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Effective Augmentative and Alternative Communication Practices provides a user-friendly
handbook for any school-based practitioner, whether you are a special education
teacher, an augmentative and alternative communication (AAC) consultant, assistive
technology consultant, speech-language pathologist, or occupational therapist. This
highly practical book translates the AAC research into practice and explains the
importance of the use of AAC strategies across settings. The handbook also provides
school-based practitioners with resources to be used during the assessment, planning,
and instructional process.
M. Alexandra Da Fonte is Assistant Professor of the Practice in the Department
of Special Education at Vanderbilt University, USA.
Miriam C. Boesch is Associate Professor in Special Education at the University
of North Texas, USA.
EFFECTIVE AUGMENTATIVE
AND ALTERNATIVE
COMMUNICATION PRACTICES
EFFECTIVE
AUGMENTATIVE
AND ALTERNATIVE
COMMUNICATION
PRACTICES
A Handbook for School-Based
Practitioners
M. Alexandra Da Fonte and Miriam C. Boesch
First published 2019
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2019 Taylor & Francis
The right of M. Alexandra Da Fonte and Miriam C. Boesch to be
identified as authors of this work has been asserted by them in accordance
with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilized in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Names: Da Fonte, M. Alexandra, author. | Boesch, Miriam C., author.
Title: Effective augmentative and alternative communication practices : a
handbook for school-based practitioners / M. Alexandra Da Fonte &
Miriam C. Boesch.
Description: New York, NY : Routledge, 2018. | Includes bibliographical
references and index.
Identifiers: LCCN 2018003726 (print) | LCCN 2018019978 (ebook) |
ISBN 9781315200750 (e-book) | ISBN 9781138710177 (hbk) |
ISBN 9781138710191 (pbk) | ISBN 9781315200750 (ebk)
Subjects: LCSH: Children with disabilities—Education—Handbooks,
manuals, etc. | Communicative disorders in children—Handbooks,
manuals, etc.
Classification: LCC LC4015 (ebook) | LCC LC4015 .D25 2018 (print) |
DDC 371.9—dc23
LC record available at https://lccn.loc.gov/2018003726
ISBN: 978-1-138-71017-7 (hbk)
ISBN: 978-1-138-71019-1 (pbk)
ISBN: 978-1-315-20075-0 (ebk)
Typeset in Bembo
by Apex CoVantage, LLC
To all the students, families, special education teachers, and
services providers who we have worked with throughout the
years. This book was inspired by you, and to help those who
are currently navigating the process to identify ways to support
students with complex communication needs.
CONTENTS
About the authors ix
Acknowledgements xi
UNIT 1
Students with Complex Communication
Needs and the Instructional Team 1
1 Understanding Students with Complex
Communication Needs 3
2 Understanding Communication Competencies 20
3 The Instructional Team 38
4 Identifying the Barriers in the Environment 64
UNIT 2
Assessment: The Student and The
Communication System 83
5 Identifying the Student’s Present Level
of Performance 85
6 Identifying the Student’s Literacy Skills 110
viii Contents
7 Defining and Identifying Unaided Communication
Systems 129
8 Defining and Identifying Low-Technology Aided
Communication Systems 145
9 Defining and Identifying High-Technology Aided
Communication Systems 169
UNIT 3
Goal Setting and Implementation Practices 199
10 Writing Effective Communication Goals 201
11 Implementing Effective Instructional Practices 233
12 Implementing Augmentative and Alternative
Communication Across Settings 264
Glossary 303
Index 314
ABOUT THE AUTHORS
Dr. M. Alexandra Da Fonte is an Assistant Professor of the Practice in the
Department of Special Education at Vanderbilt University. Dr. Da Fonte has over
25 years of experience working with students with severe disabilities including
students with complex communication needs. Her areas of interest include inte-
grating augmentative and alternative communication interventions, working with
students with severe disabilities, training pre-service special education teachers
to work with students with complex communication needs, teacher preparation,
and bridging research-to-practice. Dr. Da Fonte has conducted presentations and
training in augmentative and alternative communication at local community
partners, and at state, national, and international conferences.
x About the authors
Dr. Miriam C. Boesch is an Associate Professor in Special Education at the
University of North Texas. Dr. Boesch has over 15 years of experience working
with students with severe disabilities including students with complex commu-
nication needs. Her areas of interest include augmentative and alternative com-
munication interventions for individuals with autism, evidence-based strategies
for decreasing problem behavior, and pre- and in-service personnel preparation.
Dr. Boesch has conducted presentation and trainings in the area of augmentative
and alternative communication at the local, national, and international level.
We would like to acknowledge and offer our most sincere gratitude to all those
who helped us accomplish this adventure. A very special thanks to: Gwen Diamond
who supported us by providing feedback throughout the process and allowing
us to photograph her instructional materials; our research team (in alphabeti-
cal order), Olivia Clark, Nathan Dunnavant, Katie McCann, Haley Neil, Shaylin
Rawden, and Kayla Richardson who supported us in identifying evidence for
each chapter; Christine Douthwaite and Margaret (Mimi) Sanders who allowed
us to photograph and use their classrooms and instructional materials as examples.
Alexandra Da Fonte: I am thankful beyond words for my family’s patience, sup-
port, and encouragement. Thank you both!
Miriam Boesch: I am extremely grateful to my husband Chris. Thank you for
your unconditional love and support.
Illustrations
We would like to acknowledge and extend our gratitude to Nathan Dunnavant
for his dedication and the creation of all the customized illustrations for this book.
ACKNOWLEDGEMENTS
UNIT 1
Students with Complex
Communication Needs
and the Instructional
Team
Communication is a fundamental skill that is imperative to a child’s development.
While many children develop their communication, language, and speech in a
seamless manner, research suggests that there is an increasing number of chil-
dren who display complex communication needs, also known as CCN (Beukelman &
Mirenda, 2013; Black, Vahratian, & Hoffman, 2015; Brady et al., 2016). Balandin
(2002) defined CCN as a comprehensive term that encompasses a wide range of
physical, sensory, and environmental needs that restricts or limits an individual’s
independence. This includes an individual’s independence in communicating his
or her wants and needs across communication partners. There are several factors that
have been linked to the cause of CCN. These factors may include neurological
disorders (e.g., cerebral palsy, traumatic brain injury, or autism), physical structures
(e.g., cleft palate), genetic disorders (e.g., Down syndrome), and developmental
disabilities (ASHA, 2017a).
Communication disorders are defined as an impairment in the ability to receive,
send, process, and comprehend concepts or verbal, nonverbal, and graphic symbol
systems (ASHA, 1993). Based on these definitions, it can be concluded that stu-
dents with CCN have difficulties in any one or a combination of the aspects of
communication, language, or speech (Jacob, Olisaemeka, & Edozie, 2015). Crich-
ton (2013) explains that students with diverse communication needs may present
difficulties, such as making eye contact, interacting with others, or engaging in
or repairing a conversation when there is a communication breakdown. Needs
in these components of communication can make conversations difficult for the
student and the communication partner. Additionally, students who have difficul-
ties with expressive or receptive language may have trouble using correct sentence
structure, organizing a sequence of events, or finding the correct words to use
(Binger & Light, 2008). These areas of need make it challenging for students to
express their wants and needs and understand communicative interactions.
1
UNDERSTANDING
STUDENTS WITH COMPLEX
COMMUNICATION NEEDS
4 Unit 1 Students with CCN
Over the past years, the prevalence of students with CCN continues to
increase. The National Institute on Deafness and Other Communication Disor-
ders (NIDOCD, 2015) states that nearly 17.9 million people have trouble using
their voice. Furthermore, between 6 and 8 million people have some form of a
language impairment (NIDOCD, 2015), and, approximately 4 million Americans
are unable to meet their communication needs using natural speech (Beukel-
man & Mirenda, 2013). Moreover, in a national health survey conducted by the
National Center for Health Statistics (2012), it was estimated that 55% of students
with a communication disorder were receiving intervention services (Black et al.,
2015). With the prevalence of communication disorders and services rising, it is
expected that services will continue to increase in the classroom for students with
CCN. Because of these increasing numbers, it has become even more important
for educators to understand the various aspects of communication, how they
develop, and how to better instruct and meet the needs of their students.
Understanding the Differences Between Communication,
Language, and Speech
Communicative development begins early in a child’s life. The early interactions
begin with the sharing of affection and attention. It is at this time the child begins
to see how his or her behaviors have an impact on the environment (Colonnesi,
Stams, Koster, & Noom, 2010; Hoff, 2014). For special education teachers to be
effective elicitors of communication in the classroom, it is important that they
understand what communication is and how it develops. Da Fonte and Boesch
(2016) emphasized that “when special education teachers can recognize, iden-
tify, and provide meaning to the form and function of students’ communicative
attempts, steps can be taken to increase or modify the student’s communicative
skills to be more effective in a myriad of settings” (p. 51). Communication, lan-
guage, and speech are closely related, but there are distinct differences between
them (see Figure 1.1 for an illustration of this relationship).
Communication
Communication is the process of sharing information among two or more people.
The main goal of this process is for social interaction and involves four processes:
(1) formulation, (2) transmission, (3) reception, and (4) comprehension (Shannon, 1948;
Turnbull & Justice, 2016). Formulation is the act of pulling your thoughts together
before sharing them with another person (e.g., feeling thirsty and wanting to request
a drink of water). Transmission is the mechanics of relaying this thought to the person
(e.g., saying “I’m thirsty. May I get a drink of water?”). This transmission process
supports the last two processes of communication, which are reception, the receiving
of the message (e.g., hearing the message that the person is thirsty and processing
the information), and comprehension, the ability to interpret the information (e.g.,
understanding that the person has a need and is trying to meet it; Brady, Steeples, &
Fleming, 2005). See Figure 1.2 for an illustration of this communicative process.
Understanding Students with CCN 5
FIGURE 1.1 Relationship between communication, language, and speech.
Formulaon
Recepon and
Comprehension
Recepon and
Comprehensio
n
Form:syntax
(morphology, phonology)
Content: semancs
(lexicon)
Transmission
Use: pragmacs
(body movement, space)
FIGURE 1.2 A model of the communication process.
The goal should be for all students to become independent communicators.
Independent communicators have the ability to share their personal ideas using
an array of different modalities that they choose for themselves (Beukelman &
Mirenda, 2013; King & Fahsl, 2012). The National Academies of Sciences, Engi-
neering, and Medicine (2016) consider language to be a tool that plays a significant
6 Unit 1 Students with CCN
role in the communication process. It is crucial to remember that language is not
necessary to communicate, as people can also communicate using nonverbal com-
munication. Nonverbal communication can be expressed in many forms such as body
movement, facial expressions, eye contact, and space or distance as well as features
of the environment (Ambady & Rosenthal, 1998; Patrichi, 2013; Wood, 2016).
Language
Language can be defined as a system of conventional spoken or written symbols used
by people in a shared culture to communicate (ASHA, 2017c; O’Hare & Bremner,
2016). There are three domains inherent in language, which include (1) content, (2)
form, and (3) use (Bloom & Lahey, 1978). De Leo, Lubas, and Mitchell (2012) explain
the domains by noting that the content of language refers to the words the student uses
(vocabulary) and the meaning behind them (semantics). That is, how individuals select
appropriate vocabulary to compose their message (Landa, 2007). Form refers to the
words, sentences (syntax), and sounds (morphology and phonology) a student uses
to convey the content of their language. Lastly, use refers to how language meets the
social context, expectations, and demands during interactions. This is also known as
pragmatics, the social aspect of language. This entails the knowledge of when, where,
and to whom the student is communicating. Pragmatics skills are evident in infants
well before they develop other language skills (Grosse, Behne, Carpenter, & Toma-
sello, 2010). Considering all these components, it has been suggested that when a
student demonstrates the appropriate use of semantics, syntax, and pragmatics, com-
munication competence is achieved (Landa, 2007; O’Hare & Bremner, 2016).
Consider the example, “I’m thirsty. May I get a drink of water?” According
to Landa (2007), the consideration of the words “thirsty,” “drink,” and “water” is
referred to as semantics (content). Within semantics, these words were selected
through a vocabulary system, called a lexicon, to convey meaning (Turnbull & Jus-
tice, 2016). When the student added the /y/ to thirst, they changed the meaning
of the word, also referred to as morphology. The way the sounds were combined
to form syllables and words (i.e., /m/ and /ay/ to create may) is called phonology.
Morphology and phonology are used to structure sounds, syllables, and words into
sentences (Landa, 2007). This structural piece is referred to as syntax (form). The
facial expression, gestures, who the message was communicated to (communica-
tion partner), and eye contact used to relay the message “I’m thirsty. May I get a
drink of water?” is called pragmatics (use). When considering pragmatics, you are
determining if the student’s language is functional and how it is used to meet his
or her personal wants and needs, such as effectively conveying their need for water
(Landa, 2007; O’Hare & Bremner, 2016).
Speech
Often speech and language are used interchangeably. However, they are not the
same. Speech is a voluntary neuromuscular behavior and only one of the ways in
Understanding Students with CCN 7
which language can be expressed (O’Hare & Bremner, 2016; Turnbull & Justice,
2016). In our example, after the student was able to formulate the thought of
needing water by using language, he or she was then able to transmit this thought
to the listener using speech. While speech can be used to transmit language, stu-
dents may have the ability to produce typical speech sounds, but have difficulty
with language and its various aspects (National Academies of Sciences, Engineer-
ing, and Medicine, 2016).
It is important to note that communication is not bound by language and
speech. Communication can take place without these aspects. But, language and
speech may allow the student to communicate in a more efficient and successful
manner in the absence of other modalities (Martin, Onishi, & Vouloumanos, 2011;
Turnbull & Justice, 2016).
Typical Communication Development
In order to better support the communication development of students with
CCN, it is essential to first understand what typical communication looks like.
This knowledge will help determine where the students are in their communica-
tion development (assessment), and how you will plan to enhance their commu-
nication skills (instruction/intervention). Table 1.1 provides detailed information
on the typical stages of communication development.
Communication skills are often divided into two areas, receptive communica-
tion skills and expressive communication skills. Receptive communication involves
the understanding or comprehension of messages and words that are expressed,
while expressive communication involves the words and messages, both verbal and
nonverbal, that people communicate to listeners (Lloyd, Fuller, & Arvidson, 1997).
Figure 1.3 provides examples of specific receptive and expressive communication
skills.
Receptive Communication Skills
Receptive language skills are closely linked to cognitive development (Owens,
2012). These skills begin to develop at birth and continue to develop throughout
life. Receptive language skills are essential in demonstrating communicative com-
petence (ASHA, 2017b; Wisconsin Child Welfare Training System [WCWTS],
2017). According to ASHA (2017b), early in the development of receptive lan-
guage skills (birth to 5 months of age), children begin to recognize familiar voices,
turn their heads to voices, and react to environmental sounds. During the second
stage (6 to 11 months of age) children begin to understand the meaning of “no,”
anticipate events, and understand some routine phrases (e.g., “time to eat”). In
stage three (12–24 months of age), children begin to recognize the name of com-
mon activities, items, and people, and also begin to understand routine verbs (e.g.,
“eat”). Later in this stage, children begin to respond to simple requests, follow
TABLE 1.1 Typical Communication Development
Age Phonology Syntax and Morphology Semantics Pragmatics
Birth Recognizes different languages
in different rhythmic classes
(e.g. English vs. Japanese).
Makes reflexive sounds.
- Directs attention to where a
sound is being produced and
responds to a loud sound by
startling.
Starts paying attention to social
partners.
2 mo. Recognizes native language vs.
nonnative languages.
Makes cooing sounds.
- Investigates and holds (perhaps
with the addition of
mouthing) objects for a short
period of time.
Will look at people briefly.
Can recognize unfamiliar
situations and people.
4 mo. Recognizes different languages
in the same rhythmic classes
(e.g., English vs. Dutch).
Makes vowel sounds, squeals,
growls.
- Identifies the difference
between actions that are
performed by accident and
on purpose.
Looks at faces and will stare.
Can understand when own
name is said.
6 mo. Segments words from fluent
speech.
- Understands the meaning of the
word “no.” Makes efforts to
mimic gestures.
Participates in joint attention.
8 mo. Differentiates native from
nonnative stress patterns.
- Searches in the right place for
objects that are out of the
individual’s range of sight
and looks for objects that are
partly concealed.
Starts using intentional
communication.
Has language function pre-
verbally in the form of
attention seeking, requesting,
greeting, transferring,
protesting or rejecting,
responding or acknowledging,
and informing.
10–12 mo. Comprehends analytical actions
as ways to reach a desired
goal.
- Creates first word.
Comprehends five to
ten words. Comprehends
analytical actions as ways to
reach a desired goal.
Will use imperative pointing.
12 mo. With the exception of some
words, most speech is
indecipherable.
Half of the verbal
pronunciations made are
composed of single nouns.
First word spoken. Can understand people’s motive
for actions.
16 mo. A quarter of all words are
pronounced clearly.
33% of all spoken words are
composed of single nouns.
Negation (no) is used.
Utilizes anywhere between 3
and 20 words.
Will take turns while speaking.
20 mo. Spoken words are processed in
increments.
Grammatical morphemes
(present progressive “is”
followed by a word + -ing)
start to be used.
Can say around 50 words. Can
use a few adjectives and verbs.
Multiple gestures will be used
in combination. Gestures and
words will be used together
to form meaning.
24 mo. Questions are asked with
ascending intonation.
Roughly 65% of total words
spoken are pronounced
clearly.
Two-word combinations,
prepositions “on” and
“in,” possessive and plural
morphemes, and irregular past
tense verbs are all used.
Can say around 200 words. Can
understand around 500 words.
Will utilize language functions
that are imaginative, heuristic,
and informative.
28 mo. Pronounces roughly 70% of all
words clearly.
Proficient in the use of present
progressive morpheme -ing.
Listens for sentence structure
when hearing words for the
first time.
Can have brief conversations.
Can start talking about a new
topic or change the subject.
32–36 mo. 80% of all words are
pronounced clearly.
Uses a single verb about a
quarter of the time while
speaking. Utilizes a few
contractions.
Can say about 500 words. Can
understand about 900 words.
Asks for clarification and
clarifies while speaking to
others.
TABLE 1.1 Typical Communication Development
Age Phonology Syntax and Morphology Semantics Pragmatics
Birth Recognizes different languages
in different rhythmic classes
(e.g. English vs. Japanese).
Makes reflexive sounds.
- Directs attention to where a
sound is being produced and
responds to a loud sound by
startling.
Starts paying attention to social
partners.
2 mo. Recognizes native language vs.
nonnative languages.
Makes cooing sounds.
- Investigates and holds (perhaps
with the addition of
mouthing) objects for a short
period of time.
Will look at people briefly.
Can recognize unfamiliar
situations and people.
4 mo. Recognizes different languages
in the same rhythmic classes
(e.g., English vs. Dutch).
Makes vowel sounds, squeals,
growls.
- Identifies the difference
between actions that are
performed by accident and
on purpose.
Looks at faces and will stare.
Can understand when own
name is said.
6 mo. Segments words from fluent
speech.
- Understands the meaning of the
word “no.” Makes efforts to
mimic gestures.
Participates in joint attention.
8 mo. Differentiates native from
nonnative stress patterns.
- Searches in the right place for
objects that are out of the
individual’s range of sight
and looks for objects that are
partly concealed.
Starts using intentional
communication.
Has language function pre-
verbally in the form of
attention seeking, requesting,
greeting, transferring,
protesting or rejecting,
responding or acknowledging,
and informing.
10–12 mo. Comprehends analytical actions
as ways to reach a desired
goal.
- Creates first word.
Comprehends five to
ten words. Comprehends
analytical actions as ways to
reach a desired goal.
Will use imperative pointing.
12 mo. With the exception of some
words, most speech is
indecipherable.
Half of the verbal
pronunciations made are
composed of single nouns.
First word spoken. Can understand people’s motive
for actions.
16 mo. A quarter of all words are
pronounced clearly.
33% of all spoken words are
composed of single nouns.
Negation (no) is used.
Utilizes anywhere between 3
and 20 words.
Will take turns while speaking.
20 mo. Spoken words are processed in
increments.
Grammatical morphemes
(present progressive “is”
followed by a word + -ing)
start to be used.
Can say around 50 words. Can
use a few adjectives and verbs.
Multiple gestures will be used
in combination. Gestures and
words will be used together
to form meaning.
24 mo. Questions are asked with
ascending intonation.
Roughly 65% of total words
spoken are pronounced
clearly.
Two-word combinations,
prepositions “on” and
“in,” possessive and plural
morphemes, and irregular past
tense verbs are all used.
Can say around 200 words. Can
understand around 500 words.
Will utilize language functions
that are imaginative, heuristic,
and informative.
28 mo. Pronounces roughly 70% of all
words clearly.
Proficient in the use of present
progressive morpheme -ing.
Listens for sentence structure
when hearing words for the
first time.
Can have brief conversations.
Can start talking about a new
topic or change the subject.
32–36 mo. 80% of all words are
pronounced clearly.
Uses a single verb about a
quarter of the time while
speaking. Utilizes a few
contractions.
Can say about 500 words. Can
understand about 900 words.
Asks for clarification and
clarifies while speaking to
others.
(Continued)
Age Phonology Syntax and Morphology Semantics Pragmatics
36 mo. Starts to form shallow
phonological awareness
abilities.
Utilizes compound sentences
with the word “and,”
Uses approximately 4 or 5
words per sentence.
Utilizes pronouns like “they,”
“them,” and “us.”
Conversations become longer
in length.
40 mo. Articulatory skills are
continuing to be perfected.
Utilizes adverbs often. Utilizes
pronouns regularly.
Can say about 1,000 to 1,500
words. Can understand
between 1,500 and 2,000
words Comprehends a few
relational terms like “hard-soft.”
Starts fixing errors in
conversation.
44 mo. Can say most consonants. Uses contractions, past tense,
and articles appropriately.
Begins to narrow the possible
meanings of new words.
Comprehends indirect requests
that use pointing.
48 mo. Reduces phonological processes
(e.g., weak-syllable deletion,
cluster reduction).
Makes 4–7 word sentences. Uses reflexive pronouns such as
himself, herself, itself.
Constructs true narratives.
52 mo. Very intelligible. Uses irregular plurals correctly. Knows how to use “what
do, what does, what did”
questions.
Begins to make their own
indirect request.
56–60 mo. Knows letters in name.
Only has difficulty with sounds
that were developed later.
Makes 5–8 word sentences. Regularly speaks 1,500–2,000
words. Understands 2,500–
2,800 words. Uses this, that,
here, there.
Can begin sequencing events in
a narrative.
5–6 yr. Uses plurals correctly. Uses morphology to infer
meaning of new words.
Begins to learn to read via
decoding.
Can use repetition to repair
conversations.
7–8 yr. Can say all American sounds. Uses noun phrases, adverbs, and
conjunctions.
Uses multiword definitions.
Improves decoding skills and
begins reading unfamiliar
words.
Comprehends hints.
Makes narratives with all
components.
9–10 yr. - Understands verbs like believe
and promise.
Starts to read for information. Remains on topic during
conversation even with topic
turns.
11–12 yr. Expresses intent with stress and
emphasis.
Comprehends if and though. Can make abstract definitions.
Reads on an approximate
adult level.
Can use and understand abstract
topics during conversation.
13–15 yr. - Comprehends the use of clausal
embedding.
Considers multiple points of
view when reading.
Comprehends jokes with
ambiguity.
16–18 yr. Understands vowel-shifting
rules.
Uses more words per unit in
written language than in
spoken language.
Understands around 60,000
word meanings.
Understands the use of sarcasm,
double meaning words,
metaphors, and multiple
perspectives.
Adapted from “Language Development from Theory to Practice” (3rd ed.), by K. L., Turnbull and L. M., Justice, 2017, Upper Saddle River, NJ: Pearson, pp. 133–134, 164–165,
202–203, 237–238.
TABLE 1.1 (Continued)
Age Phonology Syntax and Morphology Semantics Pragmatics
36 mo. Starts to form shallow
phonological awareness
abilities.
Utilizes compound sentences
with the word “and,”
Uses approximately 4 or 5
words per sentence.
Utilizes pronouns like “they,”
“them,” and “us.”
Conversations become longer
in length.
40 mo. Articulatory skills are
continuing to be perfected.
Utilizes adverbs often. Utilizes
pronouns regularly.
Can say about 1,000 to 1,500
words. Can understand
between 1,500 and 2,000
words Comprehends a few
relational terms like “hard-soft.”
Starts fixing errors in
conversation.
44 mo. Can say most consonants. Uses contractions, past tense,
and articles appropriately.
Begins to narrow the possible
meanings of new words.
Comprehends indirect requests
that use pointing.
48 mo. Reduces phonological processes
(e.g., weak-syllable deletion,
cluster reduction).
Makes 4–7 word sentences. Uses reflexive pronouns such as
himself, herself, itself.
Constructs true narratives.
52 mo. Very intelligible. Uses irregular plurals correctly. Knows how to use “what
do, what does, what did”
questions.
Begins to make their own
indirect request.
56–60 mo. Knows letters in name.
Only has difficulty with sounds
that were developed later.
Makes 5–8 word sentences. Regularly speaks 1,500–2,000
words. Understands 2,500–
2,800 words. Uses this, that,
here, there.
Can begin sequencing events in
a narrative.
5–6 yr. Uses plurals correctly. Uses morphology to infer
meaning of new words.
Begins to learn to read via
decoding.
Can use repetition to repair
conversations.
7–8 yr. Can say all American sounds. Uses noun phrases, adverbs, and
conjunctions.
Uses multiword definitions.
Improves decoding skills and
begins reading unfamiliar
words.
Comprehends hints.
Makes narratives with all
components.
9–10 yr. - Understands verbs like believe
and promise.
Starts to read for information. Remains on topic during
conversation even with topic
turns.
11–12 yr. Expresses intent with stress and
emphasis.
Comprehends if and though. Can make abstract definitions.
Reads on an approximate
adult level.
Can use and understand abstract
topics during conversation.
13–15 yr. - Comprehends the use of clausal
embedding.
Considers multiple points of
view when reading.
Comprehends jokes with
ambiguity.
16–18 yr. Understands vowel-shifting
rules.
Uses more words per unit in
written language than in
spoken language.
Understands around 60,000
word meanings.
Understands the use of sarcasm,
double meaning words,
metaphors, and multiple
perspectives.
Adapted from “Language Development from Theory to Practice” (3rd ed.), by K. L., Turnbull and L. M., Justice, 2017, Upper Saddle River, NJ: Pearson, pp. 133–134, 164–165,
202–203, 237–238.
Stages Expressive CommunicaonRecepve Communicaon
Pre-intenonal
Makes sounds Smiles when spoken to
Intenona
l
Responds to soundsRecognizes speaker’svoice
Sounds become more speech-likeMoves eyes in direcon of sounds
Vocalizes excitement and displeasureResponds to change in tone of speaker’svoice
Unconvenona
l
Uses vocalizaons to get and keep aeno
nTurns and looks in direcon of sounds
Uses gestures to communicate Listens when spoken to
Imitates different speech sounds Recognizes words for common items
Convenona
l
Uses 1-2 word uerances Responds to requests
Asks 1-2 word quesons Follows 1-step direcons
Concrete symbol
sPuts 2 word uerances together Listens to simple storiesand songs
Abstract symbol
s
Uses 2-3 words to describe and ask for
objects Follows 2-step direcons
Language Directs aenon to objects by naming them
Maintains aenon for longer periods of me
FIGURE 1.3 Stages of expressive and receptive communication development.
(Sources: American Speech-Language-Hearing Association, 2016, 2017b; Rowland, 2004)
Understanding Students with CCN 13
one-step directions (with and without a gesture), and begin to identify pictures
in books, and body parts. By around 24 months of age, children typically are able
to understand approximately 300 words, can listen to stories, begin to respond
to “wh” questions, and can follow two-step directions. These receptive language
skills will continue to develop throughout life as the child’s vocabulary and com-
municative experiences continue to increase.
Expressive Communication Skills
From birth to around 8 months of life, infants who are typically developing are
considered pre-intentional communicators. Until this point, they do not predict out-
comes of their behavior. Therefore, they cannot share the intent of their com-
munication (Adeli, Rahimian, & Tabrizi, 2016; Owens, 2012). This does not mean
that infants do not communicate from birth to 8 months, but rather that their
communication is characterized by innateness (Bates, Camaioni, & Volterra, 1975).
Intentional communication (from 9 months of age on) has the motive of affect-
ing a listener (Carter & Iacano, 2002). During the intentional communicative
phase, children begin using gestures partnered with eye contact, as well as specific
vocalizations (Owens, 2012). These gestures may include showing or giving items
to listeners and pointing (Colonnesi et al., 2010). Bates and colleagues (1975)
explained that, during this stage, children begin to recognize adults as agents and
that their own signals can affect the agent. This suggests that a child begins to
understand that specific behaviors influence the world around them. In essence,
they begin to have an understanding of cause and effect and begin to develop
more sophisticated communicative interactions (e.g., words, phrases, sentences).
Differences in the Communicative Development of
Students with Complex Communication Needs
These phases of communication, speech, and language development are true
for all communicators, regardless of what point in a person’s life they develop
(WCWTS, 2017). However, it is important to remember that a person with CCN
will most likely develop these skills at a different chronological age than their
typically developing peers (Simion, 2014). Light (1997) suggests that, for students
with CCN, the process of learning language is, “a difficult one that requires con-
certed intervention to facilitate” (Light, 1997, p. 158). Students with CCN can
have deficits or needs in multiple areas of communication. The New York State
Department of Health Information (2013) suggested that students with CCN
may need intervention in the following areas: articulation, fluency, language com-
prehension, language production, morphology, phonology, pragmatics, semantics,
syntax, and voice. The goal for students with CCN is to make the move from pre-
intentional to intentional communicators with appropriate support, while keeping in
mind that these stages may just be on a different timeline from their peers who
are typically developing (Simion, 2014).
14 Unit 1 Students with CCN
A unique characteristic of students with CCN is that they may or may not
have deficits in one or more areas beyond their communication skills. Some
potential areas of difficulties can include gross motor, fine motor, sensory integra-
tion, or cognitive development, among others. Basil (1992) suggested that students
with CCN also often are passive in their communication attempts which can lead
to the phenomenon of learned helplessness. She explains that a consequence of
learned helplessness may be a lack of motivation to communicate goal-oriented
responses. Consequently, understanding the comprehensive needs of students
with CCN is critical in order to meet their unique needs in the school setting.
Importance of Understanding Complex Communication
Needs in School Settings
At some point in their career, teachers are likely to serve a student with a com-
munication disorder, more specifically, a student with CCN. The goal, as teach-
ers, should be to help students become independent in order for them to lead a
productive and enjoyable life. Communication is key in having a successful school
experience and it will play an important role in the development of various life
and academic skills, including literacy skills. As children learn to read, they also
have the opportunity to think about their use of language. Murphy, Justice, Con-
nell, Pentimonti, and Kaderavek (2016) suggested that oral language plays a pivotal
role in the development of writing and reading skills, and that writing and reading
skills play a pivotal role in language development. See Figure 1.4 for a representa-
tion of this relationship. See Chapters 4 and 11 for more information on assess-
ment and instruction of literacy skills.
Not only is communication a skill that is important at school, but it is also a skill
that affects students well beyond their school experiences and throughout their
lives. Effective communication is a key piece in developing self-determination.
Carter, Lane, Pierson, and Stang (2008) explained that the development of effective
communication skills is a key factor in students with disabilities obtaining impor-
tant post-school outcomes (e.g., independent living, secondary education, and
employment). Carter and colleagues (2008) also explain that self-determination
is a key factor in the post-school success of students with any type of disability,
but this is especially true for students with CCN. They define self-determination
as “the capacity to steer one’s own life in personally meaningful ways and val-
ued directions” (Carter et al., 2008; see Chapter 2). If a teacher’s, school’s, or
district’s main goal is to prepare students for life after high school, the first goal
should be to teach them to communicate effectively. Helping them achieve high
level communication skills will support the development of self-determination
skills and avoid learned helplessness. Communication is not just a set of skills, but
a fundamental human right. The International Communication Project (2014)
states that it is “the most fundamental of human capacities.” Regardless of level
Understanding Students with CCN 15
of speech or disability, all people have the right to make choices and changes to
their environment through communication. The Communication Bill of Rights, c r e -
ated by the National Joint Committee for the Communication Needs of Persons
with Severe Disabilities (1992, 2016), outlines the rights of all students to develop
specific appropriate communication skills with the hope that the adoption by
all practitioners would create advancements for individuals with communication
needs. This Bill of Rights consists of 15 specific rights that all individuals should
be afforded in personal, educational, and intervention settings (see Communi-
cation Bill of Rights on Figure 1.5). Target areas within the Communication
Bill of Rights are addressed that identify potential barriers, such as socialization,
learning and sharing knowledge, choice making, judicial and medical access, and
respect. In 2016, Brady and colleagues updated the Communication Bill of Rights
to highlight the importance of assessment, intervention, community access, and
socialization (see Chapter 4 for detailed information on how to evaluate access
barriers, and Chapter 7 for information on how to evaluate opportunity barriers).
In understanding students with CCN and how to best serve these students’ needs,
teachers can work together to help students become independent communica-
tors, enabling them to lead high quality and productive lives.
FIGURE 1.4 Relationship between language and reading and writing abilities.
Adapted from “Language Development from Theory to Practice” (3rd ed.), by K. L., Turnbull and L. M.
Justice, 2017, Upper Saddle River, NJ: Pearson, pp. 229–230.
16 Unit 1 Students with CCN
4. Express preferences
and feelings 5. Making choices6. Commenng
2. Requesng
Communicaon Bill of Rights
1. Social interacons 3. Rejecng
7. Ask and give informaon 8. To be informed 9. Access supports
10. Communicaon
acknowledged 11. Access AAC andAT12. Access opportunies
13. Being respected14. Addressed directly 15. Cultural and linguisc
acceptance
FIGURE 1.5 Communication Bill of Rights.
(Sources: Brady et al., 2016; Scope’s Communication and Inclusion Resource Centre, 2016)
Key Points of Chapter 1
• Communication is a fundamental skill in the development of all children.
• Communication, language, and speech are closely related. However, there are
distinct differences between them.
• Students with CCN may have difficulties with one or more aspects of com-
munication, speech, or language.
• It is important to understand how communication typically develops in order
to have a better understanding of how development is different for students
with CCN.
Understanding Students with CCN 17
• Understanding CCN is important in school settings because it affects stu-
dents in day-to-day school activities and in their post-school outcomes.
• When teaching communication skills, the goal should be for students to
become independent communicators.
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Understanding Students with CCN 19
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Understanding Students with Complex Communication Needs
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speech. Merrill-Palmer Quarterly of Behavior and Development, 21, 205226. doi:10.1177/
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Supporting children and adults with complex communication needs (4th ed.). Baltimore, MD:
Paul H. Brookes.
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K. (2016). Communication services and supports for individuals with severe disabilities:
Guidance for assessment and intervention. American Journal of Intellectual and
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18 Brady, N. C. , Steeples, T. , & Fleming, K. (2005). Effects of prelinguistic communication
levels on initiation and repair of communication in children with disabilities. Journal of
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determination for transition-age youth: Views of high school general and special educators.
Exceptional Children, 75, 5570. doi:10.1177/001440290807500103
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communicative acts. Augmentative and Alternative Communication, 18, 177191.
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and language development: A meta-analysis. Developmental Review, 30, 352366.
doi:10.1016/j.dr.2010.10.001
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communication needs in children. Community Practitioner, 86, 4447.
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communication competencies for special education teachers. Journal of International Special
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150110
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language disorders in children: Implications for the social security administrations
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doi:10.17226/21872
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speech-language
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guidelines, communication disorders. Retrieved from
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MA: Cengage Learning.
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