AAC for Adults with Developmental Disabilities

What does supporting communication look like for adults with intellectual and/or developmental disabilities?

When we think of quality of life, we are thinking about psychosocial competence. One’s ability to maintain a state of well-being. To deal effectively with the demands and challenges of everyday life. Going deeper, it is life skills that enable us to manage everyday demands and challenges. 

The World Health Organization (WHO, 1994) identified a core set of skills that promote well-being:

• decision making 
• problem solving 
• creative thinking
• critical thinking 
• effective communication (which includes literacy!)
• interpersonal relationship skills 
• self-awareness 
• empathy
• coping with emotions 
• coping with stress 

These are life skills. Skills in each of these areas provide a foundation for psychosocial competence. These life skills enhance the quality of one’s life. These are universally needed and/or desirable to be a full participant in everyday life. 

When we look even deeper, we realize that ALL the communicative competencies are needed to develop these life skills:

• linguistic competence – receptive language (including text-based), expressive language (including text-based), vocabulary, grammar, morphology, etc.
• operational competence – skills needed to use the AAC system, including navigation and adjusting volume
• social competence – skills that support making and keeping relationships
• strategic competence – skills to fix communication issues and increase communication effectiveness
• psychosocial competence – motivation, attitude, confidence, resilience, etc.
• emotional competence – being able to identify, respond to, and manage own emotions as well as the emotions of others

All the communicative competencies support well-being and quality of life.

People with IDD reach adulthood with a range of communication skills. Their communication abilities may be emerging. Or they may be able to communicate independently. Some adults with IDD do not have a reliable way of communicating using symbolic language. They may have developed unique, unconventional ways of communicating. Other adults with IDD use symbolic language to communicate anything to anyone in any situation. They may even be able to read and spell.

What does supporting communication look like for this age group? It looks like meeting the person where they are at and helping them build on their strengths. It looks like continuing to support their development of language, literacy, communication, and other life skills. It looks like supporting the goals they have for themselves.

Wait and be patient!

Read more about providing AAC users opportunities to take turns in conversations and discussions: The Right to Express Preferences and Feelings, Make Comments, and Share Opinions (Right #9)

Be a good communication partner.

An important part of supporting communication for this age group is by learning how to be a good communication partner. Good communication partners do the following:

• ensure access
• presume competence (making connections)
• accept all forms of communication
• pause and wait
• listen actively
• clarify and confirm
• be respectful
• model and coach

Read more about being a good communication partner: The Right to Participate Across Settings as Full Communication Partners (Right #5)

Continue Working on Communication Skills

It is important to continue developing communicative competence. To be a full participant in daily life, to self-advocate, and to have self-determination, a person must have autonomous communication! Human beings have the capacity to learn even in adulthood.

It bears repeating. Many, if not most, agencies and organizations that provide job help to disabled adults look for the disabled person to have strong independent communication skills. Even many adult day programs need the people attending their program to be able to communicate without caregiver help. This is unfortunate. Many disabled adults who can successfully (and autonomously) communicate using partner-assisted methods, may not have the physical capacity for completely independent communication.

Age-related changes.

As people with IDD become adults, there are new age-related issues that influence communication and AAC use, as well as quality of life.

• Often young adults age out of the school system without an AAC system they own, leaving them without an AAC system as an adult.
• There are still many adults that have no or limited history of AAC use, which means they have developed a lifetime’s worth of behaviors and unique signals that serve as their primary means of communication. They may have also developed learned passivity and lack of interest in using AAC based on their life experiences. 
• If the adult does have an AAC system, often there is limited appropriate vocabulary available to them.
• Some adults with IDD are emerging communicators. Emerging communicators of any age can be tricky! Some seem to show little response to or interest in interacting with others. Most communication partners are not taught how to engage older emerging communicators.
• The majority of communication partners in adult settings have a lack of AAC knowledge and training. So if the adult relies on a communication partner to assist with their communication, communication gets abandoned.
• There is a huge lack of SLP, PT, OT support in adult day or residential programs. Many adults go YEARS without appropriate support of communication tools.
• Available SLPs, OTs, PTs often lack AAC expertise, which often means no focus on AAC.
• Adults with IDD will age and likely face health care issues – both their own and related to their aging parents. Aging means potential need for modifications to AAC systems and/or new AT equipment or interventions to accommodate new developing issues (e.g., arthritis, vision issues, hearing loss, cognitive changes, etc.).
• Adult AAC users have the right to fair employment opportunities. They have the right to participate within their communities (political, spiritual, education, recreational spaces, etc.). And they have the right to build and engage in meaningful, positive relationships, both platonic and romantic. Without judgement, persecution, or infantilization.