Systematic Review of the Effects of Interventions to Promote Peer Interactions for Children who use Aided AAC (summary)



People who use augmentative and alternative communication (AAC) have been found to be at risk of social isolation and often lack interaction with their peer groups. Children who use AAC face the same barriers as others with disabilities in developing communication with peers and at the same time might struggle to communicate using their AAC systems. Adults are more likely than other children to respond to communication attempts and to do so in predictable ways.

It has been found that whilst the number of turns taken in interactions between children who use AAC and their peers is more equal than when an adult is the communication partner the children using AAC still initiate less and respond more. Only around 5% of interactions by children who use AAC take place with their peers alone, 89% are only with adults and around 6% with adults and peers.

It is important that peer interaction is encouraged as a way to develop friendships.

This project aimed to review studies involving children with disabilities who use AAC. The authors carried out a systematic review of studies that used interventions to increase or improve peer interaction, to consider the strengths and limitations of available evidence and to discuss the implications of this for practice and possible future research.


What did they do?

Following initial searches 19 studies were included in the review. 56 participants took place in the selected studies, there was an age range from 3 to 21 years and a variety of developmental disabilities. All of the studies measured peer interactions at school and three also included interactions during breaks at job placements.

The studies all looked at communication outcomes for children who used AAC, several different variable were considered; interventions with the child who used AAC, interventions with peers and environmental interventions.


What did they find?

All of the studies reported some positive gains in peer interaction though it was not easy to say which particular elements of interventions were most beneficial. Studies looking at multiple intervention types generally showed greater results i.e. those that included child-specific, peer and environmental interventions.

In general older children showed larger gains than younger.

Physical disabilities and social communication issues are not specifically addressed but are acknowledged to be possible influences on outcomes.

The quality of evidence found in the review was of the highest standard in 3 of the studies with 5 more being considered very good. 11 papers had some minor weaknesses in research design meaning further research into these is needed.



The studies included in the systematic review showed that, with support, children who use AAC and their peers could interact more often throughout the school day. Adults supporting peer interaction for children with complex communication needs might lead to increased time spent in peer interaction.

In providing these interventions consideration needs to be given to the individual AAC user, communication partners and the context in which communication takes place. Focussing on all three of these areas increases the likelihood of a positive benefit to the communicative competence of the child who uses AAC.



This study does not consider children who use unaided AAC and whether interventions used with this group would also be beneficial to children who use aided AAC.

It is possible that some studies relevant to the research were not included in the review, and papers that are not peer-reviewed were not included though they might have provided some insight.

In addition it is possible that unpublished studies that were not included in the review might have given more information about ineffective interventions thus leading to suggestions for further research.

Things you may want to look into:

Communication Opportunities for Elementary School Students who use Augmentative and Alternative Communication

Children’s attitudes toward interaction with an unfamiliar peer with complex communication needs: comparing high- and low-technology devices

‘‘He Cares About Me and I Care About Him.’’ Children’s Experiences of Friendship with Peers who use AAC

Added to site January 17