Children Who Use Communication Aids Instructing Peer and Adult Partners During Play-Based Activity (summary)



Play is important to children’s social, emotional and cognitive development, helping to develop an understanding of the world, problem solving skills etc. It is not known how limited access to play might affect children with significant motor impairment who use communication aids as they acquire language.

Construction play, in which something is made or built, accounts for a large percentage of play activity in typically developing pre-school children, however as it involves manipulation of physical objects children with severe motor impairments might not be able to engage with it independently even with the use of technology.

In children with motor impairments language is often their strongest skill, but aided vocabulary tends to be more restricted and slower to produce than natural speech. However aided communication can offer a means of actively participating in play and other activities by giving instructions to others to act for them. There is limited information about the extent to which children and young people who use communication aids do this, interactions are generally thought to be dominated by the speaking communication partner.

To be able to direct another person to carry out actions that are not already known requires the use of ‘referential communication’ i.e. naming or describing items so that the listener can identify them. This skill develops over time in typically developing children as they begin to understand the minimum amount of information they need to give.

Barrier games have been suggested as a way to develop this skill in people who use augmentative and alternative communication (AAC), this study used this type of activity to investigate how children who use AAC provide real instructions about unknown items to listeners.


What did they do?

The study involved at a group of 18 children aged between 5 and 15 who had severe motor difficulties and used AAC. It looked into a number of factors influencing  the extent to which children who use communication aids succeed in leading a goal-oriented interaction including whether they give instructions that are similar to or different from those of typically developing children who use natural speech. A comparison group of 17 children were also included.

The children interacted with up to three familiar communication partners, parents, professionals and peers. They were assessed on four tasks, each presented twice; dressing a doll, making a bead necklace, building a tower of blocks and making a pattern of dominoes. The tasks included 29 objects and 67 attributes needed to describe their size, shape, colour, location, orientation and sequence. The interactions were analysed into five categories; success, time required, misunderstandings, child contributions and partner contributions.

The activities were all presented as barrier tasks in which the child had to instruct the communication partner to create an identical model to the one they could see.


What did they find?

The children in the comparison group generally gave more information when describing the elements and as a result there was little spoken interaction between them and their communication partners during the tasks as the partners focussed on constructing the model and listening to the instructions. The aided communication group’s partners had lots of waiting time as the children constructed messages.

The AAC user group made significantly more errors and took longer to complete the tasks than the comparison group. This group also had more misunderstandings; mainly communication partners not understanding the children. Around two-thirds of these were resolved, often through questioning by the communication partner. The AAC user group also showed lower than expected specificity/precision in their descriptions.

The communication partners of the children who used AAC provided more help than those in the comparison group, requesting specific information whereas the typically developing children tended to be asked more open-ended questions.

It was found that the older children and those with higher levels of communication functioning and non-verbal reasoning were more successful in solving the tasks. There was no association between the length of time taken and the success rate.



The authors conclude that children with motor impairments can successfully instruct others to carry out tasks and in doing so alter the balance of a communication partnership.

On average it took the children who used AAC five times longer to solve tasks than their speaking peers and access to the communication device through scanning was much slower than direct selection, but did not interfere with the ability to successfully complete the activity.

It is suggested that limited access to a communication aid and restricted vocabulary availability are likely to impact on participation and communication, and that the vocabulary to express subtle differences between e.g. a square and a cube might not be available to AAC users.

The authors conclude that children who use communication aids can direct the actions of others in construction play, though not always as successfully as typically developing peers. They suggest that interventions focussing on offering opportunities for autonomous communication in structured activities might promote the development of aided language and autonomy in children with severe physical impairments and little or no speech.



This was a small sample of children with no cognitively matched control group. It did not consider what children might have done with a communication system specially designed to meet the needs of the task nor with unfamiliar communication partners.

There is also a need for more detailed analysis of a wider range of activities.


Things you may want to look into:

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

Differences in maternal responsive and directive behavior during free play with and without aided AAC

Participation and Enjoyment in Play with a Robot between Children with Cerebral Palsy who use AAC and their Peers


Added to site August 2016