Augmentative communication, evolution, and progress for nonspeaking children

Technology has provided a recent emergence of augmentative communications systems for nonspeaking children. The effective use of such systems is dependent on the knowledge and skills of physicians, speech-language pathologists, educators, parents, and other professionals working with the child. This article examines the components of an augmentative system including the mode of communication, which includes choices among manual, non-electronic, and electronic systems. The advantages of each mode are discussed. Another major component, the symbol selection process, follows an ascending hierarchy from a representational code involving actual objects to a complex symbolic code with spelling and numerals. Clinical application at the Child Development and Rehabilitation Center of the Oregon Health Sciences University points to the need for thorough interdisciplinary team evaluation during system selection or modification. Data obtained from assessment of 28 multihandicapped children reveal necessary changes, additions, and follow-up for both the mode and symbol system in the majority of children examined.