We host an interview conducted in collaboration with Dr. Emanuela Maggioni. A child neuropsychiatrist, physiatrist and phonographer, she worked in rehabilitation services dedicated to the developmental age in public and private facilities. She is currently Health Director of the Benedetta D’Intino Centre in Milan, in the sectors of Psychotherapy and Augmentative and Alternative Communication. It follows children, teenagers and their families. Member of the Scientific Committee of ISAAC – Italy (International Society for Augmentative and Alternative Communication, Italian section).
What is augmentative communication?
Augmentative and Alternative Communication System (AAC) is the term used to describe the set of knowledge, techniques, strategies and technologies that facilitate and increase communication in people who have difficulty in using the most common communication channels, especially oral language and writing.
The adjective “augmentative” indicates how the methods of communication used are not intended to replace, but to increase natural communication: the objective of the intervention must be the expansion of communication skills through all available methods and channels.
The AAC is not a substitute for oral language, not inhibit its development when this is possible; AAC instead translates into support for understanding relationship and thought.
Augmentative and Alternative Communication is now an area of clinical practice and research that seeks to reduce, contain, compensate for the temporary and permanent disability of people who present a serious communication disorder both on the expressive and receptive side, through the enhancement of existing skills, the enhancement of natural modes and the use of special modes.
In which cases does it apply?
The AAC intervenes in all situations where people have complex communication needs. This may be the case for congenital or acquired clinical conditions in children and adults.
Children with complex congenital disabilities may have communication difficulties such as in the most severe forms of infant cerebral palsy or genetic disorders that compromise the evolution of all cognitive functions, including language.
Even in autistic spectrum disorders, communication is compromised at different levels, both in the linguistic and pragmatic components.
Serious degenerative diseases can cause loss of verbal language in adults, such as amyotrophic lateral sclerosis or Alzheimer’s disease.
In addition, patients admitted to hospital may be in a temporary or permanent state of communicative vulnerability as a result of the pathology leading to hospitalisation (as stroke) or as a direct consequence of health interventions (as in the case of intubationally assisted breathing). In these situations, augmentative communication can effectively support communication between the patient and health care workers.
You say that augmentative communication is not an instrument but a process. What does that mean?
Communication takes place in the relationship, therefore, communicative exchanges and opportunities for participation are indispensable for the child development, not only the ability to express himself, but above all, intentionality and motivation to communicate.
The AAC’s intervention cannot therefore be limited to the child, but it is essential that it is also aimed at the family and social environment along a path that follows the child as he or she grows, progressively adapting to his or her abilities and needs.
How can we involve people at home, at school, who will follow children with autism when they are away from care centres?
All communicative partners are an integral part of the AAC intervention and are involved from the beginning of care so that they know how to interact with the child by grasping the signals of communication, support him/her in using effective communication strategies and foster shared experiences.
The involvement of the partners takes place, both through the presence of family members and teachers at the intervention sessions, and through the possibility that the AAC operator can make observations in the family and school environment, observing the communicative interactions and suggesting changes to the environment, when they are necessary, to respect the particular needs of the child with complex communicative needs.