I have been working with students with complex needs for 25 years in public school in addition to having a son with complex communication needs (vision and hearing impairments). He has a vision impairment, but staff insisted for years that he could use PECS. Prior to exploring PECS, he had an AlphaTalker and it died. He was effective and successful with that, but no one was interested in finding a VOD for him. He could use PECS in very structured speech setting where the pictures could be in predictable locations, but when they weren't he couldn't spend 30 minutes scanning hundreds of pictures to say one thing to make a request. This is not effective or efficient, yet that is what we were asked to do at home. His vocabulary was well beyond 200 hundred words and we had a notebook with all of those symbols, but it took a lot for me to manage it for his access and I couldn't do it all the time. It was good for sentence development concept, but not for functional communication.

I have worked with other students in collaboration with SLP / SPED teams and successfully used a visual system to get them started with initiating communication and developing verbal skills, but there are kids who this isn't the case and I didn't see the progress. Sometimes the staff are convinced that progress will just be slow rather than considering the possibility that it doesn't make sense and the voice output is motivating and helpful. For my son the audio support is so important as well as the consistent placement of the words. I find that many of the students that I work with who need systems for their complex communication needs have motor planning challenges and needs their words to be found in a consistent place that is quick and easy to access. I know LAMP isn't for everyone, but I haven't found anything better for complex needs and true access to language.

I have used ProLoQuo2 Go and have heard great things from others, but I have never seen it successfully use with anyone I have worked with since it came out. I have had several students who have access to it, but don't ever use it. It isn't modeled. I don't think it is modeled because the staff/ parents don't know how to navigate and find the words they want to model. I think it could be a good system if the words were not organized categorically, but more associative in nature. I have spent several hours trying to get familiar with the software, but then the layout is different on each student's device so it is near impossible for me and support staff to learn to model consistently how to use the language system.

I have worked with students who can literally only lift an eyebrow. Switch scanning has to be simple and easy, but the staff don't want to take the time to set it up because of the amount of time and energy it takes. They forget that the student is a human being with the right to say whether he wants to take a bath before he gets his teeth brushed. I present these concepts, but when it isn't important to the family either it is hard to do much about it. In these situations even holding objects for eye gaze if often too much or done so inconsistently there is little meaning. For those who have persevered though, using object symbols has been awesome and students show in their body language anticipation and sometimes excitement.

So in response to your thoughts... it is a complex beast. Often most people on the team have any idea where to start or what can even be done. Then if there is someone who has an idea, not everyone on the team understands all the factors to consider let alone how to address each of the complex issues. It makes me sad to see so many students reading junior high and high school with no formal system or even an informal but well documented system of gestures and cues for communication. I have a student new to me this year who has gestures that seem very purposeful, but no one who has worked with her for the past year knows what any of them mean.... We are going to try a several formal VOD system and see what she does with it even though she has a vision and hearing loss.

So we must persevere and education as many as we can and advocate for resources because each individual is unique and deserves a voice regardless of the form of that voice. Blessings to you.

I have loved your work for many years, Jane, and am so happy to hear from you. I feel that AAC has a connotation of meaning "using speech generating devices that are electronic." I think we should think of it in broader terms, and your Every Move Counts program taught me a lot about learning to read nonverbal behaviors and shape communicative intent in individuals who have severe disability. I see many devices and switches on dusty closet shelves, never used and yet prescribed in good faith by AAC teams. I am really frustrated with the disdain some people show when they say that an individual who is using nonsymbolic low-tech systems for communicating "has no communication system" and that their parents or caregivers "rely on mindreading." While those devices gather dust, the "mindreading" continues, and if we would really observe and pay attention to the cues those mindreaders use, we could learn a lot and build a more intentional and varied communication system for our nonverbal clients. I know this is perhaps not a very popular response, but your question about when voice output is "needed" triggered this outpouring. Thanks for all you've done in this field to help us learn that all behavior is communication!