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Dr. Caroline Ramsey Musselwhite

Sunday, November 8, 2020

Device Adoption and Abandonment

I wrote this in a response to a question posted in the ASHA Special Interest Group SIG 12. Somebody asked if we could define which AAC systems or vocabularies are more likely to be adopted long term or abandoned to collect dust on the shelf. I have modified the format slightly to create this blogpost.

I myself have devices in my home that are still on the shelf gathering dust because I could not bear to throw them away or bother to take them to electronic recycling center. A couple that come to mind – an old iPod, a pager, an old PDA, and even a cell phone. That doesn’t mean they weren’t great devices; the technology just changed and I moved on to other things. And the AAC tools that I have used with my clients have changed over the years, as well. If I dug through my boxes, I am sure I would find old spare batteries and screen protectors that don’t fit anything any more. And some light and mid tech devices that have corroded batteries, waiting for the perfect person to donate them to.  I loved these things so much that I was afraid to let them go, and instead forced them into exile on my shelf.

What Is Long Term Device Adoption?

I think sometimes there is a fundamental problem in identifying “long term AAC device adoption.” We are becoming aware of how critical it is to provide multiple modes of expression to people who are not able to consistently access intelligible verbal speech. What we need to be careful of is avoiding mandating modes and discriminating against those who value other methods of expression over high tech AAC systems.  We all choose different methods of expression depending on the dynamics of the interaction. So, when asked if a person uses AAC, we may get different answers from that person, from his/her communication partners, and from the casual observer. 

Expectations of Outcomes.

Another consideration is the expected outcome from long term adoption of AAC. For some people, using symbol-based AAC is a way to reduce the stress of verbal speech in specific instances. Over time, the AAC tools used may vary, even throughout a single day. Others learn to visualize and integrate some techniques to become more verbally fluent and foster friendships with those who take time to learn their speech patterns. Using high tech AAC may be less frequent, but not necessarily less valued by those individuals and the people who care about them. 

Using Literacy to Support Communication.

Another end goal for AAC is having the tools necessary to say “whatever you want, whenever you want to whomever you want (Gayle Porter).”  In the AAC Profile (Tracy Kovach), achieving the highest levels of operational proficiency with a communication device includes being able to program it independently.  Most communication applications are currently configured in a way that customizing and saving messages to be used at a later date requires at least some literacy skills.  Achieving the highest levels of proficiency in strategic skills may also incorporate literacy skills.  Finding where words are located in robust pre-programmed systems is easier when you can access the letters of the alphabet (e.g., look for pages of verbs that begin with “S,” or search for words that start with “B” at the beginning of an alphabetized category page).  Vocabularies such as WordPower Basic 60 are highly robust and support sentence-building, morphology, and even spelling patterns (pages for phonetics, word families, and word prediction).  The same can be true for many grid-based robust AAC vocabularies (Crescendo, Snap + Core First, SuperCore for Grid).  But once they have achieved a level of literacy, many adults will use other tools that are more integrated into their other communication tools. If they can use the keyboard on a computer, smart phone or tablet, they are likely to use that instead of trying to start from an AAC app because it is one less step. Again, this wouldn’t diminish the value of AAC for certain situations – if they find using social media and email a more comfortable method of connecting with others, the use of other AAC tools may not be as prevalent in day to day interactions. Individuals who need alternate access are likely to use other adapted on-screen keyboards and may or may not identify them as AAC if not tied to speech output (such as the use of alternate keyboard in Grid, Communicator, or even Essence).

Inherent Differences in Language Systems.

There is also a significant difference in symbol-based strategies for word retrieval. People who use semantic compaction and icon sequencing (e.g, Unity, Unidad, LAMP Words for Life, Speak for Yourself) learn different ways to expand their vocabulary exponentially based on icon combinations. Having everything on the home page has potential to provide quick access to thousands of words without using spelling.  I have known many adults who use icon sequencing long term and have figured out ways to integrate this system into other social media by using it as an alternative keyboard. 


I don’t know if this necessarily answers your question, but may help you figure out another way to ask more specific questions. Think about whether you are asking the people who are teaching AAC, learning AAC, or living with a family member who had diminished capacity for intelligible speech. Think about why somebody might adopt a different piece of technology over time and remember not to jump to the conclusion that what was used earlier was any less valuable just because it isn’t being used now.  

Consider asking about the value of a tool that may have had only a brief period of brilliance, but nonetheless was life-changing. For some of the people that I have connected with, people who use AAC have lifelong relationships with their speech/language pathologist. So even though many people I am friends with on Facebook don’t use AAC with everybody, and may not even use it very often, it was what drew is together in the first place. Identifying as someone who loves AAC and values multimodal expression makes me part of a diverse community. 

Look for me in lots of Facebook groups, connecting with people who use and/or advocate for use of AAC. Wish me luck in creating my new website: LanguageAACtivist.xyz

Deanna K Wagner, MS/CCC-SLP

Email: outandabout@therapyone.com