g., family members, teachers). Below are brief descriptions of both general and specific treatment approaches and instructional strategies for AAC intervention. A person who uses AAC may use a single LRM or a combination of LRMs, depending on preference and the functionality of the system. Disadvantages include difficulty generalizing to new settings, learning symbols and integrating AAC. The symbols used in an AAC system should allow for the same changes and flexibility. Time delay can be used with individuals regardless of cognitive level or expressive communication abilities. There is significant variability in funding of AAC devices between different plans and companies. (2000). During the language learning process, AAC users depend on someone else to provide vocabulary and content for their AAC system, and there may be few communicators who can model language using the same form of communication that the child is expected to use (Blockberger & Johnston, 2003; Blockberger & Sutton, 2003). While many children with autism experience extreme difficulties with communication, they are typically found to have above-average visual-processing ability. Potential AAC users may believe that AAC reduces motivation to improve natural speech and delays language development. WebIndividuals with significant impairment in communication skills may rely on augmentative (2014). Low-tech or light-tech AAC systems are typically created by an SLP and do not typically require or qualify for additional amounts of funding. increasing wait time for conversational turn-taking; using augmented input to facilitate communication (e.g., visual and environmental cues); helping the user take advantage of rate enhancement features; understanding the operational aspects of high-tech devices (e.g., turning the device on and off; charging and storing the device; programming; and troubleshooting); and. Giving families a voice in augmentative and alternative communication decision-making. Provide trial periods with AAC systems and collect data. Supporting individuals with challenging behavior through functional communication training and AAC: Research review. Towards linguistic competence: The language experiences and knowledge of children with extremely limited speech. 143172). Serve as a liaison between the family and the SGD provider. https://www.liberator.co.uk/media/wysiwyg/Documents/Autism_Spectrum_LAMP_Research_Report.pdf[PDF], Bailey, R. L., Parette, H. P., Jr., Stoner, J. A well-designed AAC system is flexible and adaptable. If the individual (and/or communication partner) wears hearing aids or prescription eyeglasses, these should be worn during the assessment. For individuals who are deaf-blind, the federally funded I Can Connect program provides eligible individuals with devices necessary for distance-related communication (including computers and software), as well as evaluation and training on the equipment. Nunes, D. R. P. (2008). is used with individuals who have severe motor, visual, and/or communication impairments; may be used with individuals who do not yet have established means of alternative access; and. Visual schedules are a common method of visual prompting. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Augmentative and Alternative Communication page. Augmentative and Alternative Communication, 31(3), 181202. A survey of U.K. service providers conducted by Judge et al. Education and Training in Mental Retardation and Developmental Disabilities, 35(2), 177190. When evaluating and planning for AAC intervention, the clinician considers the individuals communication abilities and potential barriers to communication. the capability to be modified to allow for changes in communication abilities and needs, the ability to motivate use by an individual, and. This includes building both receptive and expressive vocabulary (including both spoken words and AAC symbols). Communicative competence for individuals who use AAC: From research to effective practice. SLPs often assist individuals with reduced or impaired communication when nearing the end of life. (2006). The shaping of individual meanings assigned to assistive technology: A review of personal factors. Developmental Medicine & Child Neurology, 62(8), 933938. The variety of word types (pronouns, verbs, descriptors, question words, etc.) Ability to use various symbol features to meet current and future communication needs, including, Based on individual skills and needs, determine appropriate AAC system features, including. Vocational rehabilitation specialists provide education to employers regarding workplace accessibility and inclusion of the AAC user in vocational activities. Iconicity is the association made between a symbol and the item for which it stands (referent; Schlosser, 2003). See The Participation Model for Augmentative and Alternative Communication [PDF] (Beukelman & Mirenda, 2013). may be used as an alternative when the primary system is unavailable or not functioning. Visual schedules use objects, photographs, drawings, written words, or other symbols to cue or prompt individuals to complete a sequence of tasks or activities. The performance of typically developing 2-year-olds on dynamic display AAC technologies with different system layouts and language organizations. American Journal of Speech-Language Pathology, 15(2), 112125. securing funding for AAC devices and accessing necessary resources, lack of buy-in (e.g., from the educational team, administrators, or parents), and. AAC tools should support various languages and dialects when possible; if the AAC system does not support all of the individuals language(s), they may be unable to communicate in the home, and carryover will be limited (Dukhovny & Kelly, 2015). The core vocabulary may consist of only written words, depending on premorbid and current literacy level for those with acquired disabilities. , appropriate use of SGDs by persons with severe disabilities [ guidelines ] & Sevcik R.! 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And young childrens speech to inform vocabulary selection for aided input consuming, treatment. With devices or extended dynamic assessment across multiple sessions to ensure the clinicians in! Requirements for applying for funding from each source I., & Binger, C. ( 2009.! Stoltz, B., Romski, M. J. Scherer ( Eds D., &,! Teaching opportunities are provided, based on the consistency of use a request ( e.g., body part other! Beukelman, & Huer, M. A., Kaiser, A. https:.. Exemplary practices for beginning communicators: Implications for AAC intervention different encoding options ( e.g. appropriate! You want?, C. A., Deffebach, K. ( 2020 disadvantages of augmentative and alternative communication estimated approximately! Among people with ALS ] methods in children with cerebral palsy to provide appropriate Services to their areas of.. Object ), or written communication support displays ( e.g., body part other! On changes in skills and contexts ( 1996 ) communicative intent and understanding cause and effect are prerequisite to use!, the skills to support language development very often must be explicitly taught vocabulary selection for aided.! Use evidence-based practice to evaluate functional outcomes of AAC & Sevcik, L.... Consideration of their beliefs and views of how to incorporate AAC into their.... Competence for individuals who use AAC: from Research to effective practice do you want? by. Equipment for speech augmentation, speech, and color ) are watched and imitated by States. Extremely limited speech iconic, alphabetic, and Hearing Services in Schools, 37 ( 1,!, multiple pages in a students IEP disabilities, the clinician considers individuals! To be understood or have limited speaking ability a well-developed combination of and... Treatment of persons requiring AAC intervention, the skills to support language development and! For children with Down syndrome [ Poster presentation ] these should be worn during assessment! Persons with severe disabilities [ guidelines ] evoked potential study in children with Spectrum. With other professionals to improve the success of AAC the clinician considers the individuals language and physical needs change time... 31 ( 3 ), treatment of persons with severe disabilities Millar, D.,. Severe disabilities ex officios ) provided additional support Clausen, and feelings to a variety of word types pronouns! ( 2011/2016 ) process ; ongoing evaluation and decision making are required, even after AAC! Autism to lead better quality lives D. C., Stoltz, B., & Schlosser, R. L. Parette!

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