Beating the Odds in AAC Device Abandonment

Handing a child their brand-new augmentative and alternative communication (AAC) device can be a rewarding experience for a therapist. But the sad fact is that as many as three out of five AAC systems may be abandoned and left on a shelf within a year by caregivers who could not—or would not—make it work.¹

Fortunately, there are steps you can take to make device rejection or abandonment less likely, informed by research on the perspectives of both parents and therapists.^{2, 3, 4}  These recommendations are rooted in family-centered service, an approach that builds families’ capacity and self-efficacy while honoring their perspectives, needs, and expertise.

Meet the Family Where They Are

First, put on your counselor’s hat and listen. If this will be a child’s first speech device, parents may be experiencing some degree of denial or grief that they must move through in order to be “ready” to try AAC.

If other devices have already been tried and failed, you may need to help with processing those previous negative experiences. Here are some other important ways to keep your conversations family-centered:

• Don’t do all the talking. Instead, ask “What do you know about AAC?” and “What are your worries, hopes, and questions?”
• Defeat the deficit mindset. Rather than focusing on what a family lacks, consider their strengths and their unique expertise, and then build from there.
• Make connections. Help families find other AAC families to support them on their journey.

To Make It Work, Make It Workable

For an AAC device to be a success, it needs to work for the family, both in the technical sense of functioning reliably, but also in the context of their home and routines. If the time and effort needed to make use of the device outweigh the motivation behind that use, the dusty shelf is the next stop.

Improve the motivation-to-effort ratio in one of two ways, or ideally both:

• Increase motivation and buy-in by giving parents choices: “Here are a few devices I think might work for Jose. Let’s explore them, and you can tell me which one you want to try with him.” Work together to establish realistic expectations and small goals, and build up momentum with early wins.
• Decrease effort of use by offering hands-on training, functional practice, and ongoing coaching. Make sure that meaningful vocabulary is available, and that parents can find or add those words themselves. Focus on ways to incorporate the device into their existing routines rather than making it something “extra” they need to do. Finally, spend some time anticipating barriers to success and planning ways around them.

Check Your Professional Ego

This part can feel uncomfortable—some proportion of those “abandoned” devices were just simply the wrong device for that child. If you are new to AAC or only choose to work with one type of device or app, chances are that you may make some less-than-perfect recommendations. Trialing multiple options (and taking caregivers’ input seriously), will take you a long way here.

Beyond that, if you need more training, seek out professional development along with advice or mentorship from other therapists with more experience using AAC devices. Vendor reps can be a good resource, but don’t let a relationship with one company keep you from exploring other options that could be a better fit for your client.

Consider multiple factors in your device-matching process, including durability, portability, ease of use and navigation, and availability of technical support. A well-matched device, chosen and implemented in partnership with the child’s caregivers, is likely to be a well-used device too.

To learn additional suggestions for how to support and prioritize successful communication in children who use AAC, MedBridge instructor Laura DeThorne offers this six-part course on the role of SLPs as communication specialists working with pediatric clients and their families.