We investigated caregivers’ experiences with early augmentative and alternative communication (AAC) services and explored the contextual factors shaping AAC use in family routines. We conducted thematic analysis of semi-structured online interviews with 20 caregivers of children aged 24–60 months with intellectual and developmental disabilities. Caregivers reported three service delivery challenges in early intervention (EI): limited AAC instruction, systemic barriers to access, and provider resistance to high-tech AAC. Seven contextual factors also shaped AAC use at home, including early “growing pains,” societal perceptions, device cost, time and fatigue, design gaps for young children, evolving caregiver beliefs, and reliance on non-symbolic communication. These findings highlight the need for greater provider support to help families use AAC effectively at home. Future research should test strategies to address these common barriers to AAC implementation.
AlbertP.RomskiM.SevcikR. A.MorrisR. D. (2021). Patterns of cognition, communication, and adaptive behavior in children with developmental disabilities. American Journal on Intellectual and Developmental Disabilities, 126(4), 324–340. https://doi.org/10.1352/1944-7558-126.4.324
AndersonK.BalandinS.StancliffeR. (2014). Australian parents’ experiences of speech generating device (SGD) service delivery. Developmental Neurorehabilitation, 17(2), 75–83. https://doi.org/10.3109/17518423.2013.857735
4.
AndersonK. L.BalandinS.StancliffeR. J. (2016). “It’s got to be more than that”. Parents and speech-language pathologists discuss training content for families with a new speech generating device. Disability and Rehabilitation: Assistive Technology, 11(5), 375–384. https://doi.org/10.3109/17483107.2014.967314
5.
ArserioA. P.BiggsE. E.HolzE. (2023). Experiences of parents supporting their young children who use speech-generating devices. Journal of Early Intervention, 46(4), 562–583https://doi.org/10.1177/10538151231199898
6.
BekteshiS.KoningsM.KarlssonP.CriekingeT. V.DanB.MonbaliuE. (2023). Teleintervention for users of augmentative and alternative communication devices: A systematic review. Developmental Medicine & Child Neurology, 65(2), 171–184. https://doi.org/10.1111/dmcn.15387
7.
BeukelmanD. R.LightJ. C. (2020). Augmentative & alternative communication: Supporting children and adults with complex communication needs (5th ed.). Brookes.
8.
BiggsE. E.TherrienM. C. S.AbarcaD.RomanoM.Barton HulseyA.CollinsS. C. (2024). Examining the family-centeredness of speech-language pathologists working with children who use augmentative and alternative communication. American Journal of Speech-Language Pathology, 33(2), 1021–1039. https://doi.org/10.1044/2023_AJSLP-23-00301
9.
BingerC.DouglasN.Kent-Walsh Jennifer. (2022). Planning for implementation science in clinical practice research: An augmentative and alternative communication example. American Journal of Speech-Language Pathology, 31(3), 1039–1053. https://doi.org/10.1044/2021_AJSLP-21-00085
BraunV.ClarkeV. (2021). Thematic analysis: A practical guide. Sage.
12.
CoburnK. L.JungS.OusleyC. L.SowersD. J.WendelkenM.WilkinsonK. M. (2021). Centering the family in their system: A framework to promote family-centered AAC services. Augmentative and Alternative Communication, 37(4), 229–240. https://doi.org/10.1080/07434618.2021.1991471
13.
CookC. R.LyonA. R.LockeJ.WaltzT.PowellB. J. (2019). Adapting a compilation of implementation strategies to advance school-based implementation research and practice. Prevention Science, 20(6), 914–935. https://doi.org/10.1007/s11121-019-01017-1
14.
CreswellJ. W.PothC. N. (2018). Qualitative inquiry and research design: Choosing among five approaches. SAGE Publications.
15.
CrispC.DrauckerC. B.EllettM. L. C. (2014). Barriers and facilitators to children’s use of speech-generating devices: A descriptive qualitative study of mothers’ perspectives. Journal for Specialists in Pediatric Nursing, 19(3), 229 – 237. https://doi.org/10.1111/jspn.12074
16.
CroweB.MachalicekW.WeiQ.DrewC.GanzJ. (2022). Augmentative and alternative communication for children with intellectual and developmental disability: A mega-review of the literature. Journal of Developmental and Physical Disabilities, 34, 1–42. https://doi.org/10.1007/s10882-021-09790-0
17.
DadaS.FloresC.BastableK.SchlosserR. W. (2020). The effects of augmentative and alternative communication interventions on the receptive language skills of children with developmental disabilities: A scoping review. International Journal of Speech-Language Pathology. 23(3) 247–257. https://doi.org/10.1080/17549507.2020.1797165
DonatoC.SpencerE.Arthur-KellyM. (2018). A critical synthesis of barriers and facilitators to the use of AAC by children with autism spectrum disorder and their communication partners. Augmentative and Alternative Communication, 34(3), 242–253. https://doi.org/10.1080/07434618.2018.1493141
20.
DouglasN. F.BurshnicV. L. (2019). Implementation science: Tackling the research to practice gap in communication sciences and disorders. Perspectives of the ASHA Special Interest Groups, 4(1), 3–7. https://doi.org/10.1044/2018_PERS-ST-2018-0000
21.
GevarterC.ZamoraC. (2018). Naturalistic speech-generating device interventions for children with complex communication needs: A systematic review of single-subject studies. American Journal of Speech-Language Pathology, 27(3), 1073–1090. https://doi.org/10.1044/2018_AJSLP-17-0128
22.
GlaserB.StraussA. (1967). The discovery of grounded theory: Strategies for qualitative research. Sociology Press.
23.
GoldbartJ.MarshallJ. (2004). “Pushes and pulls” on the parents of children who use aac. Augmentative and Alternative Communication, 20(4), 194–208. https://doi.org/10.1080/07434610400010960
24.
HetzroniO. E.Ne’emanA. (2023). Augmentative and alternative communication continuing education programs for multidisciplinary teams—Does it make a difference?Journal of Policy and Practice in Intellectual Disabilities, 20(4), 359–370. https://doi.org/10.1111/jppi.12467
25.
Individuals with Disabilities Education Act, 20 U.S.C. § 1400. (2004).
JohnsonH.Van NieropM.IaconoT. (2021). Parents’ perspectives of an Australian augmentative and alternative communication service: “I clapped for my child.”Research and Practice in Intellectual and Developmental Disabilities, 8(1), 46–59. https://doi.org/10.1080/23297018.2020.1861552
28.
JohnstonS. S.BlueC.GevarterC.IvyS.StegengaS. (2020). Opportunity barriers and promising practices for supporting individuals with complex communication needs. Current Developmental Disorders Reports, 7(3), 100–108. https://doi.org/10.1007/s40474-020-00195-w
29.
Kent-WalshJ.BingerC. (2013). Fundamentals of the ImPAACT program. Perspectives on Augmentative and Alternative Communication, 22(1), 51–58. https://doi.org/10.1044/aac22.1.51
30.
Kent-WalshJ.MurzaK. A.MalaniM. D.BingerC. (2015). Effects of communication partner instruction on the communication of individuals using AAC: A meta-analysis. AAC: Augmentative & alternative communication, 31(4), 271–284. https://doi.org/10.3109/07434618.2015.1052153
31.
KimJ.SotoG. (2024). A comprehensive scoping review of caregivers’ experiences with augmentative and alternative communication and their collaboration with school professionals. Language, Speech, and Hearing Services in Schools, 55(2), 607–627. https://doi.org/10.1044/2024_LSHSS-23-00117
32.
LorangE.MaltmanN.VenkerC.EithA.SterlingA. (2022). Speech-language pathologists’ practices in augmentative and alternative communication during early intervention. Augmentative and Alternative Communication, 38(1), 41–52. https://doi.org/10.1080/07434618.2022.2046853
33.
MandakK.LightJ. (2018). Family-centered services for children with complex communication needs: The practices and beliefs of school-based speech-language pathologists. Augmentative and Alternative Communication, 34(2), 130–142. https://doi.org/10.1080/07434618.2018.1438513
34.
McWilliamR.A. (2010). Routines-Based early intervention: Supporting young children and their families. Brookes Publishing.
35.
MoorcroftA.ScarinciN.MeyerC. (2020). ‘We were just kind of handed it and then it was smoke bombed by everyone’: How do external stakeholders contribute to parent rejection and the abandonment of AAC systems?International Journal of Language & Communication Disorders, 55(1), 59–69. https://doi.org/10.1111/1460-6984.12502
36.
OgletreeB. T. (2021) Augmentative and alternative communication: Challenges and solutions. Plural Publishing, 2021.
37.
O’NeillT.LightJ.PopeL. (2018). Effects of interventions that include aided augmentative and alternative communication input on the communication of individuals with complex communication needs: A meta-analysis. Journal of Speech, Language, and Hearing Research, 61(7), 1743–1765. https://doi.org/10.1044/2018_JSLHR-L-17-0132
38.
O’NeillT.WilkinsonK. M. (2020). Preliminary investigation of the perspectives of parents of children with cerebral palsy on the supports, challenges, and realities of integrating augmentative and alternative communication into everyday life. American Journal of Speech-Language Pathology, 29(1), 238–254. https://doi.org/10.1044/2019_AJSLP-19-00103
39.
OstergrenJ. A.Vento-WilsonM. (2023). Speech-Language Pathology assisstance: A resource manual (3rd ed.). Plural Publishing Inc.
40.
QuinnE. D.CookA.RowlandC. (2019). An online community of practice to improve intervention for individuals with complex communication needs. AAC: Augmentative and Alternative Communication, 35(2), 142–147. Scopus. https://doi.org/10.1080/07434618.2019.1566400
41.
QuinnE. D.KurinK.CookA. R.KaiserA. P. (2024). Delivering enhanced milieu teaching to toddlers with down syndrome via hybrid telepractice: A single-case experimental design. American Journal of Speech-Language Pathology, 33(6), 2991–3011. https://doi.org/10.1044/2024_AJSLP-23-00454
42.
RobertsM. Y.KaiserA. P.WolfeC. E.BryantJ. D.SpidalieriA. M. (2014). Effects of the teach-model-coach-review instructional approach on caregiver use of language support strategies and children’s expressive language skills. Journal of Speech, Language, and Hearing Research, 57(5), 1851–1869. https://doi.org/10.1044/2014_JSLHR-L-13-0113
43.
RomanoM.SchnurrM. (2022). Mind the gap: Strategies to bridge the research-to-practice divide in early intervention caregiver coaching practices. Topics in Early Childhood Special Education, 42(1), 64–76. https://doi.org/10.1177/0271121419899163
44.
RomskiM. A.SevcikR. A.AdamsonL. B.CheslockM.SmithA.BarkerR. M.BakemanR. (2010). Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents. Journal of Speech, Language, and Hearing Research, 53(2), 350–364. https://doi.org/10.1044/1092-4388(2009/08-0156)
45.
RomskiM.SevcikR. A.AdamsonL. B.SmithA.CheslockM.BakemanR. (2011). Parent perceptions of the language development of toddlers with developmental delays before and after participation in parent-coached language interventions. American Journal of Speech-Language Pathology, 20(2), 111–118. https://doi.org/10.1044/1058-0360(2011/09-0087)
46.
RomskiM.SevcikR. A.Barton-HulseyA.WhitmoreA. S. (2015). Early intervention and AAC: What a difference 30 years makes. Augmentative and Alternative Communication, 31(3), 181–202. https://doi.org/10.3109/07434618.2015.1064163
SchladantM.DowlingM. (2020). Parent perspectives on augmentative and alternative communication integration for children with Fragile X Syndrome: It starts in the home. Intellectual and Developmental Disabilities, 58(5), 409–421. https://doi.org/10.1352/1934-9556-58.5.409
51.
SevcikR. A.RomskiM.WaltersC.KaldesG. (2021). Earlier is better: Challenges to implementing AAC during the first years of a child’s life. In OgletreeB. T. (Ed.), Augmentative and alternative communication: Challenges and solutions (pp. 21–30). Plural.
52.
SotoG.VegaJ. (2024). Designing cultural adaptations of caregiver-implemented interventions for latinx caregivers of children who use augmentative and alternative communication: Key considerations. American Journal of Speech-Language Pathology, 33(5), 2266–2279. https://doi.org/10.1044/2024_AJSLP-24-00101
53.
WaltersC.SevcikR. A.RomskiM. (2021). Spoken vocabulary outcomes of toddlers with developmental delay after parent-implemented augmented language intervention. American Journal of Speech-Language Pathology, 30(3), 1023–1037. https://doi.org/10.1044/2020_AJSLP-20-00093
54.
WilsonL. L.MottD. W.BatmanD. (2004). The asset-based context matrix: A tool for assessing children’s learning opportunities and participation in natural environments. Topics in Early Childhood Special Education, 24(2), 110–120.
WoodsJ.KashinathS.GoldsteinH. (2004). Effects of embedding caregiver-implemented teaching strategies in daily routines on children’s communication outcomes. Journal of Early Intervention, 26(3), 175–193. https://doi.org/10.1177/105381510402600302
57.
YauS. H.ChooK.TanJ.MonsonO.BovellS. (2024). Comparing and contrasting barriers in augmentative alternative communication use in nonspeaking autism and complex communication needs: Multi-stakeholder perspectives. Frontiers in Psychiatry, 15, 1–10. https://doi.org/10.3389/fpsyt.2024.1385947
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