Communicative participation changes in pre-school children receiving augmentative and alternative communication intervention (summary)



Participation or ‘involvement in life situations’ is recognised as vital to children’s development. Children with special needs generally want to participate meaningfully in their communities, however this is not always easy. Children who have significant communication impairments can face limited social interactions which in turn can lead to restricted play skills and possible rejection by their peers. These restrictions reduce opportunities to practise communication skills and so can become a vicious circle.

There are a limited number of studies into the effectiveness of augmentative and alternative communication (AAC) intervention with pre-school children. Those studies that have been carried out tend to focus on particular ‘skills’ or language functions rather than the effect of AAC intervention on participation outcomes in naturalistic settings.

This study aimed to measure communication participation outcomes for eight children who were receiving AAC interventions over a 12 month period.

What did they do?

Eight pre-school children, aged from 16 months to 4 years 11 months, and their families were involved in the study. Prior to intervention the communication levels for all of the children were reported to be either ‘inconsistent sender and/or receiver with familiar partners’ or ‘seldom an effective sender and receiver even with familiar partners’.

Parents completed two outcome measures assessments at the beginning and end of the 12 month intervention period. One of these, the Focus on Communication Outcomes Under Six (FOCUS), was also completed at the six-month point.

The children were introduced to AAC after completion of the initial questionnaires. The AAC systems used varied and included signs, Picture Exchange Communication System (PECS) and assistive technology. Interventions were carried out by the children’s local speech and language teams who were not given any direction about the form or frequency of intervention sessions. On average the children received around 15 hours of input over the 12 month period, with a range from 4.5 to 24 hours. This included individual work and support for families.

As well as outcome questionnaires parents and speech and language pathologists were asked to describe changes in the child at the 6 and 12 month points.

What did they find?

The findings were positive. Six children showed significant improvements in FOCUS scores. Seven children showed improved communication skills in the second outcome measure used, the Ages and Stages Questionnaire-Social/Emotional (ASQ-SE). Only two participants showed improvements in the non-communication elements of the measures, indicating that the changes were likely to be due to the AAC intervention.

The greatest improvements were in receptive language/attention, pragmatic use of communication and social/play, with some variation between the first 6 month period and the second.


The authors suggest the AAC interventions made a ‘real-world’ difference to the children’s communication participation. Comments from parents and therapists support this being true across a range of communicative functions, intelligibility and peer interaction.


This study involved only a small number of children and its findings might not generalise to the wider population. As the intervention was different for each child ‘cause and effect’ conclusions cannot be drawn. More and longer term studies, including measurement of the children’s perceptions and experiences are needed.

Things you may want to look into:

Early Intervention and AAC: What a Difference 30 Years Makes

Enhancing the Alternative and Augmentative Communication Use of a Child with Autism through a Parent-implemented Naturalistic Intervention

Teaching Paraeducators to Support the Communication of Young Children with Complex Communication Needs

An Examination of Relations Between Participation, Communication and Age in Children with Complex Communication Needs

The use of augmentative and alternative communication methods with infants and toddlers with disabilities: a research review

Added to site May 2016