As speech-language pathologists working with clients who use augmentative and alternative communication (AAC), we spend a significant amount of time exploring a variety of communication options and providing direct instruction to our clients. We extensively consider features of various AAC programs, ensuring that they system’s adequately meet the needs of our clients. However, device abandonment occurs in approximately one-third of AAC cases, with lack of family involvement in the AAC process cited as a key factor (ASHA AAC Practice Portal. (n.d.). A literature review was conducted with the goal of exploring parent perspectives related to AAC and factors that can best support caregiver training and carry-over.
A team of clinicians from Nationwide Children’s Hospital participated in a clinical outcome group (COG), the purpose of which is to explore the available research to determine best practice guidelines for a given area of our field. This COG sought to answer the question: “For children who use AAC, what components of caregiver training during outpatient treatment sessions promote caregiver confidence of use of AAC to assist patients across environments and negate device abandonment?” The literature review examined 24 peer-reviewed articles addressing caregiver perceptions of and instructional strategies for augmentative and alternative communication (AAC) use, with a focus on relevance to the pediatric population. The COG identified ten articles as most directly aligned with the clinical question, as well as most relevant to the outpatient setting and the pediatric population served at Nationwide Children’s Hospital. The reviewed studies included meta-analyses and single-group designs, with common limitations including small sample sizes and lack of control groups. The articles were reviewed and the team members discussed and identified key themes across each of the articles. Key themes that emerged highlight barriers to AAC carry-over, such as caregivers’ limited knowledge of AAC systems, cultural and linguistic mismatches, inadequate service coordination, and persistent expectations for verbal speech. These factors often contribute to device abandonment and reduced engagement (Donato, 2018). Research indicates that parent-focused interventions, including structured training and coaching in strategies like partner-augmented input (PAI) and RAAP (Read, Ask, Answer, Prompt), can improve caregiver confidence and increase AAC use at home (Senner, et al., 2019; Dodge-Chin, et al., 2022). Cultural considerations in caregiver training programs were emphasized, with recommendations for adapting interventions to better support diverse families. Overall, findings underscore the importance of equipping caregivers with targeted, culturally responsive AAC instruction to promote consistent and effective communication support in natural environments.
As part of this presentation, we will discuss caregiver-identified barriers to AAC carry-over, with regards to both AAC system selection and use. We will discuss clinical implications to best support feature matching during the AAC assessment process, with an emphasis on cultural factors. Additionally, we will review elements of successful caregiver-training to best support AAC intervention in the home environment.
