Communication

Communication Basics

Whilst it is true that the majority of people with Angelman Syndrome do not develop fluent spoken language, they are excellent communicators from an early age. When you receive a diagnosis of AS, the lack of ability to speak is usually one of the hardest obstacles to overcome as a parent or carer. Many people worry that they will never hear their child say ‘Mummy’, ‘Daddy’ or ‘I love you’, but we need to remember that the majority of communication is non-verbal for all of us. A smile, body language, gestures or a certain look can all convey meaning, and we are used to interpreting this non verbal language in our day to day lives. It is important to remember that people with AS also have the ability to communicate through the same means.

But how can we help them to develop a way of communicating with people outside of their immediate family or support network?

The end goal for anyone with AS, of any age, is to have a robust language system that is appropriate for them and can be understood by others. AngelmanUK strongly advocates the use of Augmentative and Alternative Communication (AAC) within a total communication environment from as early as possible.

Total Communication means that we use ‘whatever works’. If someone can make their needs known by using a gesture such as a point, we need to recognise and honour that communication. Some people with AS can use their own modified signs – they may be based on Makaton or British Sign Language, but they will probably be adapted to their own physical ability and therefore harder for people to understand. Most people with AS do not learn to use sign language effectively. Some people will bring a cup to you if they want a drink for example, or will point to a photograph in a magazine to request food. Whilst we need to focus on teaching people with AS to improve their communication skills and to use an AAC system, we shouldn’t ignore their attempts to communicate by using other means available to them.

AAC is discussed in more depth in the following chapters but can take the form of a low tech system such as a PODD book or a high tech system like an iPad or Voice Output Communication Aid using a system like Proloquo2Go or PODD amongst others. AngelmanUK has provided training in both of these systems as we have found that they are the most accessible for people with AS. There are several other robust language systems and a good Speech and Language Therapist will be able to go through what is available and can offer an assessment. Some parents and professionals assume that a person can be too young or too old to learn how to use AAC, however we know from experience that this is simply not true. It needs to be viewed as one would look at a multilingual family. A French mother and a Spanish father would each speak their respective language to a new baby from before birth. That baby would then grow through childhood speaking both French and Spanish and possibly English as well! Introducing a person with AS to AAC is the same as learning a new language and you may need to learn this new language together. AngelmanUK regularly provides training and liaises with many communication experts. Please contact us if you require more information or help to get started.

We shouldn’t view communication as a chore. It should be something which evolves over time, however we may need to put in a little more effort with someone with AS. Make learning fun. A toddler with AS is still a toddler and will usually enjoy all the usual toddler activities. Use playtime as an opportunity to interact with your child and build up a bond, learn about turn taking and shared experiences. Read regularly to your child and make books available – board books may be more robust! People with AS of all ages enjoy the physical interaction that comes with shared play and reading opportunities. If you have a communication book or device these are ideal times to model language and create a fun learning environment for everyone. Many local authorities will offer a course called It Takes Two to Talk by The Hanen Centre. Whilst this course does not focus on AAC, it will help parents and carers of young children with AS understand how to make learning language fun.

As your child gets older and attends school or nursery you will come across PECS. PECS was designed to help children with autism learn how to initiate communication by choosing a symbol from a book and placing it on a message strip in order to make a request. People with AS do not need help initiating communication and will usually find PECS unmotivating. They also like to eat the shiny plastic covered symbols! It is important to work with school and your Speech and Language Therapist in order to give your child the opportunity to move from PECS on to using a Robust Language system which meets their needs.

Intensive Interaction (II) is also something which many schools and professionals use. When used alongside AAC, Intensive interaction has many benefits. It can help to teach receptive interaction between the person with AS, and the carer who may sometimes miss communication cues, along with helping the person with AS understand the concept of turn taking. It is important to recognise that II should be seen as a tool to help the person with AS use AAC effectively, and not as a standalone communication system for people with Angelman Syndrome.

A Communication Passport provides a practical and person-centred approach to passing on key information about people with complex communication difficulties who cannot easily speak for themselves. You may come across them being used in schools or day centres and you can find templates to create your own by following the link above.

Above all, we need to recognise that by helping someone with Angelman Syndrome access effective communication, we are opening up their world. Being able to communicate gives people autonomy and independence. It will take time and dedication, but the hard work is worth it!

Please see below for more in depth information about AAC and Communication in AS.

What is communication?

Communication is seen as a basic human right. Every person communicates. At it’s simplest communication is an interaction between two people but it is also an exchange and is dynamic. It changes as a result of what each person adds to the conversation. We may communicate with a number of people, as part of a group discussion or as an internal dialogue. This communication can happen in lots of different ways; we use speech, writing, facial expressions, gestures, pictures, GIFs, emojis, to name a few. Communication happens for lots of different reasons.

So what are Complex Communication Needs (CCN)? Generally, it is accepted that someone who struggles to meet most of their communication demands through speech has CCN. These people need extra communication aids to be understood. The aids should help facilitate all the different ways that we may want to communicate.

Some simple ways we can start off with are to share stories with others. Remnant books can be photos or scraps collected from days out that help people to share experiences.

Helping others to understand the communication that people with AS already have can be very useful. Communication charts can help you gather the information you need to record what the person with AS is trying to say. Recording various attempts to communicate using video on a mobile phone can be very helpful.

Recording and thinking about communication also helps us to think about next steps. We all develop our communication throughout our lives and people with AS are no different.

What is AAC?

Augmentative and Alternative Communication (AAC) is the umbrella term used to describe any communication that is not spoken. Everyone uses AAC in the form of expression, gesture and written communication. However, for people with AS and other Complex Communication Needs (CCN) it is essential. Sign language is the most well-known formal AAC language but many others use symbol based languages.

There are three main categories of AAC; no tech, low tech (also called light tech or soft tech) and high tech.

No type of communication is better than any other but for those using high tech AAC systems they should also have a low tech back up to be used in event of a breakdown or in circumstance when high tech is difficult to use e.g. bright sunshine, near water.

Communication and AS

Studies suggest that many individuals with AS prefer to use unaided forms of AAC including, facial expression, gesture, pointing, physical manipulation, enhanced natural gestures and signing. Whilst there have been no recent studies into electronic devices for AAC a 2014 study showed that 67% of participants had used an electronic AAC device within the previous 3 years and the majority (62%) of parents reported that had a positive effect on the individual. It would be realistic to think that these numbers would be higher today as more people develop awareness.

There have been several studies to determine if there is a difference between the four genetic subgroups of AS and their communicative function. The findings from these studies suggest that deletion positive individuals were less likely to use sign, enhanced natural gestures or speech. So far no studies have shown any difference between the subgroups and the use of robust AAC. Anecdotally we know that many of the best communicators are deletion positive. Robust communication should be given to all individuals regardless of genetics. It is essential to build receptive as well as expressive language.

How to choose a system

One of the most common questions that people ask is which communication system should we choose. Many people are left making this decision without professional help and it can be daunting.

It may help to understand the factors that are considered to be the most important for success of a system. Johnson, et al. (2006) came up with the following list:

Person who uses AAC system experiences success 91.76%

Of course it can take a long time for someone to learn how to use a communication system so not everyone will experience immediate success. However we can try to maximise the chances by taking into account motor, aural and/or visual difficulties that a person may have. For example a low tech book may be more accessible to someone who has no point but can use a fist to indicate what they would like. Conversely if a person has difficulty with audio processing the standardisation of the voice from a Speech Generating Device may be best.

Degree to which the system is valued by the user and partners as a means of communication 90.58%

It may be worthwhile contacting schools, nurseries or adult placement services that AS individuals attend or are likely to attend. If they already use a system it may be worth using the same one. Not only will they value it but they are more likely to be able to offer support.

System serves a variety of communicative functions 89.85%
System is used for communication, not just as a toy or therapy tool (Real communication) 87.20%

Both points above are related to abandonment by the individual. If AAC is only ever used for limit functions and as a tool to suit the people around them rather than as a device for actual communication it is likely that AS individuals will lose interest.

Other areas:
Appropriate device selected
Support for system

The appropriateness of device is clearly important it is not the most important decision.

Beginning communicators

Everyone is a communicator but for some people with AS it is very difficult to progress without input. If individuals are very early in their communication journey they may have been described as pre intentional or pre symbolic.

Pre intentional communication means that an individual does not yet use their communication to convey a message.

Pre symbolic communicators use communication to convey a message but it is not yet in the form of a word, sign or symbol.

The most important thing we can do for people who are still at the beginning of their communication journey is to attribute meaning to all of their communication attempts. For example:

You are flapping your arms I think that means you are excited.
You turned away I think that means you are saying no.
You smiled I think that means you like it.

Some important considerations for people with AS:

laughter does not always mean something is fun. Most parents know the difference between a genuine laugh or a laugh that signifies something is wrong, if possible explain to others the difference.
excitement and anxiety are very finely balanced be careful of attributing meaning of someone in a highly aroused state.

Choice making is a good way of attributing meaning. However please be aware that it must be choice making for a genuine reason of interest to the individual not the person offering the choice. Note the difference between:

What do you want to do today? Then offering park or beach
Today we can go to the park or the beach, which would you prefer?

The first question is an open ended question which is then limited by choices. We can never know in this circumstance whether the individual had chosen somewhere different but that choice wasn’t recognised. In b even if we don’t know if the person has understood the question, or what is being asked we can use it as an opportunity to attribute meaning.

You looked at the card with beach, I think you want to go to the beach.
You threw away the card with the park, I think you want to go to the beach.

If possible always offer a choice of something different, this helps to keep the choice making genuine.

Beginning communicators can share stories by the use of remnant books, personal experience stories or social stories. See attached example and further info below.

Always remember that if a person is pre-intentional it does not mean they are not ready for robust AAC. These individuals may need more input for receptive language skills to develop and therefore need a full language system as soon as possible. The aim for everyone is to help them share in communication for those not yet using a robust AAC system there are still plenty of ways that we can help support communication.

AAC Myths

There are many myths that surround AAC, there is no well-researched peer reviewed literature that backs these myths up and indeed there many to the contrary. In 2005 Romski and Sevcik discredited 6 the most popular myths of AAC (below) yet many of these are still used as reasons to wrongly withhold robust AAC.

Myth 1 AAC is a “last resort” in speech-language intervention.
Myth 2 AAC hinders or stops further speech development.
Myth 3 Children must have a certain set of skills to be able to benefit from AAC,
Myth 4 Speech-generating AAC devices are only for children with intact cognition.
Myth 5 Children have to be a certain age to be able to benefit from AAC.
Myth 6 There is a representational hierarchy of symbols from objects to written words (traditional orthography).

Numbers 3 – 6 are most relevant to people with AS.

Myth 3 Children must have a certain set of skills to be able to benefit from AAC

The guidelines in the UK still refer to pre-requisites and many professionals still believe in them. If a person with AS is told they are not ready it is most likely because someone has wrongly decided that they don’t meet a pre-determined set of skills. It is nonsensical to think of children requiring a skill set before they begin to learn language: we often speak to babies before they are even born in order to teach them their language.

Myth 4 Speech-generating AAC devices are only for children with intact cognition.

Robust AAC whether high or low tech may be described as too overwhelming or too much for certain individuals. However it is very difficult to prove cognition without first being offered the opportunity of language. Think of how difficult it would be for you to prove intellect in a foreign language, now add in significant motor and/or visual skills. Language aids cognition and cognition aids language.

Myth 5 Children have to be a certain age to be able to benefit from AAC.

The best age to start being exposed to AAC is the one the individual is right now. There is no upper or lower limit. Learning language is a lifelong pursuit for everyone and individuals with AS are no exception. Children as young as two and many older adults who only got access to AAC after they had reached adulthood have shown they are successful communicators.

Myth 6 There is a representational hierarchy of symbols from objects to written words.

This idea first came about from some flawed research using verbal university students. In the experiment they actually chose written words as the most representative. There is no link between what verbal students chose and what is useful to teach communication. There are many words that cannot be represented by objects and pictures but fortunately there is no need to start with these before symbols.

The reason these ideas exist is that they are simply the way things have always been done. The dangerous part is that belief in these myths becomes a self-fulfilling prophecy. If someone isn’t given an opportunity to learn language in a natural way then the chances of progression are slim, therefore it may look like they were never a good candidate for robust AAC.

The truth is everyone is a good candidate for robust AAC, some will progress further than others but we will never know what a person’s potential is unless we give them access.

Multimodal communication

People with AS can be very good at using a wide variety of communication techniques to get their message across. This is known as multi-modal communication. It is very important that we do not stop responding to these methods of communication when a more robust system is put in place. It is useful to add a model of how they could say the words with symbols but ignoring previously successful communication may result in frustration and confusion. It is highly unlikely to increase the chances of successful system use.

It is also very natural to use a wide range of communication modes. Think of how we change our communication according to our surroundings and company. If someone verbal was asked to repeat themselves even although their message had been understood we would consider that person extremely rude! There should be no difference.

Aided Language Stimulation

This short video explains Aided Language Stimulation.

In order for a person to become an AAC user they need to be shown how to use the system. Aided Language Stimulation, Aided Language Input, Aided Language Immersion or Modelling is needed. Aided Language Stimulation not only teaches the type of communication that is appropriate depending on the situation and people that are being communicated to but it also necessary to teach the meaning behind the symbols. Mary Louise Bertram has written a great blog here.

It is when we use the person’s AAC usually by pointing to the symbols whilst we say the words, best practice is just one or two words more than the number the user is saying. Whilst modelling we should keep language as natural as possible, comment rather than question.

Observe and respond

During communication observing and responding to the person with AS is vital. All communication attempts should be acknowledged even if you are unsure of the intent behind it. This is a great way to teach what the symbols mean and increase the confidence of the AAC user.

Prompting

AAC users may need a long time to process information or to allow their bodies to respond. It is crucial that you leave enough time before prompting. Time may pass by slowly so count to remind yourself not to act too soon. Prompting may be essential but it does change the context of the interaction so should only be used when necessary. No-one should ever be forced into making a response, invite and encourage response but never force. Partial prompts are also useful and better than a direct prompt this could be directing towards a choice of topics to consider or an appropriate area of the AAC system.

Expanding

When expanding a message we can

add in an extra words. So if the person says “PARK” you can say yes we can “GO” to the “PARK”.
say message in a different way. E.g. “MY GO” could be yes its “YOUR TURN”
replace words to make it more grammatically correct “WANT ME OUT” OK you saying “I WANT OUT” lets get you out (you could also choose to model extra words in this sentence.

It is important to keep expansions to within one or two words of the current ability of the AAC user. There is no point in modelling a 7 word, grammatically correct sentence to someone who is only using one word utterances.

Tools for AAC

Whilst there are no skills required to begin AAC and have it modelled it is important that we help teach people the required skills they will need to become competent autonomous communicators. One of the most popular concepts to group these skills is Janice Light’s communication competences namely social, operational, linguistic and strategic competence.

Linguistic competence refers to both receptive and expressive language. In order for a person to become a competent AAC user they must understand language.

Operational competence is the practical element of AAC use. This is perhaps the most obvious of the four competences and will be discussed later.

Social competence refers to the use of AAC during social interaction. After all communicating with another person is much more fun.

Strategic competence is essential for all AAC users due to the complexities of their own bodies as well as limitations of AAC systems and communication partners. Learning strategies will help communication despite these things.

Pathways for Core First has an assessment tool based on these strategies. It is helpful even for those not using Core First as a language system providing ideas and strategies in order to help achieve the next goals.

Strategies for Teaching AAC

Create opportunities and Motivate

The most important thing you can do is to ensure that whatever they do and wherever they go a person with AS has access to language. If the language is not right there then the moment will pass, you will not model and they will not communicate. Some examples of this are Aided Language Displays in the bathroom or trampoline, a float with ALD for the swimming pool. Harness and straps should be used to carry the AAC system and a mount is required for those in wheelchairs.

When we are teaching people AAC it is extremely important that we do not make it seem like work or just another task to do. Most times throughout the day when we communicate it is for fun and it is something we want to discuss. AAC should be no different.

Access methods/assistive technology

The easiest way to access symbols is by pointing to them yet this isn’t an option for many people with AS. Fortunately people can still communicate their own messages using other means. Both high and low tech AAC devices can have accommodations made to them to help aid access. This includes key guards, spacing of symbols and the use of high contrast symbols. If an individual with AS is able to use a tablet successfully, they will have the motor and visual skills to navigate any AAC system.

Partner assisted scanning can be used when motor skills are not yet developed enough for direct access. With this method the individual is helped to navigate the system by the partner showing or pointing to the symbols and/or reading aloud the words. The individual indicates a yes or no response to convey their message. This can be time consuming and it takes more practice, but it has been used to great effect with individuals who have problems with motor skills and for individuals with Cortical Visual Impairment (CVI). CVI is not uncommon amongst people with Angelman Syndrome and using a well-spaced, high contrast symbol set may also aid here.

NOTE: Some AAC users are able to use direct access most of the time but it is very useful to model partner assisted scanning too, as if they are particularly anxious or finding it difficult to focus, this method may be much easier for them.

Here is a link to a video of Karen Owens demonstrating how to do partner assisted scanning. She is using a switch to give the ‘yes’ and no’ responses but this could also be done with a head nod and shake, vocalisations or any other method.

Switch access can also be used for access to high tech devices for those who find direct access difficult. It also uses a scanning technique but here the individual uses a switch/button to indicate their choice. There are technologies available that can allow this to be done without a partner. It is unlikely that using switch access would be taught before partner assisted scanning.

Eye gaze Is an access method where the user selects a symbol on a page on the computer by looking at it. Normally it is used for people with severe motor difficulties, e.g. Cerebral Palsy or Rett Syndrome but can also be useful for some people with Angelman Syndrome. Low tech communication books can be made suitable for eye gaze as well as sophisticated high tech options. Eye gaze can take lots of practice and is very tiring so individuals may find partner assisted scanning much easier.

SETT is a framework that can be used to help determine the right tools required for different tasks depending on the environment and the person (student). The guidelines and resources are free to download.

Assessment

Most individuals with Angelman Syndrome are intentional communicators but many would struggle to demonstrate this through traditional testing methods. People with AS do not perform well in tests due to significant dyspraxia and apraxia that can be enhanced within a testing situation. It is also likely that individuals are not given the tools to answer questions in a standardised test appropriately. Another problem with standardised tests is that they may unfairly categorise people. One example is a study that suggested deletion positive individuals rarely progress beyond 13 months of cognition when they used standard methods of testing. If this study were to be used to match cognition to communication it would seem pointless to try robust AAC with these individuals as it would be unlikely that a 13 month old could. Yet we know both anecdotally and from research that many deletion positive individuals can use full AAC systems very successfully.

Assessment is however necessary in order to plan for progression of communication. Dynamic assessment tools are more suitable for people with AS. The pragmatic profile and communication matrix are two such assessment tools.

Regardless of where an individual has tested or appears to have tested they need access to a full language system. This is because full language systems are the best way to build receptive language. When people use robust language systems they speak in a very familiar and predicable way. This is more effective than separate symbols.

Pathways for Core First is a free app that can be adapted for those using all communication systems. It is based on Janice Light’s communication competences namely social, operational, linguistic and strategic competence.

Linguistic competence refers to both receptive and expressive language. In order for a person to become a competent AAC user they must understand language.

Operational competence is the practical element of AAC use. This is perhaps the most obvious of the four competences and will be discussed later.

Social competence refers to the use of AAC during social interaction. After all communicating with another person is much more fun.

Strategic competence is essential for all AAC users due to the complexities of their own bodies as well as limitations of AAC systems and communication partners. Learning strategies will help communication despite these things.

Further information

Calculator, S. N. (2015) Overview of Augmentative and Alternative Communication and Special Considerations for Individuals with Angelman Syndrome in S. Calculator (Ed.), Angelman Syndrome: Communication, educational and related considerations (p115-130).  Retrieved from http://ebooks.benthamscience.com/book/9781681081168/

Sheldon, E. (2015). Learning characteristics of students with Angelman Syndrome and related instructional strategies. In S. Calculator (Ed.), Angelman Syndrome: Communication, educational and related considerations (p35-42).  Retrieved from http://ebooks.benthamscience.com/book/9781681081168/

Dynamic Learning Maps (DLM) –

These free courses are aimed at professionals but are suitable for parents too. A certificate is emailed to those wishing to use it for CPD. They are between 30-45 mins in length, the most relevant for each aspect of AAC will be included within the further information section of the website. This site will link to the individual modules but resources are available for groups if preferred.

Beginning Communicators

This module describes symbolic and non-symbolic forms of communication, the distinction between pre-intentional and pre-symbolic communicators, and identifies additional sources of support for building communication skills.

Remnant books and personal experience stories

http://www.angelman.org/wp-content/uploads/2016/01/writing-remnant-personal-experience-handout.pdf www.youtube.com/watch?v=PXdjxj2IQJY&index=20&list=PLihsTkrStCHZVZBHDC0Qr7z10cYWC0ltx

Social stories

www.angelman.org/wp-content/uploads/2015/11/Social-Scripts-2-21-16HO4.pdf

www.youtube.com/watch?v=vowOf6EHL1I&feature=youtu.be

AAC Myths

praacticalaac.org/praactical/aac-myth-buster-wrap-up/

http://www.janefarrall.com/dos-and-donts-of-implementing-real-communication-through-aac/

Dynamic Learning Maps (DLM) – Symbols
This self-directed module provides an overview of symbols to support communication and interaction. It also describes the use of symbols and photographs in text.

ASF communication series webinar on Aided Language Stimulation https://www.youtube.com/watch?v=zOr7MO7ZnzM

ASF communication series webinar on non-directive language

youtu.be/e0pUzJdWcBU

teachinglearnerswithmultipleneeds.blogspot.com/2016/03/rethinking-aac-prompting-hierarchy-in.html

www.janefarrall.com/why-we-do-aided-language-stimulation-and-you-should-too/

www.janefarrall.com/dos-and-donts-of-implementing-real-communication-through-aac/

Follow we speak PODD on YouTube

Lotsacomptons also have a YouTube page they use Snap plus Core First

literacyforallinstruction.ca/access-to-communication/

www.rettuk.org/resources/resources-for-families/communication/

http://www.i-asc.org.uk/

http://www.janefarrall.com/what-is-beginning-aac

http://literacyforallinstruction.ca/access-to-communication/

References

Clayton-Smith, Jill (2010) Angelman Syndrome. Journal of Pediatric Neurology , Volume 8 (1) – Jan 1,

Calculator, S.N. (2013). Use and acceptance of AAC systems by children with Angelman syndrome. Journal of Applied Research in Intellectual Disabilities, 26(6), 557-567. [PMID:23606637]

Calculator, S.N. (2014). Parents perceptions of communication patterns and effectiveness of use of augmentative and alternative communication systems by their children with Angelman syndrome. American Journal of Speech-Language Pathology, 23(4), 562-573.dx.doi.org/10.1044/2014_AJSLP-13-0140 [PMID:24700165]

Didden, R. , Sigafoos, J. , Korzilius, H. , Baas, A. , Lancioni, G. E., O’Reilly, M. F. and Curfs, L. M. (2009), Form and Function of Communicative Behaviours in Individuals with Angelman Syndrome. Journal of Applied Research in Intellectual Disabilities, 22: 526-537. doi:10.1111/j.1468-3148.2009.00520.x

Gentile, J.K., Tan, W.H., Horowitz, L.T., Bacino, C.A., Skinner, S.A., Barbieri-Welge, R., Bauer-Carlin, A.,Beaudet, A.L., Bichell, T.J., Lee, H.S., Sahoo, T., Waisbren, S.E., Bird, L.M., Peters, S.U. (2010). A neurodevelopmental survey of Angelman syndrome with genotype-phenotype correlations. Journal of Developmental & Behavioral Pediatrics, 31(7), 592-601.[PMID: 20729760]

Hyppa Martin, J., Reichle, J., Dimian, A., & Chen, M. (2013). Communication Modality Sampling for a Toddler With Angelman Syndrome. Lang Speech Hear Serv Sch, 44(4), 327-336. doi: 10.1044/0161-1461(2013/12-0108).

Quinn, E. and Rowland C. (2017) Exploring expressive communication skills in a cross-sectional sample of children and young adults with Angelman syndrome. American Journal of Speech-Language Pathology, Volume 26, pages 369-382. doi:10.1044/2016_AJSLP-15-0075

www.communicationmatters.org.uk/page/what-is-aac

praacticalaac.org/praactical/talking-about-talking/

www.assistiveware.com/dos-and-donts-aac-multi-modal-communication

www.studentswithnospeech.org.au/

Calculator, S. N. (2015) Overview of Augmentative and Alternative Communication and Special Considerations for Individuals with Angelman Syndrome in S. Calculator (Ed.), Angelman Syndrome: Communication, educational and related considerations (p115-130).  Retrieved from ebooks.benthamscience.com/book/9781681081168/

Sheldon, E. (2015). Learning characteristics of students with Angelman Syndrome and related instructional strategies. In S. Calculator (Ed.), Angelman Syndrome: Communication, educational and related considerations (p35-42).  Retrieved from ebooks.benthamscience.com/book/9781681081168/

Kangas, K. and Lloyd, L. (1988). Early cognitive skills as prerequisites to augmentative and alternative communication use: What are we waiting for?. Augmentative and Alternative Communication, 4(4), pp.211-221.

Light, J. and McNaughton, D. (2012). The Changing Face of Augmentative and Alternative Communication: Past, Present, and Future Challenges. Augmentative and Alternative Communication, 28(4), pp.197-204.

Romski, M., & Sevcik, R. A. (2005). Augmentative communication and early intervention: Myths and realities. Infants & Young Children, 18(3), 174-185.

www.assistiveware.com/how-be-super-communication-partner

Light, J., & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication?. Augmentative and Alternative Communication, 30, 118. doi:10.3109/07434618.2014.885080

[Retrieved from arxiv.org/ftp/arxiv/papers/1411/1411.6568.pdf ]

www.augcominc.com/newsletters/index.cfm/newsletter_46.pdf

Jeanne M. Johnson, Ella Inglebret, Carla Jones & Jayanti Ray (2006) Perspectives of speech language pathologists regarding success versus abandonment of AAC, Augmentative and Alternative Communication, 22:2, 85-99, DOI: 10.1080/07434610500483588

Light, J., & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication?. Augmentative and Alternative Communication, 30, 118. doi:10.3109/07434618.2014.885080 [Retrieved from arxiv.org/ftp/arxiv/papers/1411/1411.6568.pdf]

Calculator, S. N. (2015) Overview of Augmentative and Alternative Communication and Special Considerations for Individuals with Angelman Syndrome in S. Calculator (Ed.), Angelman Syndrome: Communication, educational and related considerations (p115-130).  Retrieved from ebooks.benthamscience.com/book/9781681081168/