AAC Intervention For Multicultural Families - Similarities and Differences Across Cultures
by Wen-Hsin Ku, MA CCC-SLP (speech/language pathologist), NWACS guest blogger (she/her) and Hsiao-Ting Su, MA, CCC-SLP, NWACS guest blogger (she/her)
Reading Time: 6 Minutes
The views expressed in this post are that of the authors and do not necessarily reflect the views and policies of NWACS. No endorsement by NWACS is implied regarding any device, manufacturer, resource, or strategy mentioned.
There are limited AAC resources in minority languages, currently. SLPs should make every effort to meet the needs of multicultural families. It is crucial for SLPs to understand cultural differences when supporting multicultural families. We are two bilingual English-Mandarin speaking SLPs. We have worked with both families in the U.S. and Taiwan. And have first-hand experience navigating similarities and differences across cultures. Here we describe some similarities and differences we have encountered most often.
Similarities:
Families worry that AAC will hinder verbal communication development.
Families benefit from reassurance that child-led exploration on an AAC device is encouraged.
Differences:
Many families from Taiwan benefit from SLPs encouraging play-based, child-led approaches.
Multilingual families living in the U.S. benefit from SLPs' advocacy for minority language preservation.
Let's explore the common similarities, differences, and additional considerations we've identified.
Similarity: Families worry that AAC will hinder verbal communication development.
Many parents in Taiwan and the U.S. worry that using AAC might hinder their child’s speech development. As a result, many parents choose not to use AAC and seek out therapists to work only on spoken language.
Example: One family that I (Hsiao-Ting) worked with asked,
“After using AAC, will our child become lazy and stop speaking, only relying on the device to communicate?”
To address the concern, I reassured the family based on research and my own experience. I explained that using AAC does not impede speech development. It serves as a valuable tool that supports and enhances communication. I highlighted and celebrated each of the child's small achievements in communication, like:
gestures
facial expressions
body movements
I let the family know that all forms of communication are valid. The family began to understand that their child was already expressing himself. Using symbols through AAC could further enhance his communication. It was important to provide ongoing reassurance and guidance. This empowered the family to better support their child's communication development.
Similarity: Families need reassurance that it is okay for children to explore their AAC device.
Many parents have difficulties accepting their child making mistakes. This is another cross-cultural barrier. Mistakes may include pressing the wrong buttons or exploring buttons on the AAC device. When the children fail to select the correct symbol or button, they may be unfairly labeled as:
incompetent in using AAC
not understanding visual representations
non-compliant troublemakers who only play with buttons randomly
Example: I (Hsiao-Ting) once worked with a mom who would hold her son's hand to press each button on the AAC device.
She would take it away if he randomly pressed buttons. She said,
“He doesn’t understand. He’s just randomly pressing buttons.”
I explained that it is okay and in fact encouraged for children to explore and experiment with their AAC device. This is like children who use spoken language engaging in playful vocal experiments. I emphasized that we cannot be certain if the child was pressing buttons randomly or actually attempting to communicate. Responding to his actions as if he were communicating would help him associate the symbol he pressed with the message he conveyed. After reassuring and consulting with the mom, she started modeling on the AAC device without expecting her son to use it immediately. She allowed him to explore it while also seeing his exploration as communication. After a while, the mom and I were both thrilled to see her son pointing to symbols to communicate as expected. It is important to avoid too much direction and correction. Instead allow children to experiment and practice. This develops self-confidence in their ability to communicate and learn.
Difference: Many families from Taiwan need additional information about the benefits of play-based, child-led approaches.
Many families we have encountered report less familiarity with unstructured therapy approaches, like:
routines-based
play-based
child-led
This may be due to the cultural differences, including parents’ beliefs that:
Children should respect their elders and obey all orders given by an elder/teacher.
Children should remain focused and learn while seated at a desk.
Children learn more in highly structured activities.
Unstructured playtime is often viewed as a “break” or “reward” after learning. Not an integral part of learning.
We often have to provide a strong rationale for our choice of less structured approaches. This is especially true when previous SLPs used more structured, adult-led therapy approaches.
Example: I (Wen-Hsin) worked with a Taiwanese family that benefited from family education at the beginning of our therapeutic relationship.
During our first few therapy sessions, my client’s grandmother insisted that my client must clean up all the toys in the living room for our “class to begin.” I decided to spend time discussing the importance and benefits of utilizing a child-led, play-based approaches:
Creating opportunities for modeling and language learning in natural communication contexts. These are meaningful to the child and:
increase the child’s intrinsic motivation.
facilitate carryover across communication contexts
decrease prompt dependency
This family required more time and support to understand the importance of child-led, play-based approaches. They did become convinced. They gradually noticed their child spontaneously using his AAC device to communicate his wants, needs, and ideas more frequently. As a result, they saw:
less frustration
increased mood
increased intrinsic motivation
their child looked forward to therapy. This was not always the case. They had previous therapists who utilized more structured, compliance-based, adult-led approaches.
Difference: Multilingual families living in the U.S. benefit from SLPs’ advocacy for minority language preservation.
We have encountered challenges with minority language preservation. In the U.S., it is not uncommon for bilingual and multilingual families to receive misguided advice. This comes from well-meaning medical professionals. Families are advised that they should “only use English” at home when their child has:
a developmental disability
complex communication needs
a language delay
This is outdated advice. Research has shown that bilingual and monolingual autistic children have comparable developmental outcomes. Yu (2018) also found that “home language development is beneficial for English acquisition.” We have found that facilitating minority language preservation is a delicate, ongoing conversation. As therapists, our personal preference is to provide ample information on the benefits and importance of home language development and bilingualism. We intend to help parents make a more informed decision. We also need to respect caregivers’ decisions regardless of their choice. This may be to focus on English or preserve their home language in a bilingual approach.
Example: I (Wen-Hsin) worked with a family in which both parents were native Toisanese (a Chinese dialect) speakers. They chose to primarily use English with their 3-year-old non-speaking autistic son.
I repeatedly explained the benefits of bilingualism and home language development. I offered numerous suggestions on how parents could increase their child's exposure to Toisanese on his AAC device. This was already difficult because there is not an AAC system programmed for Toisanese. My client’s parents decided to start small. They changed the speech output of certain food and family member icons from English to Toisanese. Parents chose to program the words that they mostly used in Toisanese:
milk
noodles
mom
dad
older sister
This provided me an opportunity to show parents how to customize their child's AAC system (Proloquo2Go). We used recorded Toisanese words as the speech output for certain icons (e.g., “milk” became “nainai”). With the Toisanese recordings, we saw their child quickly understand the meanings of these icons. He began spontaneously using them to communicate.
Limited AAC Resources in Minority Languages
One significant difference between Taiwan and the U.S. is the availability of resources and information. This has a notable impact on AAC intervention. There are limited resources and information about AAC in Chinese. Parents of children who need AAC have difficulty finding an SLP who knows how to teach AAC in Taiwan. There have been some positive developments in recent years. Several Chinese AAC resources have become available, such as:
@aacaactionnow AAC今天就開始 accounts on Facebook and Instagram
AAC跨越鴻溝溝通平台 website
newly established AAC SLP and parent support groups on messaging platforms like Line.
Parent support groups provide parents a platform to connect with other families and children using AAC. They may be uncertain about using AAC with their children. With the support group, parents may no longer feel isolated. They get to know others using AAC as a communication tool as well. With the SLP support group, SLPs a platform to share information and discuss their difficulties using AAC. These exchanges can lead to better strategies and practices for AAC intervention in Chinese.
Conclusion
Research has shown us the significance of parent education. Family involvement is an integral part of AAC intervention. It leads to:
increased carryover at home
reduced risk of AAC device abandonment
improved general communication success for clients and students.
There are many considerations when working with multicultural families to introduce AAC strategies. In addition to introducing strategies such as:
modeling without expectations
core words
attributing meaning to all forms of communication
SLPs must also consider cross-cultural differences. These may affect a family’s perspective on AAC intervention. We must ask, how we can best support our clients and families while respecting each family’s unique cultural values and differences.
References
Berenguer, C., Martínez, E.R., De Stasio, S., & Baixauli, I. (2022). Parent’s perceptions and experiences with their children’s use of augmentative/alternative communication: A systemic review and qualitative meta-synthesis. International Journal of Environmental Research and Public Health, 19(13), 80-91. Article Link
Romski, M., Sevcik, R.A. (2005) Augmentative communication and early intervention: Myths and realities. Infants & Young Children, 18(3), 174-185. Article Link
Schlosser, R.W., & Wendt, O. (2008) Effects of augmentative and alternative communication intervention on speech production in children with autism: A systematic review. American Journal of Speech-Language Pathology, 17(3), 212-230. Article Link
Yu, B. (2018). Bilingualism and autism: A summary of current research and implications for augmentative and alternative communication practioners. Perspectives of the ASHA Special Interest Groups, 3(12), 146-153. Article Link
Zangari, C. (2015, January 29) Stimming or learning? Considerations for kids who repeat themselves with AAC. PrAACtical AAC. Article Link
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