Communicative Competence for Individuals who require Augmentative and Alternative Communication: A New Definition for a New Era of Communication?

Functionality of Communication

Historically, communication interventions focused on attempting to remediate speech and/or language impairments in isolation in an effort to “repair broken parts” (CitationLyon, 1998, p. 204). These interventions seldom resulted in the attainment of functional communication skills for those with complex communication needs (e.g., CitationEstrella, 2000; CitationFox & Fried-Oken, 1996). In order to ensure the attainment of communicative competence, AAC interventions need to focus not on the demonstration of isolated skills within labs, clinic rooms, or therapy sessions, but rather on actual communication performance within naturally occurring contexts (CitationLight, 1989; CitationWilliams, Krezman, & McNaughton, 2008). The need for a focus on functional communication and participation within society is recognized in the World Health Organization's proposed International Classification of Functioning, Disability, and Health (CitationEnderby, 2013; CitationSimeonsson, Björck-Åkesson, & Lollar, 2012). A functional approach emphasizes functional outcomes in the real world, with intervention to build skills that have consequences that are valued by individuals with complex communication needs and their partners in daily life, including the ability to express needs and wants, exchange information, develop social closeness, and participate as required in social etiquette routines (CitationLight, 1988).

The functionality of communication skills, that is, the success of the skills (or the lack thereof), depends on the communication demands present within the individual's environment, be it home, school, work, and/or the community. Martin Pistorius, an adult with a neurodegenerative condition who relies on AAC, highlighted the critical importance of functional communication skills to meet daily communication needs throughout the day:

Adequacy of Communication

Hand in hand with the focus on the functionality of communication, consideration of communicative competence also requires a focus on the attainment of an adequate level of communication skills to meet environmental demands and reach communication goals (CitationLight, 1989). The attainment of communicative competence does not require mastery of the art of communication; rather, communicative competence is a threshold concept with a focus on the attainment of sufficient knowledge, judgment, and skills to meet communication goals and participate within key environments. An individual's communicative competence may vary across contexts depending on the partners, environments, and communication goals. For example, some individuals with complex communication needs may have developed adequate skills to meet the demands of interactions with familiar partners in routine contexts, but may struggle to communicate effectively with less familiar partners in more novel contexts where the demands are greater.

What defines adequacy of communication will vary depending on the goals of the individual who uses AAC and the communication requirements to meet those goals. Individuals who require AAC may define the success of intervention differently than professionals do, depending on their personal goals; these views must be respected. CitationWertz (1998) provided this account of the intervention that he planned for Doug who had aphasia following a stroke:

As described in this account, Doug determined that he had attained an adequate level of communication to meet his goals in his daily life; from his perspective, he had attained sufficient communicative competence for the situations that mattered most to him, and his priority was to return to living his life, rather than participating in further intervention.

Sufficient Knowledge, Judgment, and Skills

According to CitationLight (1989), the adequacy of functioning required to attain communicative competence is predicated upon sufficient knowledge, judgment, and skills in four interrelated domains: linguistic, operational, social, and strategic. Linguistic and operational competencies reflect knowledge, judgment, and skills in the tools of communication whereas social and strategic competencies reflect knowledge, judgment, and skills in the use of these tools in daily interactions.

Linguistic Competence. If individuals with complex communication needs are to develop communicative competence, they must develop sufficient knowledge, judgment, and skills in the linguistic code of the language(s) spoken and written in the individual's family and broader social community, including receptive skills and as many expressive skills in these languages as possible. In addition, they must also learn the language code of the AAC systems that they utilize, including the representational aspects of AAC symbols (CitationMineo Mollica, 2003) as well as the semantic and syntactic aspects required to express meaning (CitationBlockberger & Sutton, 2003). Doing so is complicated by the fact that many AAC systems are not actually true language systems (CitationLight, 1997). They are essentially semantic systems that include sets of symbols to convey concepts, but have no inherent syntax or morphology. Developing competence with the language code of the AAC systems is further complicated for there is an asymmetry (CitationSmith & Grove, 2003) between the language code through which individuals who require AAC receive their input (i.e., the spoken language of their families and broader social community) and the language code through which they must express themselves (i.e., the form and content of multimodal expression that may include use of some speech or speech approximations, use of gestures or signs, and use of aided AAC symbols). Furthermore, individuals with complex communication needs typically have limited access to models of effective communication via AAC (CitationBallin, Balandin, Stancliffe, & Togher, 2011). Gus Estrella, an experienced and sophisticated communicator via AAC, emphasized the importance of concerted intervention to build the linguistic skills that underpin communicative competence:

Operational Competence. Operational skills involve skills in the technical operation of AAC strategies and techniques, including: (a) skills to produce the hand or body positions, shapes, orientations, and movements for gestures, signs, or other forms of unaided communication (e.g., eye blink codes, head nod/shake); (b) skills to utilize selection technique(s) for aided AAC systems (e.g., direct selection with a finger or fist, eye gaze, scanning with a single switch); and, (c) skills to navigate and operate aided AAC systems accurately and efficiently (e.g., navigate between pages, enter codes to retrieve pre-stored vocabulary items). These operational skills must extend across the full range of modes used by the individual with complex communication needs, including both unaided and aided means of communication, and both low tech and high tech systems (CitationBeukelman, Fager, Ball, & Dietz, 2007; CitationHodge, 2007). Randy Horton described the significant demands of learning the operational skills for a single AAC system (approximately 96 hours in Randy's case) and the lack of instruction typically provided to support the development of these skills:

Social Competence. Individuals who require AAC must develop social competence to ensure appropriate functional use of AAC tools to meet their communication goals; they must learn when, when not, what, where, with whom, and in what manner to communicate (CitationHymes, 1972). Social competence requires both sociolinguistic and sociorelational skills. Sociolinguistic skills refer to the pragmatic aspects of communication, in other words, discourse skills (e.g., taking turns, initiating and terminating interactions, maintaining and developing topics) and skills to express a wide range of communicative functions (e.g., requesting attention, requesting information, providing information, confirming). Sociorelational skills refer to the interpersonal aspects of communication that form the foundation for developing effective relationships. CitationLight, Arnold, and Clark (2003) identified a range of sociorelational skills that may further the communicative competence of individuals who use AAC (e.g., participating actively in interactions, demonstrating interest in partners, projecting a positive self image). Sociorelational skills bear special importance for individuals with complex communication needs who may face significant barriers to interpersonal relationships (CitationAnderson, Balandin, & Clendon, 2011; CitationLight et al., 2003). Jim Prentice, an expert communicator via AAC who worked as a statistical record keeper at a large company, poignantly illustrated the importance of developing social competence:

Strategic Competence. Because of their significant disabilities, the substantial environmental barriers confronted in society, and the inherent restrictions of AAC systems, individuals with complex communication needs invariably confront limitations in their linguistic, operational, and/or social competence. In these cases, they must develop coping strategies that allow them to bypass these limitations and to make the best of what they do know and can do (CitationMcNaughton et al., 2008; CitationTodman, Alm, Higginbotham, & File, 2008; CitationWilliams, 2004). These compensatory strategies may be temporary, used for a time while the individual recovers or learns new linguistic, operational, and/or social skills; or the compensatory strategies may be required long term in situations where limitations in the linguistic, operational, and/or social domain cannot be remediated (CitationLight, 1989). In order to obtain communicative competence, individuals with complex communication needs may rely on a range of strategies to overcome: (a) linguistic constraints (e.g., asking the communication partner to write or type as they speak, in order to support comprehension difficulties; directing the partner to provide choices when faced with vocabulary limitations); (b) operational constraints (e.g., using telegraphic messages to enhance the rate of communication; asking partners to guess as messages are spelled to reduce fatigue); and (c) social constraints (e.g., using an introduction strategy to explain the AAC system and how to use it or humor to put unfamiliar partners at ease) (CitationMirenda & Bopp, 2003). Randy Kitch, an expert communicator who uses his foot to access AAC, illustrated the importance of strategic competence to overcome the difficulties that he encountered when a store clerk ignored his communicative attempts:

Psychosocial Factors that Influence Communicative Competence

In 2003, Light expanded the preliminary model of communicative competence and argued that the attainment of communicative competence by individuals with complex communication needs is impacted by not just their linguistic, operational, social, and strategic competence but also a range of psychosocial factors including motivation, attitude, confidence, and resilience.

Motivation. Motivation to communicate impacts the individual's desire or drive to communicate with others in daily situations (CitationLight, 2003). Communication via AAC is a complex process that imposes significant motor, cognitive, sensory perceptual, and linguistic demands (e.g., CitationThistle & Wilkinson, 2013). When motivation to communicate is high, individuals with complex communication needs are more likely to tackle the demands of communication via AAC; when motivation is low, they may be overwhelmed by these demands and may elect to forego many communication opportunities (CitationClarke, McConachie, Price, & Wood, 2001; CitationFox & Sohlberg, 2000). Jan CitationStaehely (2000), who utilizes AAC to support her communication, described the challenge of maintaining motivation when she did not have effective means to communicate:

Individuals with complex communication needs require numerous positive and successful communication experiences to build their motivation to attain communicative competence.

Attitude. Attitudes of individuals with complex communication needs and their families, especially as they relate to AAC, also impact the attainment of communicative competence. Attitudes towards AAC may predispose the use (or lack of use) of AAC as required within social situations. CitationLasker and Bedrosian (2000) proposed a model of AAC acceptance that considered the impact of three sets of factors: (a) milieu factors (e.g., partners, setting, time of day); (b) person factors (e.g., disability, personality, age, skills, needs, history, expectations); and (c) AAC-related factors (e.g., ease of learning, appearance, functionality). Attitudes may change with changes to person, milieu, and/or system factors. Rob Rummel-Hudson, the father of a daughter, Schuyler, who requires AAC, described the effect of different AAC systems on his daughter's attitude toward AAC and, as a result, her willingness or unwillingness to utilize AAC to support her communication:

Confidence. Motivation impacts the individual's drive to communicate, and attitude toward AAC impacts the individual's willingness to use AAC to communicate, but it is confidence that actually determines the individual's propensity to act – in other words, to attempt to communicate in any given situation. Confidence has to do with the individual's self-assurance, in this case, specifically self-assurance that he or she can communicate successfully in the given situation(s). Using AAC to meet communication needs requires individuals with complex communication needs to try techniques that may initially be new and unfamiliar, to both them and their communication partners, typically with few models of others who successfully communicate using AAC (CitationBallin et al., 2011; CitationLight et al., 2007). Seeing or interacting with others who use AAC and who have attained communicative competence may serve as a critical support in building communicative confidence. Rick CitationCreech (1995), who was a pioneer in his use of AAC in both post-secondary settings and the workplace, explained:

Resilience. Although confidence may determine the individual's propensity to attempt to communicate, it is resilience that influences whether or not the individual perseveres with communication despite the many challenges and potential failures encountered. Resilience refers to the “…capacity which allows a person … to prevent, minimize, or overcome the damaging effects of adversity” (CitationGrotberg, 1995, p. 7). It is inevitable that individuals with complex communication needs will confront failure at times in their attempts to communicate successfully. These failures may result from limitations in their linguistic, operational, social, and strategic skills and/or from barriers within the environment (CitationBalandin, Hemsley, Sigafoos, & Green, 2007; CitationSnell, Chen, Allaire, & Park, 2008). Communication failures provide important opportunities for learning and may ultimately fuel subsequent success, but only if the individual is resilient enough to move on and try again. Resilience is a dynamic factor that is affected by the adversity encountered (e.g., the nature, severity, timing of the adversity), as well as protective factors (both individual resources and environmental supports) that may support recovery from the adversity (CitationLuthar, Cicchetti, & Becker, 2000; CitationMasten, 2001). For example, individual protective factors that support resilience may include problem-solving skills, self-esteem, optimism, or faith; environmental protective factors may include encouragement and support from family, mentors, teachers, employers, or peers. Individuals with complex communication needs who have access to clusters of protective factors are more apt to demonstrate resilience in the face of communication failures and are therefore more apt to build, re-build, or sustain communicative competence in the face of adversity (CitationDickerson, Stone, Panchura, & Usiak, 2002; CitationSmith & Murray, 2011). In contrast, those who do not have access to protective factors will have greater difficulty rebounding from adversity, learning from these failures, and ultimately developing communicative competence. Morrie Schwartz, a man who had amyotrophic lateral sclerosis (ALS), wrote about the importance of resilience in the face of the adversity that he faced as his disease progressed:

Environmental Supports and Barriers

Communicative competence is impacted not only by factors intrinsic to the individual with complex communication needs (e.g., linguistic, operational, social and strategic skills as well as psychosocial factors such as motivation, attitude, confidence and resilience), but also by extrinsic factors, including barriers in the environment that may impede communicative competence, and environmental supports that may enhance communicative competence (CitationLight, 2003). Ultimately, communication is an interpersonal process where meaning is created in partnership (CitationBlackstone et al., 2007; CitationTeachman & Gibson, 2014). As a result, intervention to enhance communicative competence necessitates intervention with not only the individual with complex communication needs but also partners in the environment, in order to reduce barriers and ensure appropriate supports as required (CitationBall & Lasker, 2013; CitationKent-Walsh & McNaughton, 2005; CitationSoto, 2012). Jan Staehely, who uses AAC to communicate, emphasized the interpersonal nature of communicative competence as follows:

All individuals who require AAC are impacted by environmental factors, but the extent of the impact will vary across individuals depending on their intrinsic communication resources: Those with strong linguistic, operational, social, and strategic skills and well-developed psychosocial factors will be less vulnerable to environmental barriers and constraints than those who are beginning communicators or who experience significant language/cognitive limitations (CitationMcNaughton & Light, 2013; CitationWilliams, Beukelman, & Ullman, 2012). According to CitationBeukelman and Mirenda (2013), environmental barriers and supports may cut across a range of domains including policy, practice, attitude, knowledge and skill barriers or supports.

Policy and Practice Barriers and Supports. Individuals with complex communication needs may encounter policy and practice barriers that are systemic within society and serve to limit their communication opportunities and therefore their development of communicative competence (CitationCooper, Balandin, & Trembath, 2009; CitationStancliffe et al., 2010). Policy barriers result from official laws, standards, or regulations, whereas practice barriers result from conventional procedures within schools, work settings, or society that may not be officially documented but are accepted practice (CitationBeukelman & Mirenda, 2013). John Draper, a competent communicator who relies on AAC, discussed some of the policy/practice barriers he encountered during his education in an inclusive school environment:

Sometimes practices that appear to be inconsequential to professionals have substantial negative effects on the lives of individuals who require AAC. John Draper described some of the practices at his high school that created barriers in his interactions with his peers:

Ultimately, as CitationCarter and Draper (2010) suggest, the goal is to eliminate policy and practice barriers and ensure that there are sufficient supports for participation and meaningful inclusion of individuals who require AAC in all aspects of society. CitationMirenda (1993) summed up this goal best when she wrote:

Attitude Barriers and Supports. As CitationMirenda (1993) suggested, achieving true membership in communities is not just about policy and practice supports, it also requires the elimination of attitude barriers. Attitude barriers occur when people hold negative feelings that predispose them to act in ways that limit the communication opportunities of individuals who require AAC (CitationHodge, 2007; CitationMcCarthy & Light, 2005). Bob CitationWilliams (2000) described the problem of pervasive attitude barriers for individuals who require AAC:

As Williams suggested, too often attitude barriers result in reduced expectations for individuals with complex communication needs and limited opportunities for participation. Concerted advocacy and intervention is required to address attitude barriers and ensure that individuals with complex communication needs who use AAC have meaningful opportunities to communicate and to participate at school, at work, in their families, and in their broader social communities.

Knowledge and Skill Barriers and Supports. Even when the necessary policy, practice, and attitude supports are in place, it may not be sufficient to ensure the development of communicative competence by individuals who require AAC. Learning to communicate using AAC is a complex process (CitationBailey, Parette, Stoner, Angell, & Carroll, 2006; CitationRackensperger, Krezman, McNaughton, Williams, & D’Silva, 2005). Many individuals who require AAC experience significant linguistic, operational, and social constraints and require support from their partners to ensure successful communication (CitationBlackstone et al., 2007). In order to provide appropriate supports, partners (e.g., family members, educational personnel, employers, co-workers, friends) require knowledge of AAC systems and services as well as competencies in appropriate interaction strategies (e.g., CitationKent-Walsh, Binger, & Hasham, 2010; CitationSorin-Peters, McGilton, & Rochon, 2010). Jean Dominique CitationBauby (1997) emphasized the importance of the partner's knowledge and skill in determining the success (or failure) of his communication attempts using AAC following a brainstem stroke:

As CitationBauby (1997) suggested, partners may require instruction to develop the knowledge and skills required to interact effectively and support communicative competence with individuals who require AAC.

Changes in the Demographics of the Population that Uses AAC

During the past 25 years, the field of AAC has witnessed significant increases in the numbers of people with complex communication who receive or might benefit from AAC services; furthermore, the population receiving AAC services is increasingly diverse in terms of age, disability, language, culture, and race/ethnicity (CitationBeukelman, 2012; CitationLight & McNaughton, 2012a; CitationMueller, Singer, & Carranza, 2006; CitationSoto & Yu, 2014). In addition to the increased prevalence of individuals with complex communication needs, there have also been significant improvements in preservice and inservice training in AAC over the past 25 years (e.g., CitationCostigan & Light, 2010; CitationRatcliff, Koul, & Lloyd, 2008), resulting in greater professional awareness and acceptance of AAC intervention generally. AAC interventions are no longer viewed only as a last resort to be implemented with individuals with no speech or extremely limited speech, once traditional speech and language interventions fail; rather, an increasing number of professionals now understand the potential benefits of AAC intervention for those who are at risk for speech and language development (e.g. CitationRomski et al., 2010), who rely on speech but require augmentation to clarify or enhance intelligibility (e.g., CitationHanson, Beukelman, & Yorkston, 2013), who are recovering following a stroke or traumatic brain injury (e.g., CitationPetroi, Koul, & Corwin, 2014), who are experiencing the loss of speech or language skills due to degenerative conditions (e.g., Fried-Oken, Beukelman, & Hux, 2012), and who may have temporary conditions (e.g., CitationCostello, Patak, & Pritchard, 2010). As a result, AAC interventions are now implemented with a much larger and more diverse population, including individuals across the life span, both younger and older than ever before, and individuals with a wide array of disabilities who present with a much more diverse array of needs and skills than ever before.

Beyond the increased diversity in the age and disability profiles of individuals who require AAC, there is also increased diversity in language, culture, and ethnicity/race of those who are receiving AAC services (CitationSoto & Yu, 2014). This linguistic, cultural, and racial/ethnic diversity results from two key developments: First, the global reach of AAC intervention has been extended worldwide, especially to developing countries, through the efforts of families and professionals (CitationAlant, 2007; CitationBornman, Bryen, Kershaw, & Ledwaba, 2011). Evidence of the growing impact of AAC worldwide is found in the recognition of the International Society for Augmentative and Alternative Communication (ISAAC) as a Non-Governmental Organization in consultative status with the United Nations Economic and Social Council. Second, as Soto and Yu noted, unprecedented movement of the population over the past 20–25 years (e.g., from developing countries to developed ones, from rural to urban areas) has resulted in substantial increases in the number of children and adults with complex communication needs receiving AAC services who come from culturally and linguistically diverse backgrounds.

Implications of the Changing Demographics for Communicative Competence. What are the implications of these changing demographics for the definition of communicative competence and for interventions to enhance communicative competence? The greater range of ages and disabilities served has necessitated a greater range of AAC interventions, including those designed (a) to build communicative competence for the first time with those who have developmental disabilities through instruction in linguistic, operational, social, and strategic skills (e.g., CitationSnell et al., 2010); (b) to re-build communicative competence with those who have acquired disabilities or temporary conditions, capitalizing on existing linguistic and social strengths and teaching operational and strategic skills to bypass limitations in these domains to maximize communication performance (e.g., CitationCostello et al., 2010; CitationLight & Gulens, 2000; CitationPetroi et al., 2014; CitationSimmons-Mackie, King, & Beukelman, 2013); and, (c) to sustain communicative competence for as long as possible with those who have degenerative neurogenic disabilities through implementation of AAC supports (e.g., CitationFried-Oken et al., 2012).

These interventions must respond to not only the motor, sensory perceptual, and cognitive skills of individuals who require AAC but also their cultural and linguistic backgrounds (CitationBinger, Kent-Walsh, Berens, Del Campo, & Rivera, 2008). Individuals with complex communication needs who live in bilingual or multilingual environments face significantly increased linguistic and operational demands in the development of communicative competence, for the different languages and cultures in which they participate will no doubt require different modalities of communication, different vocabularies, different representations, different layouts, and different organizations (e.g., CitationNakamura, Iwabuchi, & Alm, 2006; CitationSoto & Yu, 2014). Individuals who require AAC who live in bilingual and multilingual environments must develop competence in (a) the spoken and written languages of their family and broader social communities, including comprehension skills and as many expressive skills as possible, including the phonological, semantic, syntactic, morphological and pragmatic aspects of these languages, which may differ significantly depending on the specific languages involved; (b) the language codes of the different AAC strategies and techniques that they use to communicate in these different cultural and linguistic environments; (c) the operational skills to produce and/or technically operate these different unaided or aided AAC systems; and (d) the social skills to know when and how to code switch between languages and different AAC strategies and techniques across different environments. Clearly, the linguistic, operational, and social demands to attain communicative competence are multiplied when individuals with complex communication needs come from bilingual or multilingual environments. CitationEstrella (2000) poignantly described the challenges:

CitationSoto and Yu (2014) highlighted the benefits of bilingual intervention for individuals with communication disabilities. However, they noted that in order to provide effective bilingual intervention, AAC professionals must develop the competencies required to provide culturally competent services, specifically the skills (a) to accurately assess communication skills of individuals with complex communication needs who come from diverse cultural and linguistic backgrounds; (b) to support language development and/or recovery across the languages of the family and broader social community; (c) to select, customize, and implement culturally appropriate AAC strategies and techniques to support communication across diverse environments; and (d) to work effectively with families from diverse backgrounds. The increased diversity of the population that would benefit from AAC has increased the urgent need for high quality preservice and inservice training to ensure that professionals from multiple disciplines have the competencies required to provide effective, culturally-competent, evidence-based AAC services to foster communicative competence with individuals across the life span who present with a wide array of needs and skills (CitationCostigan & Light, 2010; CitationSoto & Yu, 2014).

Changes in the Scope of Communication Needs

Along with the changes in the demographics of the population that requires AAC have come dramatic changes in the scope of the communication needs that must be addressed. Twenty five years ago, there was an emphasis on providing the means to express needs and wants; increasingly there is a growing recognition that communication extends well beyond needs and wants, and must serve to foster the development of social relationships, the exchange of information, and participation in social etiquette routines (CitationDe Leo, Lubas, & Mitchell, 2012; CitationWaller et al., 2013). Perhaps the mother of Brian, an 8-year-old boy with severe multiple disabilities, summed it up best when she said, “There's more to life than cookies” (CitationLight, Parsons & Drager, 2002; p. 187). In fact, with the advent of social media and a new arsenal of tools to link people together, there is increased emphasis in society on establishing, maintaining, and developing social connections across a wide ranging network (CitationSundqvist & Ronnberg, 2010; CitationWilliams et al., 2012).

Twenty-five years ago, the focus was primarily on maximizing the communication of individuals with complex communication needs within face-to-face interactions. Now there is increased recognition that communication needs extend well beyond face-to-face interactions and also include written communication to meet demands at school or in the work place; social media such as Facebook and Instagram to network, share experiences, and establish membership in peer communities; cell phones and texting to connect with friends; blogging to provide commentary and build communities with like interests; Twitter to instantaneously update status and express short bursts of opinion; e-commerce to fulfill a wide array of needs and wants, and so on (CitationLight & McNaughton, 2012a).

Implications of the Changing Scope of Communication for Communicative Competence. With the dramatic change in the scope of communication and the explosion of tools through which to meet communication needs, individuals with complex communication needs now have access potentially to a much wider and more diverse audience than ever before. They have mechanisms available to address what was previously one of the greatest barriers: limited social networks and communication partners (CitationBlackstone & Hunt Berg, 2003). Glenda Watson CitationHyatt (2011), who uses a variety of AAC technologies (including the iPad™^Footnote1) to communicate, described the deeper level of communication possible as a result of the greater range of social media tools:

With access to an increased array of potential partners, however, have come increased demands for independent and easily intelligible communication. In using various media tools, individuals with complex communication needs cannot co-construct messages with familiar partners as they do in face-to-face interactions; rather, they must develop the skills to independently use these new tools, adhere to their conventions, and communicate with a broader audience that includes those who may have limited or no prior experience with AAC. In general terms, establishing greater independence and intelligibility of communication to reach a wider audience requires more advanced linguistic skills, specifically, the ability to effectively convey meaning through traditional orthography, with appropriate form and content as required by the target media and audience (CitationFager, Bardach, Russell, & Higginbotham, 2012).

Interestingly, many of these new social media do not rely solely on linguistic content to communicate; rather, linguistic content may be supplemented with extensive use of visual images (i.e., photos, video) as channels of expression. This trend towards increased use of photos and video has some potential advantages for individuals with complex communication needs for use of visual images such as photos to enhance communication has a long history in the AAC field (CitationHanson et al., 2013). With the advent of many social media applications, photos and video have become widely-accepted channels of expression across society (CitationLight & McNaughton, 2012a), and are used to support communication for educational, employment, health, and social purposes (CitationRaghavendra, Newman, Grace, & Wood, 2013).

However, in order to effectively use these diverse media to enhance communication on social media platforms (e.g., Facebook, Twitter, Instagram), individuals with complex communication needs typically require functional literacy skills as well as the ability to capture photos and video of meaningful events and experiences. Thus, these media impose increased linguistic demands (e.g., functional literacy skills; semantic, syntactic and morphological skills) and increased operational demands (e.g., capture and posting of photo and video). Furthermore, for each communication media, individuals with complex communication needs must learn the rules of social use (i.e., with whom, what, when, where, in what form, and for what purposes to communicate). These rules vary across media: For example, written papers for school or reports for work require formal vocabulary, syntax, and morphology, whereas Twitter is limited to 140 characters, with the use of sentence fragments and spelling abbreviations acceptable to provide status updates and express opinions. Furthermore, individuals who use AAC must learn the sociolinguistic rules for using each of these media without the benefit of immediate, visible, partner feedback. Given the dominance of social media in today's society and the potential benefits for individuals with complex communication needs, future research is required to investigate the use of social media and other mainstream communication tools by individuals who require AAC.

Changes in AAC Systems

Implicit in considering the dramatic changes to the scope of communication needs is the realization that individuals with complex communication needs can no longer rely on a single speech-generating device to meet their communication needs if they are to participate fully within educational, vocational, and social contexts (CitationWilliams et al., 2008). Rather, they must have access to a wide range of means to augment and enhance their communication that may include unaided AAC (e.g., gestures, signs, speech or speech approximations), low-tech aided AAC systems (e.g., communication boards or books), high-tech AAC systems (e.g., traditional speech-generating devices, mobile technologies with AAC “apps”), and other mainstream communication apps and social media tools (e.g., Facebook, Twitter, Instagram, SnapChat).

Implications of Changes in AAC Systems for Communicative Competence. The dramatic changes in the range of AAC systems/apps, communication technologies, and social media tools bring both benefits and challenges in terms of building, rebuilding, and sustaining the communicative competence of individuals who require AAC. The iPad and mobile technology revolution and the greater use of social media tools have positively impacted social awareness and acceptance of AAC, reducing attitudinal barriers to AAC use (CitationMcNaughton & Light, 2013). As a result, individuals with complex communication needs may be more apt to make use of these tools as AAC techniques to enhance communicative competence. Rob Rummel-Hudson, a parent of a teenager who uses AAC, emphasized the positive effects of mobile technologies on attitudes of individuals with complex communication needs and their families:

Although there are substantial benefits to the increased range of AAC systems/apps, social media, and mainstream communication tools that are available to individuals who require AAC, there are also significant challenges. The increased diversity of communication tools means substantially increased operational demands for individuals with complex communication needs. Each of the tools is designed with different representations, organizations, and layouts of information as well as different access techniques (e.g., swiping, tapping, double tapping). And each of these different designs imposes different motor, cognitive, sensory perceptual, and linguistic learning demands for individuals with complex communication needs. Typically, these tools are not well integrated, increasing the operational demands on individuals with complex communication needs who must learn not only operational skills for each tool but also how to navigate between apps or tools as required.

The development of operational competence lies at the intersection of the demands imposed by the communication technologies and the intrinsic skills of the individual who requires AAC. Traditionally the focus of intervention has been on teaching individuals with complex communication needs the necessary motor skills; however, research demonstrates that visual, cognitive, and linguistic processing skills also play critical roles in determining operational competence (e.g., CitationCostigan et al., 2012; CitationWilkinson, Light, & Drager, 2012).

To date, most attention has focused on intervention to teach skills to the individual with complex communication needs. Much less attention has been directed towards improving the design of AAC systems specifically (and the design of mainstream social media tools generally) to reduce operational demands, ease learning, and facilitate use. As CitationLight and McNaughton (2012b) noted, “The lack of attention to the design of AAC technologies/apps is rather ironic since this component of intervention is one that substantially affects performance and it is also the one that is most easily amenable to change” (p. 36). Clearly, future research is required to investigate the basic visual, cognitive, linguistic and motor processing demands of AAC systems and to untangle the effects of specific system components in order to optimize the designs of AAC systems and social media tools, and thus support operational competence for individuals with a wide range of disabilities.

There is an urgent need to define basic design specifications that will facilitate use across apps and social media tools for people with disabilities, and to support rapid individualization that will provide access to these tools for persons with specific disabilities and strengths (CitationEmiliani, Stephanidis, & Vanderheiden, 2011; CitationVanderheiden et al., 2012). Otherwise, individuals with complex communication needs will either be forever playing catch up, trying to learn new operational requirements as new technologies emerge; or they will be excluded from access to apps and social media tools when the designs impose demands outside of their motor, sensory perceptual, linguistic, and cognitive capabilities. With increased diversity in the scope of communication needs and increased availability of a wide range of AAC systems and social media tools to meet these needs, there is a greater need than ever before for multidisciplinary teams with expertise in a wide range of domains that include not just traditional speech and language skills but also literacy skills, human computer interface, visual cognitive processing, motor performance, and instructional design, to name just a few. No longer can AAC intervention be limited in focus to the use of speech-generating devices in face- to-face interactions; rather, intervention must extend well beyond speech prostheses to maximize communication across a broad array of media (CitationShane, Blackstone, Vanderheiden, Williams, & DeRuyter, 2012). Concerted advocacy is required to ensure that public policy and funding agencies keep pace with these developments; they must recognize and support access to the wide breadth of communication tools required for full participation in educational, vocational, and social contexts (CitationVanderheiden et al., 2013).

Changes in Expectations for Participation

Twenty-five years ago, many individuals with complex communication needs lived in large residential institutions, segregated from their families and communities with limited educational and vocational options (CitationMirenda, 2014). Now, however, increasing numbers of individuals with complex communication needs live within their communities (CitationLakin & Stancliffe, 2007); attend schools with the other children in the neighborhood and participate in general education classrooms (e.g., CitationCalculator, 2009); obtain full-time or part-time work through community jobs, telework, or micro-enterprises (e.g., CitationIsakson, Burgstahler, & Arnold, 2006; CitationMcNaughton, Rackensperger, Dorn, & Wilson, in press); and engage in a wide range of meaningful activities within the community (CitationThirumanickam, Raghavendra, & Olsson, 2011; CitationTrembath, Balandin, Stancliffe, & Togher, 2010).

Implications of Changing Participation Patterns for Communicative Competence. With these changes in living, schooling, employment, and community living have come substantial increases in the communication demands for individuals with complex communication needs across these different environments (CitationJohnson, Douglas, Bigby, & Iacono, 2009; CitationRaghavendra, Virgo, Olsson, Connell, & Lane, 2011). Twenty-five years ago, many individuals with complex communication needs had only opportunities to interact with staff in the institutions and residences in which they lived; they were pre-empted from many communication opportunities and had only limited choices. Now, individuals with complex communication needs require AAC systems to support their communication and full participation at home, at school, at work, in health care settings, and within the community (CitationCollier, Blackstone, & Taylor, 2012; CitationCollier & Self, 2010). It is no longer sufficient for individuals with complex communication needs to have access to the means to simply request a preferred food or activity; rather they need access to communication to build friendships with peers, to learn at school, to share their expertise on the job, to manage their health care needs, and to participate successfully as full citizens of society (CitationBryen, Chung, & Lever, 2010; CitationKennedy, 2010). Individuals with complex communication needs face increased requirements for linguistic, operational, social, and strategic competencies to meet the increased communication demands of participation in diverse environments (e.g., home, school, work, community). AAC interventions must serve to help build the necessary knowledge, judgment, and skills to ensure the development of communicative competence. With increased expectations for full participation in society, individuals who require AAC now interact with a much broader range of partners in much more diverse contexts than ever before and, as a result, face increased communication demands. In order to meet these challenges, it is more critical than ever for individuals with complex communication needs to develop the necessary protective factors to fortify their motivation, attitude, confidence, and resilience in the face of the adversity that they will no doubt face at times. Furthermore, there is increased need for intervention to break down environmental barriers in society that limit participation and to replace them with positive supports to enhance the communicative competence of individuals who require AAC (CitationJohnson et al., 2009).

Knowledge, Judgment, and Skills that Support Communicative Competence

As CitationLight (1989) first proposed, communicative competence rests on the integration of knowledge, judgment, and skills in four interrelated domains: linguistic, operational, social, and strategic. These four fundamental domains have not changed over the past 25 years. What has changed, however, is the breadth of linguistic, operational, social, and strategic skills required to attain communicative competence (see Table I for a summary and examples).

Linguistic Domain. As noted earlier, the attainment of communicative competence is predicated, at least in part, upon linguistic skills, including receptive and expressive skills in the spoken and written language(s) of the individual's home and broader social community, as well as skills in the language code of the AAC systems used to communicate in these environments. The demand for linguistic skills has increased significantly over the past 25 years. As individuals with complex communication needs expand their social circles and interact with a broader audience in a wider range of environments, there are increased demands for independent, intelligible messages utilizing appropriate vocabulary, syntax, and morphology as defined by the tools and contexts of communication. There are increased demands for the development of literacy skills to facilitate access to the vast array of information technologies and social media (CitationWilliams et al., 2012). Furthermore, with increased globalization, more and more individuals with complex communication needs live, go to school, and work in bilingual and multilingual communities (e.g., CitationSoto & Yu, 2014); they require receptive and expressive skills in more than one language, and AAC systems to support their communication needs across different environments, thus magnifying the linguistic demands.

Operational Domain. Beyond linguistic skills, individuals with complex communication needs also require operational skills to support communicative competence, including skills in the production of unaided modes of communication and in the access and technical operation of aided AAC systems. The need for operational skills has not changed over the past 25 years; however, with the explosion of mobile technologies and social media tools available and the current lack of universal design features across these technologies, individuals with complex communication needs face increased operational demands to effectively and efficiently access and control these diverse technologies (CitationEmiliani et al., 2011).

Social Domain. While linguistic and operational skills ensure that individuals with complex communication needs have access to the tools necessary to communicate, it is social skills that allow individuals with complex communication needs to use these tools effectively to meet communication goals. With the dramatic changes in the scope of communication and the media through which communication goals are attained, individuals with complex communication needs face increased demands in the social arena as well; they must learn with whom, about what, where, when, why, and via what media to communicate (or not to communicate). They must learn to assess the demands of diverse audiences. With access to a much greater audience, they may face attitudinal barriers within society in many different environments (educational, vocational, social) and may need to develop increased sociorelational skills to put partners at ease and build positive relationships (CitationLight et al., 2007; CitationSenner, 2011).

Strategic Domain. Despite intervention to build, re-build and /or sustain linguistic, operational, and social skills, individuals with complex communication needs will inevitably encounter situations where they face significant limitations that negatively impact their communicative competence; these situations require strategic competence. As the scope of communication needs and expectations for participation have increased (resulting in heightened communication demands in general), it is inevitable that there will be increased demands for effective coping strategies to ensure successful communication in the face of significant limitations. There is an urgent need for research to investigate strategic competence (CitationMirenda & Bopp, 2003); the field has much to learn from individuals who require AAC who have attained communicative competence and effectively meet their communication goals across a wide range of environments via various media (CitationRackensperger et al., 2005; CitationSmith & Connolly, 2008).

Psychosocial Factors that Support Communicative Competence

Linguistic, operational, social, and strategic competence may be mitigated by a range of psychosocial factors, including motivation, attitude, confidence, and resilience (CitationLight, 2003). Table II provides a summary and examples of psychosocial factors that may impact the attainment of communicative competence. With the increased demands of communication and the increased expectations for participation, individuals with complex communication needs will inevitably face increased communication challenges. As a result, psychosocial factors such as motivation, attitude, confidence, and resilience will play an even greater role in the attainment of communicative competence than in the past. Intervention is required to foster these protective factors to ensure that individuals with complex communication needs have the drive to communicate, the willingness to use AAC and the actual propensity to do so, and the perseverance to communicate despite the many challenges and potential failures encountered (CitationHodge, 2007; Smith & Connolly, 2008). To date, these issues have largely been neglected in the field; future research is required to advance understanding of these psychosocial factors and to improve current practices.

Environmental Supports for Communicative Competence

Since communication is a reciprocal process, communicative competence rests on not just factors related to the individual who requires AAC but also extrinsic factors related to the environment and communication partners (CitationBlackstone et al., 2007). Policy, practice, attitude, skill, and knowledge barriers may impede the realization of communicative competence by individuals who require AAC, whereas environmental and partner supports may serve to bolster the development, rebuilding, or maintenance of communicative competence by those with developmental, acquired, or degenerative disabilities (CitationBeukelman & Mirenda, 2013). Environmental supports play an even greater role in the face of the increased communication challenges confronted by individuals who use AAC, especially for those who are most vulnerable. Table III provides a summary and examples of environmental supports that may facilitate the development of communicative competence.

Future Challenges

There is no doubt that the bar has been raised. Individuals who require AAC bring a vast array of needs and skills to their communication interactions that may include significant strengths and/or limitations in motor, sensory perceptual, cognitive, and/or language skills. The challenge is to develop effective evidence-based, culturally-competent AAC interventions to support these individuals in the realization of communicative competence, so that they are able to express their needs and wants, develop social closeness, exchange information, and participate in social etiquette routines as desired at home, at school, at work and/or in the community.

Twenty-five years ago, the field was focused on demonstrating what was possible with access to appropriate AAC interventions (CitationMirenda, 2014). Now that the possible has been established, the challenge will be to ensure that it becomes the probable and that every individual with complex communication needs has access to effective evidence-based AAC intervention to maximize participation and communication (CitationBeukelman et al., 2007; CitationRispoli, Franco, van der Meer, Lang, & Camargo, 2010). There remain far too many individuals with complex communication needs who do not receive the effective, culturally competent, evidence-based AAC services that they require to realize communicative competence and achieve their full potential (CitationBaxter, Enderby, Evans, & Judge, 2012; CitationHodge, 2007). Communicative competence is essential to the enhancement of the quality of life of individuals with complex communication needs; it is fundamental to the attainment of the basic human need, the basic human right, the basic human power of communication. As Bob Williams articulated so eloquently: