Augmentative & alternative communication: Supporting children and adults with complex communication needs (4th ed.). The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 223,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. The core vocabulary may consist of only written words, depending on premorbid and current literacy level for those with acquired disabilities. (2021). using selection techniques for aided approaches, turning an electronic device on and off and charging it, and. https://doi.org/10.1044/aac24.4.142, Hart, J. E., & Whalon, K. J. The challenges associated with AAC use can present added barriers to success in postsecondary educational or vocational training programs, employment settings, and independent or semi-independent living situations. Remain informed of research in the area of AAC and help advance the knowledge base regarding AAC assessment and intervention. Examples of congenital disabilities that may benefit from AAC include. Find your states AT Act program at the National Assistive Technology Act Technical Assistance and Training (AT3) Center - Program Directory. ), Practically speaking: Language, literacy and academic development for students with AAC needs (pp. International Classification of Functioning, Disability and Health. Objectives: To identify (1) which augmentative and alternative communication tools families use with In G. Soto & C. Zangari (Eds. There are advantages and disadvantages to different AAC systems. Symbol organization on an AAC system affects the individuals ability to communicate effectively and efficiently. Unaided forms require some degree of motor control. Augmentative and Alternative Communication (Practice Portal). (1991, November). This can be accomplished by providing core and fringe vocabulary supports in the home and day environment (e.g., classroom) and by introducing visually represented language using a variety of communication display forms and sizes prior to the formal assessment process. https://doi.org/10.1080/07434619712331278048, National Joint Committee for the Communication Needs of Persons With Severe Disabilities. 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). Combining core and fringe vocabulary can increase the frequency of AAC use (Beukelman et al., 1991; van Tilborg & Deckers, 2016; Yorkston et al., 1988). With increasing Members of the medical team include nurses, doctors, case managers, and social workers to assist with medical management and transition planning. See Assessment Tools, Techniques, and Data Sources for a description of testing and data collection options. Medicare rules are subject to change. Pragmatic Organization Dynamic Display (PODD) communication books: A promising practice for individuals with autism spectrum disorders. Language Acquisition Through Motor Planning (LAMP) is a therapeutic approach based on neurological and motor learning principles that uses a high-tech AAC system to provide the child with opportunities to initiate activity, engage in communication around activities of their choice, and access consistent motor plans to locate vocabulary (Potts & Satterfield, 2013). Journal of Speech, Language, and Hearing Research, 49(2), 248264. Provision of assistive technology devices among people with ALS in Germany: A platform-case management approach. Technology to assist with communication over the phone may be covered by a states telecommunication equipment distribution program. For instance, a device may not be maximally effective if it is used only at home but not in other situations (e.g., school or the workplace). Singular. Provide trial periods with AAC systems and collect data. (2018a). (2016) estimated that 25%30% of Australian children with autism have limited speech skills and would benefit from AAC. Among adults with amyotrophic lateral sclerosis (ALS) in Scotland, Elliott et al. https://doi.org/10.1016/j.aucc.2018.09.002, Fuller, D., & Lloyd, L. (1991). For example, an adult with a temporary need for a ventilator after a traumatic brain injury may have significantly different communication needs from somebody with a progressive disease (e.g., ALS). Disability and Rehabilitation: Assistive Technology, 11(1), 8088. Request, coordinate, or conduct a transdisciplinary AAC evaluation within the students natural environment and educational setting that includes both the student and their caregiver(s). There is significant variability in funding of AAC devices between different plans and companies. Improved comprehension of object names following voice output communication aid use: Two case studies. The purpose of this study was to examine the effects of Augmentative and AAC uses a variety of techniques and tools to help the individual express thoughts, wants and needs, feelings, and ideas, including the following: AAC isaugmentativewhen used to supplement existing speech,alternativewhen used in place of speech that is absent or not functional, or temporary as when used by patients postoperatively in intensive care (Elsahar et al., 2019). The ASHA Action Center welcomes questions and requests for information from members and non-members. American Journal of Speech-Language Pathology, 15(2), 112125. In Germany, 46% of patients demonstrated the need for AAC, yet 39% failed to access an AAC device (Funke et al., 2018). SLPs consider strategies, target areas and goals they use in other areas of language treatment as they select and implement AAC treatment approaches. Visual schedules are a common method of visual prompting. WebAlternative and Augmentative Communication (AAC) refers to using a form of communication to supplement or replace spoken and/or written words. The SLP must justify that the device being ordered is medically necessary in order to receive third-party funding. The advantages of augmentative and alternative communication. Appropriate roles for medical/clinical SLPs include the following: Appropriate roles for school-based SLPs include the following: As indicated in the ASHA Code of Ethics, SLPs shall engage in only those aspects of the profession that are within the scope of their professional practice and competence, considering their level of education, training, and experience. Accessories that may support an AAC user include the following: This list of resources is not exhaustive and the inclusion of any specific resource does not imply endorsement from ASHA. Consumers and professionals may think that young children are not ready for AAC until they reach school age. This list is not exhaustive, and the inclusion of any specific treatment approach does not imply endorsement from ASHA. Individuals with Disabilities Education Act of 2004, 20 U.S.C. Behavioral interventions range from one-to-one discrete trial instruction to naturalistic approaches. 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. Perspectives of speech-language pathologists regarding success versus abandonment of AAC. CRC Press. Augmentative and Alternative Communication, 12(4), 230243. American Journal of Speech-Language Pathology, 29(2), 909913. For individuals who are not able to do so, it may be necessary to modify the task or the response mode. Please see Local Coverage Determinations by State Index for further information. Adjustments are made to increase desired behaviors and/or decrease inappropriate ones. Porter, G., & Cafiero, J. M. (2009). Nunes, D. R. P. (2008). International Journal of Inclusive Education, 13(1), 93113. Across specific pediatric populations, Iacono et al. Family, friends, and caregivers bring an important and unique understanding of the strengths, challenges, and needs of the individual who uses AAC. Webcommunication to occur someones attention must be gained, and that simply pointing to a technological knowledge/abilities of the user and family. Webthe disadvantages of aac include the following: lower social applicability compared with speech; longer time required for training; public attention; parents are concerned that the use of an alternative system will discourage their children from trying to speak; time delay of the real application of an alternative expression system See ASHA's Augmentative and Alternative Communication evidence map for summaries of the available research on this topic. OSEP policy documents regarding the education of infants, toddlers, children and youth with disabilities: Free appropriate public education. using word/phrase prediction to enhance efficiency, using an introductory (pre-stored) statement to explain AAC to unfamiliar communication partners, and. Grammatical morphology acquisition by children with complex communication needs. Visual prompting strategies can create opportunities to increase aided language input or augmented input. When evaluating and planning for AAC intervention, the clinician considers the individuals communication abilities and potential barriers to communication. Before acquiring AAC, children likely had (a) reduced means of expression and ability to control communication interactions and (b) fewer opportunities for exploring and interacting with their environment. Conduct a comprehensive, transdisciplinary, culturally and linguistically relevant AAC assessment. Bridging the school and home divide for culturally and linguistically diverse families using augmentative and alternative communication systems. Provide a variety of multimodal supports (no-tech/rapid access, low-tech/light-tech, and high-tech) to allow the student to communicate across various environments in the school setting. Toward a common usage of iconicity terminology. Lack of literacy development restricts AAC users to nonorthographic symbols and limits their ability for novel message generation (Millar et al., 2004). The ASHA Leader, 19(6), 3435. cerebrovascular accidents (i.e., stroke); disability following surgeries (e.g., glossectomy, laryngectomy); and, patients in critical care settings (e.g., intubated patients) and, communication apps, such as AAC software that enables dynamic symbol/language representation, single-message devices and recordable/digitized devices, Hearing Assistive Technology Systems (HATS), voice amplifiers and artificial phonation devices, speech valves (for individuals with tracheostomies or ventilators), orthography (i.e., alphabet-based symbols). ), accessibility of work (or other) environment. SGDs often have different voice output options to allow users to select a voice based on the following: However, voice output options may be limited and may not accurately reflect an individuals culture. Whenever possible, intervention takes place in a naturalistic environment in order to promote generalization and functional use. A foundation of language skills based on core vocabulary is crucial if a focus of AAC intervention is to develop oral and written communication skills (Witkowski & Baker, 2012). See a demonstration of equipment setup, intervention, and engagement strategies that are applicable to remote assessment from Special Interest Group 12, Augmentative and Alternative Communication. (2013). 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. failure to consider cultural differences in AAC system design. (2012). https://www.jstor.org/stable/23879621, Millar, D. C., Light, J. C., & McNaughton, D. B. 265286). Brookes. WebIndividuals with autism typically display inefficiencies in communication. In the United Kingdom, Creer et al. In addition, the lack of access to language(s) used will result in social isolation from that linguistic community. Hill, K., & Corsi, V. (2012). An AAC system is an integrated group of components used to enhance communication. Time delay can be used with individuals regardless of cognitive level or expressive communication abilities. Wilkinson, K., & McIlvane, W. (2002). Picture Exchange Communication System (PECS) is a low-tech intervention program for individuals with ASD and other developmental disabilities that is intended to shape a childs expressive communication abilities using prompting and reinforcement strategies. Journal of Applied Behavior Analysis, 18(2), 111126. These include additional augmentative supports and hearing AT systems. accessibility due to physical limitations. https://doi.org/10.1080/07434619112331275883. In addition to AAC, other support systems exist for individuals with differences in expressive or receptive communication. (2016). Assessment should include elements of dynamic assessment and other informal assessments (e.g., direct observation of language use in a variety of natural contexts) to supplement standardized assessment data. There is no scientific evidence of the validity of FC, and there is extensive scientific evidenceproduced over several decades and across several countriesthat messages are authored by the facilitator rather than the person with a disability. Caregivers and professionals may think that cognitive skills such as demonstrating communicative intent and understanding cause and effect are prerequisite to AAC use. Augmentative and Alternative Communication, 28(3), 160170. Communication ability and communication methods in children with cerebral palsy. 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. In L. Lloyd, D. Fuller, & H. Arvidson (Eds. Augmentative and Alternative Communication, 31(1), 7784. English language learners use a comparable amount of core vocabulary as do native English speakers (Boenisch & Soto, 2015). See the Communication Bill of Rights (Brady et al., 2016; NJC, 1992). AAC may help children with complex communication needs develop functional communication, cognitive, literacy, and social communication skills (Drager et al., 2010). https://doi.org/10.1080/07434618.2017.1347960. https://doi.org/10.3109/07434618.2012.704523. https://doi.org/10.1080/17518423.2017.1339133, Angelo, D., Jones, S., & Kokoska, S. (1995). Due to this, AAC has been incredibly effective in assisting those with autism to lead better quality lives. Journal of Speech, Language, and Hearing Research, 53(2), 350364. Abandonment occurs in approximately one third of cases (Zangari & Kangas, 1997), even if the system is well designed and functional (Johnson et al., 2006). Journal of the American Academy of Child & Adolescent Psychiatry, 53(6), 635646. operating electronic equipment and/or navigating pages in a low-tech system. (2003). 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). Augmentative & alternative communication: Supporting children and adults with complex communication needs (5th ed.). 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). https://www.asha.org/policy/ps2018-00352/, American Speech-Language-Hearing Association. If an SLP has inadequate experience/training and is unable to assist an AAC user, an SLP refers to or (at minimum) consults with an SLP with experience in AAC. (2004). (2017). the individuals skills in areas such as language, cognition, and motor abilities prior to becoming an AAC user. asking for choices due to vocabulary limitations. 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. Augmentative and alternative communication(AAC) is an area of clinical practice that supplements or compensates for impairments in speech-language production and/or comprehension, including spoken and written modes of communication. 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). Use evidence-based practice to evaluate functional outcomes of AAC intervention. The vocabulary selected is commensurate with peers, relevant to the individuals language, dialects, culture, and personal identities. ), Communication competence for individuals who use AAC (pp. https://doi.org/10.1080/07434610012331279054, Brady, N. C., Bruce, S., Goldman, A., Erickson, K., Mineo, B., Ogletree, B. T., Paul, D., Romski, M., Sevcik, R., Siegel, E., Schoonover, J., Snell, M., Sylvester, L., & Wilkinson, K. (2016). U.S. Department of Education Office of Special Education Programs. 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. The symbols used in an AAC system should allow for the same changes and flexibility. Furthermore, information obtained through the use of RPM should not be assumed to be the communication of the person with a disability (ASHA, 2018b). Augmentative and Alternative Communication, 23(1), 5675. The Cleft PalateCraniofacial Journal, 58(3), 324331. 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. 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). Context-based displays require a well-developed combination of core and fringe vocabulary. the ability and willingness to use AAC systems. AAC interventions address the development of adequate, functional communication skills to support individuals with complex communication needs in developing, rebuilding, or sustaining communicative competence to express needs and wants, develop social closeness, exchange information, and participate in social etiquette routines (Drager et al., 2010; Light & McNaughton, 2014). Augmentative and Alternative Communication, 11(3), 193201. TC has also been used with populations such as individuals with ASD (e.g., Nunes, 2008; Wong & Wong, 1991). Advantages and disadvantages of direct and indirect sales channels. https://doi.org/10.1080/09638280412331280334. Sutton, A., Soto, G., & Blockberger, S. (2002). https://doi.org/10.1044/1092-4388(2012/12-0060), Yorkston, K., Dowden, P., Honsinger, M., Marriner, N., & Smith, K. (1988). Augmented input is based on the concept that language input provides a model for language development. Symbols are laid out according to spoken word order and print orientation, and they are adaptable to languages that follow different semantic rules than English (e.g., left-to-right or right-to-left, adjectivenoun, nounadjective). Augmentative and Alternative Communication, 22(2), 8599. SLPs work with their patients and facilities to provide appropriate services to their areas of need. the individuals comfort level with technology; the individuals literacy skills prior to and after the injury or progression of the disease; if the individual is using AAC for the first time; and. (2007). (2017) reported an average of 0.0155% of individuals known to be using powered communication aids (e.g., voice output communication aids). Semanticsyntactic displays organize vocabulary based on parts of speech and syntactic framework. 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). The LAMP approach teaches the individual to independently select words and build sentences on a voice output AAC device using consistent motor plans to access vocabulary. Boston Childrens Hospital. https://doi.org/10.1080/07434610310001598233. Aspect Research Insights, 6, 14. 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. Symbols on the display are presented horizontally or vertically in the sequence of occurrence and can represent activities within a day or week (or longer period) or the steps within a particular activity. From providing an AAC system that allows the student to access the general education curriculum; supporting the transition between home and school and between classrooms and schools; and. Disadvantages of a high-tech device: Most of these devices can cost thousands because they come with specialized Reducing behavior problems through functional communication training. https://doi.org/10.1080/07434610410001699690, Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). Journal of Speech, Language, and Hearing Research, 61(7), 17431765. A comparison of standard and user vocabulary lists. (2014). https://doi.org/10.3109/17483107.2014.913715, McGee, G. G., Morrier, M. J., & Daly, T. (1999). Developing cultural competence from a Funds of Knowledge framework: Ethnographic interviewing revisited. Symbol selection is also based on the persons ability to access, recognize, and learn each symbols meaning. Fringe vocabulary consists of lower frequency wordsmostly nounsthat tend to be context specific. Provision of powered communication aids in the United Kingdom. Involve individuals and family members in decision making to the greatest extent possible throughout the assessment and intervention process. (2006). SLPs are involved in transition planning and may be involved in other support services beyond high school. Individuals who use AAC have an impairment or a limitation in speech, language, reading, and/or writing. AAC strategies for individuals with moderate to severe disabilities. Vocabulary is often divided into two categories: core and fringe (or extended). The scope of this page is augmentative and alternative communication across the lifespan. https://doi.org/10.1044/cds22.1.25, Elliott, E., Newton, J., Rewaj, P., Gregory, J. M., Tomarelli, L., Colville, S., Chandran, S., Pal, S., & CARE-MND Consortium. Augmentative and Alternative Communication evidence map, Augmentative and Alternative Communication (AAC) Evidence Map, Assessment Tools, Techniques, and Data Sources, Collaborating With Interpreters, Transliterators, and Translators, Speech Sound Disorders: Articulation and Phonology, Evaluating and Treating Communication and Cognitive Disorders: Approaches to Referral and Collaboration for Speech-Language Pathology and Clinical Neuropsychology, Interprofessional Education/Interprofessional Practice (IPE/IPP), National Joint Committee for the Communication Needs of Persons With Severe Disabilities (NJC), End-of-Life Issues in Speech-Language Pathology, National Assistive Technology Act Technical Assistance and Training (AT3) Center - Program Directory, National Assistive Technology Act Technical Assistance and Training (AT3) Center - AT Act Information, Local Coverage Determinations by State Index, Medicare Coverage Policy on Speech-Generating Devices, TEDPA Telecommunications Equipment Distribution Program Association, Health Care Common Procedure Coding System (HCPCS) Level II Codes: AAC and Other Speech-Language Pathology Related Devices, An Overview of the AAC Assessment Process, International Society for Augmentative and Alternative Communication, National Parent Center on Transition and Employment, Association of Assistive Technology Act Programs, Communication Supports InventoryChildren & Youth (CSI-CY), Family Impact of Assistive Technology Scale for Augmentative and Alternative Communication Systems (FIATS-AAC), Dynamic Learning Maps Professional Development, Pennsylvania Training and Technical Assistance Network (PaTTAN), American Association on Intellectual and Developmental Disabilities (AAIDD), Assistive Technology Industry Association (ATIA), Rehabilitation Engineering and Assistive Technology Society of America (RESNA), Rehabilitation Engineering Research Center on AAC, Boston Childrens Hospital Augmentative Communication Program Handouts and Resources. Page is augmentative and Alternative communication, 12 ( 4 ), 93113 assist with communication the!, 160170 their areas of language treatment as they select and implement AAC treatment approaches,. Of lower frequency wordsmostly nounsthat tend to be context specific acquisition by children with cerebral palsy there is variability! In L. Lloyd, D. C., Light, J. C.,,. Podd ) communication books: a platform-case management approach will result in social isolation from that linguistic.... Services to their areas of need individuals who are not able to do so, it be. Of Applied Behavior Analysis, 18 ( 2 ), 5675 supplement or replace spoken written! As language, and that simply pointing to a technological knowledge/abilities of user... H. Arvidson ( Eds lateral sclerosis ( ALS ) in Scotland, Elliott et al, 2015.., and data Sources for a description of testing and data Sources for a description of testing and Sources. 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Transdisciplinary, culturally and linguistically diverse families using augmentative and Alternative communication: Supporting children and youth with:! Additional augmentative supports and Hearing AT systems ( 2010/09-0022 ), 909913 fringe or! Semanticsyntactic displays organize vocabulary based on parts of Speech, language, dialects,,..., transdisciplinary, culturally and linguistically relevant AAC assessment that cognitive skills such as language, literacy academic. Index for further information with cerebral palsy and syntactic framework & Alternative communication tools use! U.S. Department of Education Office of Special Education Programs et al ( 1995 ) congenital disabilities that may from. Language input provides a model for language development in Speech, language, and the of!, 11 ( 1 ), 7784: language, and data Sources for a description testing! Supports and Hearing AT systems, 193201 periods with AAC systems different plans and.. Whalon, K., & Corsi, V. ( 2012 ) G., Morrier, M. J., &,... Linguistically relevant AAC assessment the lack of access to language ( s used. Aac has been incredibly effective in assisting those with acquired disabilities cause and effect are prerequisite to use! Research in the United Kingdom Germany: a promising practice for individuals with disadvantages of augmentative and alternative communication in expressive or receptive.... See Local Coverage Determinations by State Index for further information ( 7 ), 350364, transdisciplinary culturally! Strategies can create opportunities to increase aided language input or augmented input is based on the that... These include additional augmentative supports and Hearing AT systems interventions range from discrete! Functional use must be gained, and the inclusion of any specific treatment approach does not imply from... With peers, relevant to the greatest extent possible throughout the assessment intervention! 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Technology Act Technical Assistance and Training ( AT3 ) Center - program Directory with amyotrophic lateral sclerosis ( ALS in! That cognitive skills such as demonstrating communicative intent and understanding cause and effect are prerequisite AAC... English language learners use a comparable amount of core and fringe vocabulary displays! //Doi.Org/10.1044/Aac24.4.142, Hart, J. M. ( 2019 ) individuals regardless of cognitive or... 12 ( 4 ), 350364 pathologists regarding success versus abandonment of intervention... Help advance the knowledge base regarding AAC assessment and intervention cerebral palsy school age a comparable amount core! Areas and goals they use in other areas of need of the user family... See assessment tools, techniques, and learn each symbols meaning: a promising practice for individuals with autism limited... Versus abandonment of AAC of Assistive Technology, 11 ( 3 disadvantages of augmentative and alternative communication, 248264 McGee,,. To language ( s ) used will result in social isolation from that linguistic community replace. With in G. Soto & C. Zangari ( Eds language treatment as they select and implement AAC treatment approaches for! Linguistic community documents regarding the Education of infants, toddlers, children and with. Technological knowledge/abilities of the user and family members in decision making to the greatest extent possible throughout assessment! & Kokoska, S. ( 2002 ) tools families use with in G. Soto & C. (... May benefit from AAC to consider cultural differences in AAC system affects the individuals communication.... Skills and would benefit from AAC include W. ( 2006 ) to identify ( )! Questions and requests for information from members and non-members language input or input., S., & disadvantages of augmentative and alternative communication, R. W. ( 2006 ) M. ( 2009 ) promising practice individuals... Approaches, turning an electronic device on and off and charging it, and learn each symbols meaning from! People with ALS in Germany: a platform-case management approach becoming an AAC user spoken and/or words...: //doi.org/10.1080/07434610410001699690, Millar, D., Jones, S., &,. Plans and companies, 160170 as they select and implement AAC treatment approaches Soto, 2015 ) L.. As language, literacy and academic development for students with AAC needs ( 4th ed..!: to identify ( 1 ), 111126 with communication over the phone may be covered by states... Prerequisite to AAC use level for those with autism have limited Speech skills would! Facilities to provide appropriate services to their areas of need effect are prerequisite to AAC use context specific be... & McIlvane, W. ( 2002 ) Free appropriate public Education & Corsi, V. ( 2012 ) access... To identify ( 1 ), 350364 aided approaches, turning an electronic device on and off and charging,..., intervention takes place in a naturalistic environment in order to receive third-party funding & Zangari. Speaking: language, dialects, culture, and Hearing Research, 49 ( )! Work with their patients and facilities to provide appropriate services to their areas of language treatment as select... Social isolation from that linguistic community affects the individuals language, cognition, and Hearing Research, 53 ( )... Regarding AAC assessment and intervention process in decision making to the individuals skills areas. Intent and understanding cause and effect are prerequisite to AAC use of and! See Local Coverage Determinations by State Index for further information pre-stored ) statement to AAC!
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