It’s good to talk: developing the communication skills of an adult with an intellectual disability through augmentative and alternative communication (summary)



People who have intellectual disabilities (ID) often have associated difficulties with communication which effect all aspects of their lives. Augmentative and alternative communication (AAC) systems have been identified by researchers as a way of improving communicative abilities and participation in interactions. There is a recognised link between communication difficulties and challenging behaviour, limited communication skills might lead to people using behaviour as a means of communicating their needs, wishes and feelings.

Portable speech generating devices (SGDs) can help improve communication for some people with ID. Evidence for this largely considers the introduction of SGDs for children, there is less evidence about their use with non-verbal adults, particularly with reference to the use of dynamic display SGDs with adults with moderate ID.

What did they do?

This paper presents a single case-study looking at the effect of using an SGD on the communication abilities and pragmatic skills of a non-verbal woman with moderate ID.

The 40 year old woman, Ann, had a history of expressing herself through behaviour including destruction of property and physical aggression. The main reason for her behaviours had been identified as her wish to interact with other people.

Ann's understanding of spoken language was better than her expressive abilities but she found it difficult to initiate or maintain conversations. She was non-verbal and used some unclear signs, gestures, facial expressions and pointing to communicate.

The authors introduced SGDs to determine whether its use impacted on Ann's communication abilities. They used a semi-structured interview and analysis of videos of communication interactions on three occasions, before the intervention, during the assessment phase and after the intervention, to gather data.

During the intervention period Ann was introduced to the SGDs and key staff members were trained in how best to support her use of the devices.

Initially low-tech, static display SGDs were used, but these did not provide enough vocabulary to meet Ann's needs, so a dynamic display system was introduced. By the end of the intervention period (12 months, with 3 months on the dynamic display) she was able to use 16 symbol icons on the device to convey a range of highly motivating personal messages.

What did they find?

Staff working with Ann reported improvements in her verbal expression and a reduction in 'barriers to communication' thus increasing her independence. They also felt that there were changes in Ann's social interaction, including her ability to repair conversation breakdowns. No change was seen in her understanding of spoken language.

Analysis of videoed interactions showed an increase in the number of turns Ann took in conversations. Her ability to maintain topics and introduce new topics also improved when the SGD was used. The rate of communication breakdown was reduced and less clarification was requested by Ann's communication partners.


Therapy outcome measures indicated that Ann's communication abilities were enhanced when she used a dynamic display SGD. She was no longer dependent on familiar people, environments or schedules for effective communication and was able to communicate with a wider range of people about things beyond the immediate context. The SGD was felt to contribute positively on Ann's quality of life.

The success of the intervention needed support from all people working with and supporting Ann, and good communication between them to ensure that she was provided with the best possible opportunities to develop her communication skills.

The authors conclude that the use of SGDs might be an appropriate option for other adults with a moderate ID but that further research is necessary.


This was a single case study and therefore cannot be widely generalised. There was no long term follow-up to determine whether the improvements were maintained.

Things you may want to look into:

Survey of AAC Needs for Adults with Intellectual Disability in New Zealand

The Speech Generating Device (SGD) Mentoring Program: Supporting the Development of People Learning to Use an SGD

Added to site Dec 2015