Yesterday I read an
article* that laid out several reasons that families need professional guidance,
in the form of a “full assessment” from an “AAC professional” before purchasing
or implementing an AAC app with their children. This type of evaluation, the
author argued, is necessary because “parents
are being lured by the promise of quick success” (in the form of video
advertisements that show children “effortlessly” communicating) while, in
sober/educated contrast, “AAC professionals have been formally assessing such solutions for
more than three decades.”
This article was uniquely (upsetting, offensive,
divisive) problematic in a number of ways**, but the general sentiments expressed
are unfortunately not uncommon in the world of “AAC professionals.” Some AAC professionals
(some professionals-there are many professionals who are
family-centered and family-empowering) can be quick to protest the acquisition of any AAC system
outside of a “full AAC assessment” (often including the term “feature
matching”). They seem to hold the belief that any app purchased outside of a full
assessment is, by default, unlikely to meet the needs of the AAC user.
Let’s unpack the misconceptions behind that
belief.
First, while many believe that a "full AAC assessment" conducted by an “AAC professional” is the gold standard, these professionals can be difficult to
access. Many (most?) children who receive AAC assessment receive them through
their school district. In some cases, the speech-language pathologist conducts
the assessment; in others a specialized AAC team/person may come from the
district. In many areas, there’s no specialized “AAC professional” to be found.
Second, if a family is fortunate enough
to have access to an AAC professional it’s important for them to be aware that all
professionals are not all created equal---their expertise is rooted in the
education and mentorship they’ve received. There are professionals conducting
evaluations who believe that the acquisition of prerequisite skills is
necessary before high tech AAC is to be provided. There are professionals conducting
evaluations who are making grave mistakes (e.g., moving the location of icons
during an evaluation to see if a student “can access a new area” of a grid, and
then determining, when the student keeps tapping the previous location of the
icon, that the student is unable to access the new area). *** There are AAC
professionals sharing fundamentally flawed information (e.g., providing a
hand-out to local SLPs outlining perquisite skills that a student should have
mastered prior to being referred for an AAC evaluation).*** There are AAC professionals
who are known for recommending the same app to the vast majority of students
that they evaluate (which is, understandably, because they truly believe that
their preferred system is “best” and offers the greatest potential for
long-term independent communication-but this seems to negate a bit of the
all-important “feature-matching full AAC assessment”).***
Third, yes, a full AAC assessment (if a family has access to an AAC
professional and if that professional
is one of the "good" ones) that includes feature matching can sometimes be a
helpful approach. It’s an especially important approach when the potential AAC
user has a unique physical profile or challenges (vision impairment, motoric
impairment, mounting/positioning needs, the need for an eye gaze system). However, it is also possible to undergo a full AAC assessment and receive inappropriate recommendations (as we did, twice, and as many families do). Furthermore, many AAC users can be properly served
(and, increasingly, are being
properly served) by a different approach: starting with a (carefully selected) robust
system and then scaffolding down (or, perhaps, supporting up). An example of this
would be to provide a student with a robust system and then
mask/hide words so that a small set remains (and providing a keyguard if
support for direct access is needed). While I imagine that there are some AAC
professionals reading this who would protest this approach, I also know that
there are some AAC professionals who currently operate under this methodology when
conducting an AAC assessment. This is
also the method is most commonly used by parents who independently purchase and implement
apps.
Fourth, the time has come (or past) to stop operating under
the assumption that professionals (by definition) know more about AAC than non-professionals.
A motivated AAC parent can spend hours surfing, reading, and absorbing
information about AAC online. Journal articles (which once lived on the dusty
upper floors of college libraries) can be snagged through Google scholar
searches. Videos of AAC implementation,
once recorded in clinics and shown during AAC classes, are freely available to
view and analyze on YouTube. Leading AAC researchers run Facebook pages and
groups (and they answer questions from eager-to-learn parents who send in
messages!). AAC professional development, once populated solely by professionals, is open to AAC families (often at a reduced rate!) and also exists online for convenience. Entire AAC conferences can be consumed on-demand and for free. Families can access and learn from other AAC families and AAC
professionals on a variety of social media platforms (Facebook pages and groups,
Instagram, Twitter, and probably some platforms that I’m too old to know
about). Families can access and borrow AAC apps and devices from their state’s AT lending library (or can meet up with local families or professionals to see and
try out apps). Families can absolutely attain/exceed the same level of AAC education as many speech language
pathologists/AAC professionals. (It’s worth noting here that I am both an AAC
parent and a CF-SLP.)
If we reject these four misconceptions, we can believe that it is
perfectly possible for families to select and implement AAC apps without
undergoing an AAC evaluation. It is possible for families to know more about
the best AAC app for their child than an AAC professional. It is possible for
families to make mistakes while selecting and implementing an AAC system, but
also it is worth noting that these mistakes are no worse than the mistakes that
we’ve seen (many. ugh.) AAC professionals make.
The implication (seen in this article and in
many professional online discussion groups) that parents are uneducated,
unresearched, impulsive app-buyers is harmful. It discredits families and
self-congratulates professionals. It
furthers the narrative that professionals are uniquely suited to introduce
children to AAC, and creates/facilitates the belief that family-purchased AAC
is likely to be not well thought out or ill-suited. Roughly half of the aforementioned article discusses the
need for assistance with customizing and implementing an AAC system (and I
agree that professional support can be invaluable in these areas)---but let’s
consider, for a minute, what families will encounter when they arrive in the
offices of professionals to seek these services. If these families seek assistance from
an SLP who has read similar articles/online conversations, and then disclose that
their AAC system was self-selected, will they find a professional who will
assume that the family conducted extensive research and has well-thought out
reasons for selecting a specific app (as the SLP would likely assume if the
family received the app through a “full assessment”)? Or will the SLP assume
that here is another example of an impulse-buying family who likely has a
less-than-ideal app, like the families they've heard about in articles online?
Maybe instead of assuming that families are
quick to act without professional guidance, we should examine why families are having to act without guidance. Or perhaps turn a more critical eye
to the guidance that many families (including my own) often receive during the
early years of speech therapy for nonspeaking (or minimally speaking) children.
Per one AAC mom,
“If we examine those questions, we find that when a child’s language acquisition is most crucial, many SLPs are brushing off technology or refusing to consider access until certain low/no tech milestones have been achieved. It’s hindering language development when the child is most ripe for it, then leaving families desperate and scrambling to find their own solutions when no (one) seems interested in presuming competence and providing real help.” (Haley Watkins Johnson, mom to an 8-year old who uses AAC, shared in a FB response to this article.)
A brief foray into any online AAC group will
confirm this reality---these forums are extensively populated by families resigned
to find an AAC solution on their own after being misserved by the professionals
in their child’s life.
While discussing this article online I was
introduced to a term that sums up the ability of families to privately purchase
AAC without first seeking approval/recommendation from a professional:
disintermediation. Disintermediation
refers to the removal of the middle man (such as the ability to private
purchase AAC, splints, wheelchairs, etc.-anything that at one time required an
assessment/recommendation from a professional). Ricky Buchanan, who introduced me to the concept,
had this to say:
“It seems to me (as a disabled adult) that when disintermediation comes up – anything that allows disabled people and their families to directly access technology that used to only be available via gatekeepers – that the professionals involved are very worried that this means now people will get less ideal outcomes . . . But they almost never talk about how this means that people who never had access to the professionals can now have access to technology, the almost never talk about how this means people who only have access to awful professionals can now avoid them, and they almost never talk to people whose disability meant that the gatekeepers (be them professionals, educators, insurance companies, whatever) thought they didn’t deserve or would be able to use the technology. It’s important that we get people the best outcomes possible, but ignoring all of those other factors is not helpful.”
It’s
not helpful to preach that the only right path to AAC is via a professional
assessment, thereby also implying that professional opinion is somewhat
universal (when it actually varies widely) and that the opinion of any
professional assessment would be more sound than the opinion of any
well-researched parent (nope). It’s not
helpful to assume that a family-driven app-selection process is, by default,
less informed or rigorous than a professionally-guided app-selection process.
It’s not helpful to minimalize or ignore the inconsistencies, biases, and misconceptions
that families often encounter when they do
actually seek a professional AAC assessment.
It’s
not helpful.
In
a world where AAC professionals are difficult to find, let those of us
(families and professionals alike) raise our voices online and help families
find their way. In a world where AAC professionals require prerequisite skills,
let us share our success stories (and, with permission, videos) that show our
prerequisite-skill-lacking children developing into communicators when provided
with the correct support. In a world where home implementation is tricky, let
us share our tips and tricks and strategies. In a world where an AAC evaluation
is only as good as the professional who shows up to do it, let us educate
families so that either: a) they can compare/contrast systems on their own and
select a good fit or b) they know their stuff, and how to advocate for
something robust and amazing, when the evaluator shows up. In a world where
“families need guidance”, let us welcome and guide them.
(Image is an old photo of me and my children out at the mall. We are each wearing an AAC device, iPads in bright cases hanging from straps around our necks. My youngest is sitting in a stroller, my oldest is standing behind it. Our faces are obscured.)
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*Link to original article: Families need guidance before buying a communication app for autism
** There are many problematic things in this article. I've chosen to write a measured response to the most fundmental issue, as I see it, which is the gatekeeping of AAC access and dismissal of parental knowledge that occurs when professionals insist that the only meaningful path to AAC acquisition is through a "full AAC assessment." In making this choice I've ignored other issues, such as the mention of intelligence quotient and referring to autism as a "condition," that were frustrating in other ways.
***I have personally witnessed each of these things
