Today on the iTunes store, there are around 100 Augmentative and Alternative Communication (AAC) Apps. These are specifically designed to be used by people who have complex communication needs – for people who want to use their iPhone or iPad to communicate face-to-face with others. Many of these AAC Apps are among the highest priced Apps in the App Store – but are they worth the cost? And what do they offer that more traditional speech generating devices don’t?
The answer to those questions depends on a large number of variables – including the App itself, the needs of the user, other communication options available to the user and how the user can physically access the iPad or iPhone. Let’s start by discussing the Apps.
As mentioned earlier there are around 100 AAC Apps currently in the iTunes store. Proloquo2Go, the first AAC App, developed jointly by Samuel Sennott and AssistiveWare, remains one of the best options available. It offers a range of vocabulary, a comprehensive symbol set, Symbolstix, and allows users to string together symbols to speak sentences or phrases. Users can also pull up a keyboard and type what they want to say. Proloquo2Go reflects good practice in AAC and is used by thousands of people worldwide. Numerous articles have been written in newspapers and magazines about how Proloquo2Go has been successful in giving children and adults a voice – while harnessing the “cool” factor of the iPad and iPod touch. An example of a recent article can be found here.
As seen in this article, the iPad (along with Proloquo2Go) has been a game changer for children and adults with autism spectrum disorder (ASD) in particular. So much so that Apple featured the use of the iPad with children with ASD in their launch of the iPad2.
Following on from this success, a number of other AAC Apps have been released upon the world. These vary enormously in quality and price – and some of them fill a different niche to the one carved out by Proloquo2Go. Many of them do not reflect good practice in AAC – and are incredibly overpriced for what they offer. They may not include any symbols, or don’t let the user string together words to create novel sentences. Some of them crash frequently, or have very poor quality speech – despite their comparatively high price tag.
Of course, some of the new Apps are good quality – Predictable, an AAC App released earlier this year, is well designed and well thought out. It is designed for literate end users and offers customisation, control and alternative access options. Similarly, Verbally, another AAC App released only a few weeks ago, is a high quality AAC App that is free of charge to the end user. Unfortunately, though, these high quality Apps tend to be in a minority rather than a majority – definitely a case of user beware! (And to assist potential users, I maintain a regularly updated list of AAC Apps, along with ratings, at http://www.spectronicsinoz.com/article/iphoneipad-apps-for-aac)
Moving on from the Apps, we need to look at the hardware. I am, I must admit, completely addicted to my iPad. I love it.  I can understand why many users and families want this cool, elegant and easy to use piece of technology as their speech generating device. And I hope that the ease of use and “cool” factor of this technology is providing many traditional speech generating device manufacturers with ideas for their next generation of devices. I really look forward to seeing what impact this consumer technology has on speech generating devices as a whole.
Just as I can understand why families want this technology, I can also understand why many professionals are worried about the iPad being used as a speech generating device. The volume isn’t sufficient for many situations, the hardware is a lot more fragile than many of the dedicated speech generating devices and the access options for people with physical disabilities are limited. At this stage, if I need to use a head switch or foot switch, I have only very limited control of a small number of Apps on my iPad. For this group of users, a dedicated speech generating device is still the only option which gives complete control and flexibility. As a therapist – I could spend a lot of time trying to “make” this technology work for someone when there is a piece of specifically designed technology that will work straight away and with a range of well designed page sets which only need minimal customisation for the user. Of course – this doesn’t apply to everyone. Some people fly with their iPad from day one – while others are still trying hard to get to the first step a year later. Sometimes, this is because the hardware and/or App are an inappropriate match for the end user. Sometimes, however, it is due to poor setup and support.
And that brings me to my next point – expertise. Because this technology is cool, widely accessed and relatively cheap – suddenly we have a huge turn around in AAC recommendations. Historically, speech generating devices have been recommended primarily by speech pathologists, many of whom have specialised in AAC for years. We know the technologies available and what they can do. Furthermore, once a device has been recommended we can provide support to ensure the best possible outcomes for an individual. This model of expert assessment and recommendation, however, is now being consistently bypassed when recommending AAC Apps and iPads or iPhones. People with little or no knowledge of AAC are suggesting this option as a solution – the best App for the individual isn’t necessarily being considered and the setup of the communication pages for best outcomes isn’t always happening. In addition, once an individual or family receives the App and hardware, no expertise is provided to ensure good outcomes for the user. Modelling the user’s AAC pages frequently doesn’t happen – and in many cases the vocabulary design does not reflect good practice in AAC. As a result, nearly every day we hear stories of people who received an iPad and an AAC App that they haven’t been able to use – or of a person who received an iPad for AAC but only uses it for game playing or for watching videos.
This technology is great – and some of the Apps are great too – but we need to use our usual selection and consideration principles and make an educated decision about whether this is the best option for each user – or whether some of the other AAC technology currently available might suit their needs better. Or – in fact – whether a combination of technologies might have the best possible outcomes for a user. An iPad with an appropriate App with well designed vocabulary and appropriate support can be amazing – but we need to ensure that all our usual selection processes are used for each and every individual to ensure the best outcomes for them – whether this includes an iPad or not.
And to illustrate this point – I’d like to tell you about Crystal. Crystal is a 16 year old with complex communication needs. She has been using low tech communication books and high tech speech generating devices since she was very young. Currently she has a low tech PODD and a DynaVox MT4 with a PODD page set on it.
Crystal is independently mobile – but walking can be difficult for her and carrying her DynaVox MT4 hasn’t always been possible due to weight and size. Last year, her mother purchased an iPad and Proloquo2Go for her to use. Her mother’s initial plan was for this to be for her use at social events where her MT4 was too heavy for Crystal to carry.
Her school was delighted to hear that an iPad was coming. They suggested to her mother that the iPad was sent every day to school and her MT4 stop coming. Crystal’s mother spent around 40 hours trying to program all the vocabulary from her PODD page set into the iPad – and in the end she wasn’t able to do this completely as she had fewer symbol choices and reduced page layout options.
After several weeks her school suggested that the iPad didn’t need to come to school any more – and asked for her speech generating device to start coming again. They reported that it was much harder to Crystal to find vocabulary on her iPad and that it was slower for her to use to complete school work. The decision for school has been that her DynaVox MT4 remains the most appropriate tool for this situation. In fact, they are now upgrading to a DynaVox Maestro as they feel the bigger screen and increased portability of that unit might be an even better option for school.
However – in social situations the iPad and Proloquo2Go has taken on a life of its own. It breaks the ice – people who wouldn’t normally chat to Crystal with her low tech book or her Speech Generating Device are happy to walk up and start chatting – the iPad itself has become an incredible conversation starter as total strangers ask her how she likes it. Crystal can carry it independently – and is enjoying chatting with as many people as she can.
The iPad and Proloquo2Go alone wouldn’t meet her needs – but combining her DynaVox MT4 and her iPad has led to a communication system for Crystal that has had outcomes that no other communication options have given her. Each device is used in the most appropriate situation – leading to fewer communication breakdowns and much better outcomes for Crystal.
Crystal with both her iPad and MT4 at the ready
This was a great article but I wanted to point out one point it missed. For me as a parent, with a child with complex communication needs, traditional speech therapists have failed my daughter. Our experience with AAC is that SLPs require my child to jump through hoops proving she can use the lowest-tech devices and slowly graduating to the highest tech. I’m in touch with many families and I know this is a common situation. The SLP wants my child to demonstrate mastery of a single-message voice output device before she can have a 4-message voice output device. In this scenario, a Dynavox is the pot of gold at the end of an arduous journey, a journey that treats AAC as something that has to be earned at each stage.
My daughter has not been interested or motivated by simple speech output devices. She wants to use her face, eyes, hands, expressions and body to make her requests. She has never appreciated pushing a single button to get ANYTHING. We have struggled with SLPs who are supposedly AAC experts who say she is not “ready” for anything more complex. Traditional AAC devices are wicked expensive. Her clumsy, useless GoTalk 4+ cost us half what her iPad cost! We CANNOT underestimate the cost-savings of this new technology because the traditional devices have been prohibitively expensive for most families to purchase on their own.
For us, AAC apps on iTunes and the iPad have allowed us to bypass the traditional system here where SLPs are gatekeepers deciding who is “ready” and has access to technology, and who is not ready and does not have access. We have been deemed “not ready” for years…because Maggie has not demonstrated enough of the “prerequisite skills” for any of the traditional devices. I honestly feel that many SLPs look at a child with complex communication needs and intellectual disability and assume they have nothing worth saying. If we waited for the AAC specialist to finally decide Maggie was ready for a complex device, we could be well into her golden years before she can prove the level of “mastery” and intention the SLP requires.
Instead, with the iPad and OneVoice app, on our own, hacking our way through, without any SLP support, we have been able to demonstrate that Maggie has plenty to say. We are using the iPad to prove to the SLP that Maggie needs a communication system that allows her to express everything she might want to say. The iPad, for Maggie, might one day be the ticket to “permitting” her to get another device prescribed. Its wrong it has to be this way, but this is simply the system that many of us suffer through.
I agree that in a perfect world, experienced and thoughtful AAC experts would determine the best technology for our child. But we’ve lived in two countries (the US and Canada) and at least where we’ve lived, we have yet to access a speech therapist who looks at our child and sees someone who could competently express a range of emotions, thoughts, comments and dreams. Instead, we’ve been saddled with therapists with a narrow vision and low expectations.
For us, the iPad and the OneVoice app together cost LESS than our share of a Dynavox IF a speech therapist prescribed one and funded it here in Ontario. For us, the affordable consumer technology of the iPad and iTunes AAC apps has opened up a world of communication that has been denied to Maggie. I agree that AAC experts would be wildly helpful in the pursuit of helping Maggie express herself, but until we have competent AAC support, this is what we’ve got. For us, then, this technology is simply a dream come true. Its been a way to bypass the AAC gatekeepers who have locked us out of traditional devices.
I agree Erin, the old AAC heirarchy/ladder should go! Jumping through the hoops and for the gatekeeper professionals will prevent many kids from succeeding with AAC. High-tech is often easier for them to use in the first place. Well done with doing it yourself and succeeding!
And I agree with Jane that parents would best not be entirely without professional advice – many SLPs may be useless but find the special ones who are really experts, people like Jane.
James
Hi Erin – thanks for the comment. You make a very good point. It is such a pity when people take a prerequisites view of AAC or don’t understand that in fact you need a good flexible system to enable you to model language to get the best language development. I am hoping that this attitude is gradually changing – I run an AAC camp here called Big Mouth Camp. I’ve been running it for 8 years now – and our first couple of years large numbers of the students had devices which were inappropriate for their needs and potential. Last year, however, all of the students attending had good appropriate devices and page sets (and that included an iPad user). I talk about a prerequisites model very frequently in trainings and how you can’t view AAC this way – and I know lots of other people do as much public awareness about this too as they can. There are also some great resources on the DynaVox Implementation Toolkit that you can pass onto people to read about AAC myths which cover this as well.
Thanks too Erin for the resources you make available through your own website which help us all as well.
Jane
Hi Jane
Just wanted to say how much I appreciated your article/blog entry above. You have expressed (far more eloquently and comprehensively than I could) all my concerns around the use of iPads, iPods and other similar devices as speech generating devices. I acknowledge that for some people these Apple devices will be life-changing communciation tools. However, due to the worldwide phenomenon that is the iPad, we are often seeing these devices being purchased as a speech-generating device without consideration being given to ALL the needs of the user or potential user (i.e. the person is being made to fit the tool rather than the other way around).
Kind regards and thanks for your great work!
Susan
Thanks Susan!
I think everyone who works with and supports people who use AAC is thinking long and hard about this currently as we see both amazing outcomes and outcomes which are not so positive.
Cheers
Jane
Wow, thank you Erin for your posting. As an SLP it pains me to hear of children being restricted in their communication potential by traditional approaches to AAC technology – your daughter is fortunate to have you to persist and believe in her potential. It’s a very big reminder to us as professionals to not be afraid of new AAC technology and to keep up-to-date with new progressions in this area. Susan and Jane, you guys are awesome in helping us to do this! I am totally amazed at how accessible AAC technology is becoming with the range of apps on offer and the significantly reduced costs of setting up a communication system. The design of this technology is so familiar and easy to use for our students as well. I think this is an area that has started to take off and this is just the start of it and I’m very glad to see it. As professionals we need to be open-minded (whilst still very careful that we are not prescribing inappropriate systems) and not make assumptions about the communication potential of the children that we work with in the context of their ability to utilise tech options. I am currently working with 2 teenage twins with a range of severe and complex impairments – I prescribed Dynavox M3′s when I was working with them (having previously trialled and seen a spark of potential) and I have been absolutely blown away by the communication competency that these boys are displaying. I thought it was going to be a long hard road to train these boys, but consistency from their teaching staff and family has quickly resulted in amazing outcomes and unlocked their communication abilities (they also have an iPad at home for quick communication too). I think we need to be thinking from the top in terms of our expectations of a child’s ability to handle complex AAC technology systems. So many of the complex technology options are so flexible that they cater for a large range of user skills, so seems to be no need anymore to start from the bottom and work our way up. So thank you, Erin, your posting really struck a chord with me as a professional reminder of how we need to approach these new technologies and aim high in achieving communication outcomes for the students that we work with. We are faced with many constraints in our work as SLPs, but when the team works together and you see the communication outcomes (sometimes surprising!) then it’s a really great thing.
Hi,
As a SLP student from Quebec, I am really interested in everything new technology can bring to the field of AAC. I am now looking for applications for IPad or IPhone that include french in their languages. I have searched a lot, but I have found nothing! No french synthetized speech or french word prediction. If someone knew an AAC application in french, it would be nice to let me know!
Thanks!
Geneviève Larocque
Hi Genevieve, There are definitely some AAC Apps in French in the iTunes store. My French is severely limited so I am definitely not up to reviewing these Apps – but Innov8 who are also in Canada have a great blog on this topic at http://www.inov8-ed.com/2011/02/theres-a-special-app-for-that-part-6-3-methods-of-using-augmentative-communication-apps-to-support-different-languages/. Hope that’s helpful! Jane
I have a 4 year old who has taken to the iPad. She has Down Syndrome and has very delayed speech, SLPs indicating that she is unlikely to develop legible speech, so I am looking at Aac apps to assist her. I have downloaded and customized Proloquo2go, as the school she will attend in 2013 use it. My aim is that I can get her skilled in using it prior to commencing school. I worry that it may be an ambitious place to start. I have also downloaded Tap Speak Choice, I initially started using it for her to make choices, liking the fact that it used Boardmaker symbols that she is familiar with. I know you only give it two stars, but it seems to have a lot of potential and I am wondering if it might be a better option for my daughter. I have consulted with two SLPs but neither have any expertise in these apps. I would welcome your input.
Lyn
Hi Lyn,
I really like TapSpeak Choice – and in fact I’ll be updating my table on the weekend and will be putting it up to three stars with all the recent updates it has had. It has turned into a very solid AAC App – and like you I appreciate that it has the Picture Communication Symbols from Boardmaker. When I gave it two stars there were lots of limitations e.g. you couldn’t like boards to each other, which really reduced the functionality of the App. I have found the developers very helpful and very willing to make changes though – lovely to talk to about the App and what can be done to improve it.
It doesn’t come with any pre-programmed pages – but as long as you are willing to do the programming it is a great App. It’s also really important to give her vocabulary to comment and to request, as well as making choices. And you need to use the App with her yourself to communicate – modelling using it is very important for children learning to use AAC. And modelling also helps you to realise when the vocbulary you’ve programmed is missing something critical that the user needs.
Good luck with your decision
Hi Jane, thanks for your excellent info! Is Tapspeak much different from Proloquo really? Or is it more like an slighly improved version of Proloquo? What are the best sites or You Tubes for me to see these two systems in action and compare please? I don’t have an I-Pad so I’m just trying to see them in action on internet.
James
HI James,
Proloquo2Go and TapSpeak Choice are really different – and which one would be better for you would depend on which features are most important to you. Proloquo2Go uses SymbolStix as the symbol system (www.symbolstix.com) and TapSpeak Choice uses Picture Communication Symbols from Boardmaker (www.mayer-johnson.com). Proloquo2Go comes with a pre-programmed vocabulary set which may suit some people – but for others will need to be completely re-programmed. TapSpeak Choice comes as a blank canvas – you need to do all the programming yourself. TapSpeak Choice has a range of switch and scanning options and Proloquo2Go is direct touch on the screen only. (And an update to either App could change these features at any time).
For videos, there are lots of videos of Proloquo2Go on YouTube – but there are also some webinars that were run earlier this year which are available on iTunes as Podcasts – http://itunes.apple.com/au/podcast/assistivewares-assistive-technology/id454672565. You’ll need to have iTunes installed on your computer to watch these. Videos of TapSpeak Choice can be found on the Conley Solutions YouTube channel – http://www.youtube.com/user/conleysolutions.
Hope that’s helpful
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Hi Jane,
Wonderful post on AAC technologies/Apps. I was wondering if you had any experience with Lingraphica’s AllTalk, TouchTalk, or SmallTalk.
Jenn
Sorry, should have left a url for the applications/system I referred to:
http://www.aphasia.com
J
Hi Jenn, I have only used their iPhone/iPod touch Apps. I’ve seen some of their other software demonstrated at a conference – but that’s all. Sorry I can’t help more! I’m guessing you’ve checked out their iPhone Apps – they are all free and I gather are all components of the SmallTalk package. If you go to the iTunes store and type in Lingraphica as the search item they will all come up. If you get a further look at their Mac based software, please let me know what you think.
PS Glad you enjoyed the post!!
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