Communication Opportunities for Elementary School Students who use Augmentative and Alternative Communication (summary)

School Children


Children with complex communication needs (CCN) often continue to experience educational and social barriers even after they have received appropriate augmentative and alternative communication (AAC) systems. This means that opportunities to communicate functionally need to be created and supported in the children’s natural environments including schools.

It is known that in interactions involving people who use AAC the naturally speaking partner tends to be dominant and take the lead, usually by asking a lot of direct questions. This means the number and type of communication functions used by the AAC user are limited and mainly responsive. Children who use AAC often have limited opportunities to initiate new topics of conversation and many of the interactions begun by other people are related to meeting physical or medical needs or giving instructions and the majority of interactions are with adults not peers. It has also been found that often children who use AAC in schools do not have their system available at all times.

This study aimed to look at the natural communication environments of children who use AAC.


What did they do?

The study had three areas of interest: to look at a sample of students who used AAC and attended a range of inclusive schools, to look at the consequences of AAC users communicative behaviours and to understand how communication partners could best respond to communication attempts and to look at the social participation of students who used AAC.

Overall the authors aimed to describe naturally occurring communication opportunities offered to AAC users attending elementary schools in the USA.

Twenty three students participated in the study. They had a range of disabilities and communication needs. AAC systems used included single message devices, picture cues and sentence strips, signing and speech generating devices (SGDs).

Six different schools were involved.

Each participant was observed across the school day, in a variety of lessons, break times and moving between sessions. Specific therapy sessions were not observed.

The observers recorded communication events as either ‘opportunity to respond’, ‘opportunity to initiate’ or ‘spontaneous student initiation’.

Opportunities to initiate were identified when the communication partner deliberately ‘sabotaged’ an event and allowed at least five seconds for the child to communicate about this without prompting, e.g. necessary items were held back, only small amounts of food given, items were placed out of reach etc.

Each pupil was observed for an average of 306 minutes with a range of 3 to 7 observations over multiple days.


What did they find?

A total of 2179 communication events were recorded at an average of 19 per student per hour. 90% of these were opportunities to respond and only 10% were spontaneous initiations by the child. Staff were not seen to try to set up any opportunities for the children to initiate communication. When possible opportunities to initiate were provided the five second wait to allow the child time to communicate was not observed and therefore the event was not recorded.

Over 70% of communication events took place in special needs classrooms, 20% were in mainstream classes and 9% in non-academic environments.

Most interactions (97%) were between children using AAC and adults, with an average of less than one communication event per hour involving peers. 35% of participants did not interact with peers at all during the observation period.

In 55% of opportunities to respond no response was made even with prompts. For systems that were not SGDs there was no response 64% of the time.

The main modes of communication used by the participants when responses were made were; an aided AAC system (65%), natural speech (21%), sign or gesture (9%) and hand over hand prompts on an SGD or vocal imitation (5%).

Students who used SGDs had access to their system for 63% of communication events, those who used other aided systems had them available only 27% of the time.



The authors conclude that students who use AAC need support to become active communicators and that this is not always appropriately available, leading to the need for training for communication partners and peers.

Children who use AAC also need support to develop initiation skills and to ensure their devices are available to them at all times.



The methods used to record data limited some of the information that could be gathered. There was not a great deal of information regarding context which would have been useful.

The length of observations varied between the students making it difficult to compare findings between participants.

The observations for each student took place over a relatively short, two week, period, this could be extended and possibly reduce the effects of the students being conscious of being observed.

The findings cannot be generalised beyond the areas in which it was undertaken.

Additional data about communication partners would be useful, including information about training they have received and their perceptions of what is effective in promoting communication for AAC users.

Things you may want to look into:

Teachers’ perceptions of implementation of aided AAC to support expressive communication in South African special schools: a pilot investigation

The Communication Supports Inventory-Children & Youth (CSI-CY), a new instrument based on the ICF-CY

‘The right path of equality’: supporting high school students with autism who type to communicate

Social Interactions of Students with Disabilities Who Use Augmentative and Alternative Communication in Inclusive Classrooms

Support for AAC Use in Preschool, and Growth in Language Skills, for Young Children with Developmental Disabilities

Added to site January 17