An Investigation of Aided Language Stimulation: Does it Increase AAC Use with Adults with Developmental Disabilities and Complex Communication Needs? (summary)



Adults with complex communication needs (CCN) are often unable to communicate functionally using spoken language. Their communicative attempts are often difficult for others to understand and their communicative behaviours might be seen as 'challenging'.

There is evidence that in order to increase positive communications augmentative and alternative communication (AAC) might be beneficial but teaching adults with developmental disabilities to use this effectively can be difficult.

Best practice says that AAC for adults should focus on developing functional communication in natural environments. Aided Language Stimulation (ALS) incorporates these elements. This means that communication partners model the use of AAC, usually using the AAC users own system or similar, and then support the user to respond.

There is limited research into this method of teaching AAC, particularly with adults. This study aimed to address this and looked at the effect of ALS on the functional use of AAC by adults with developmental disabilities and CCN.

What did the authors do?

They followed a five phase process to design interactive communications for adults:

  • Identification and prioritisation of activities
  • Production of interactive 'scripts'
  • Creation of communication overlays
  • Provision of overlays and devices
  • Interaction

Initially 16 adults took part in the study, all had developmental disabilities 8 had CCN and 8 who were able to communicate functionally using spoken language and so provide good role models.

All participants had the same pictures available to them regardless of AAC system used; voice output communication aid, symbols boards or individual symbols. The researchers had an enlarged copy of each overlay to enable them to model aided AAC.

Following identification of the most appropriate AAC technique for each participant they were introduced to two scripts, one, an introductory routine for a group and one used to choose which music to play and to talk about it.

During intervention sessions all participants had access to AAC so that peer modelling by the speaking participants could be encouraged. The group leader researchers followed the script and modelled the use of AAC, pointing to one or two pictures on the large overlays as they spoke and encouraged participation.

There were two episodes of intervention over a number of weeks, followed by a third in which the use of scripts and modelling stopped, participants' use of AAC was monitored to determine whether it had been maintained.

What did they find?

The researchers looked at the number of communicative turns taken and the use of aided AAC. Most turns took the form of a single word.

The pattern of results varied between participants and sometimes between sessions, but all demonstrated some increase in the number of communicative turns and use of aided AAC during the intervention sessions, suggesting that the use of ALS was effective. However this was not always maintained after the intervention period.
Data was not gathered for the speaking participants, but observation indicated some positive changes in their communicative behaviours.


The authors believe that the lack of detailed descriptions of the participants makes generalisation of the results difficult, as does the fact that generalisation of AAC use was only measured subjectively at an informal concert.

There was no formal training for staff at the centre attended by the participants to enable them to provide similar interventions consistently and no facility to monitor follow up at the centre was in place.


Overall the authors conclude that ALS can 'help adults with developmental disabilities and complex communication needs to learn, maintain and enhance their ability to communicate functionally in their natural settings, and, therefore, to participate more fully in life.'

Things you may want to look into:

The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech

Complex communication needs (CCN)

The Effect of Aided AAC Modeling on the Expression of Multi-Symbol Messages by Preschoolers who use AAC

Added to site May 2015