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CONTINUUM OF COMMUNICATION INDEPENDENCE
by Dr. Patricia Dowden, University of Washington, 2004
This continuum describes an individual's expressive communication based on observable communication behaviors. The model is useful in intervention planning. In my work, I define "independence" in communication as:
"the ability to communicate anything on any topic to anyone"
TOWARDS COMMUNICATIVE INDEPENDENCE
EMERGING
INDEPENDENT
Unreliable Symbolic Communication
Reliable Symbolic Communication
Limited vocabulary
Limited partners
All topics
All partners
EMERGING COMMUNICATION
You might think that an "emerging communicator" is an individual who is just getting started with AAC. That is close, but I want to make an important distinction between different beginners.
First, the exceptional "beginner" with AAC. These are the people who are "beginners" but they are able to communicate as soon as they are given the means. Think of a teen who is intubated after a spinal cord injury or an adult with Amyotrophic Lateral Sclerosis (ALS). They only need to be given a WAY to communicate.
The more common "beginner" is someone who is able to communicate very little, for example a young child with severe motor impairments. These children rely entirely on non-symbolic communication methods, such as pointing, gestures, facial expressions, body language and intonation. They may be learning alternative communication, but the results are inconsistent so far.
An "Emerging" communicator does not have a RELIABLE method of EXPRESSIVE communication through SYMBOLIC language.
Note the words in capital letters above; they have special significance:
RELIABLE communication means that the individual is able to communicate what he/she intends to communicate; there are no accidental selections that result in unintended messages. Reliability is crucial to independence.
EXPRESSIVE communication is emphasized because this model is based on OBSERVABLE communication behaviors: how an individual uses symbolic language. It is not based on how well he or she understands language, something that may or may not be known for emerging communicators.
SYMBOLIC LANGUAGE does NOT mean just using visual symbols. Instead, it means using something to REPRESENT or SYMBOLIZE a concept, idea or thought. For example, sounds symbolize meaning in our speech while letters and words represent meaning in our writing, and in AAC we use symbols you can hear, see or feel. Symbolic language permits us to talk beyond the "here and now" about things in another time or place. In contrast, non-symbolic communication is limited to the "here and now," for example, using pointing and gestures to respond to what one sees, hears or feels in the immediate environment.
(Note: everyone uses non-symbolic communication methods such as gestures and pointing. The important point here is that "emerging" communicators are limited to those methods only.)
So, let me restate the definition.
Communication is "Emerging" when the individual...
does not have a RELIABLE method of EXPRESSIVE communication through SYMBOLIC language.
What does emerging communication look like?
Typically, the individual relies on the following AAC techniques:
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non-symbolic communication strategies such as gestures, body language, facial expressions and familiar partners to figure out what is meant by these signals.
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perhaps a way to signal "acceptance" (e.g. a smile, or reaching for something) and "rejection" (e.g. head turn away, pushing away, etc.) but the individual does not have a reliable method of answering other yes/no questions.
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Trials of AAC strategies or devices may or may not be happening, but performance is still inconsistent.
Does emerging communication = cognitive deficits?
The short answer is "no, no, no and no"! Emerging communication means only that the individual does not have a reliable means of symbolic communication. There could be many reasons (see box to the right) that have nothing to do with cognition. Furthermore, it is impossible to test the cognition (or the receptive language) of an individual with severe motor impairments who is a non-speaker. Nonverbal tests cannot be used because there is no hand control, and verbal tests cannot be used because there is no reliable communication beyond pointing and gesturing. There are MANY stories of accomplished AAC users who were declared severely "mentally retarded" until someone provided them with a means of communication.
What might limit someone to only "emerging" communication skills?
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Device doesn't match motor capabilities, so unreliable.
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Hidden hearing impairment
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Hidden vision impairment
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Low expectations of other people, so no AAC trials.
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Lack of opportunities to communicate
CONTEXT-DEPENDENT COMMUNICATION
If "emerging" communication is when there is no reliable symbolic communication, you might guess that the next type of communication is when the individual has achieved some symbolic communication. And that is right.
A "Context-Dependent" Communicator has SYMBOLIC COMMUNICATION that is RELIABLE, but it is limited to particular CONTEXTS or PARTNERS. Note the words in capital letters above; they have special significance:
SYMBOLIC COMMUNICATION: As mentioned earlier, "symbolic" communication does NOT mean the use of visual symbols. It means any communication in which something (e.g. a word, sign, picture, etc.) represents a concept or meaning. For example, sounds symbolize meaning in our speech while letters and words represent meaning in our writing, and in AAC we use symbols you can hear, see or feel. Symbolic language permits us to talk beyond the "here and now" about things in another time or place.
RELIABLE: means that the individual is able to communicate what he/she intends to communicate, not accidentally push another key or convey a message that was not intended.
LIMITED CONTEXTS: this means that the individual is only able to talk about certain topics and/or only able to communicate in certain settings or activities, e.g. snack time, circle time (for kids) or in speech therapy (for adults).
LIMITED PARTNERS: this means that the individual is able to communicate only with some people in daily life, e.g. with mom (for kids) or a spouse (adults)
What does context-dependent communication look like?
Typically the individual has to rely on either:
1) AAC techniques with vocabulary chosen by others, for example:
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symbol displays
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word boards
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communication books
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communication devices
OR
2) AAC strategies that are effective only with familiar partners, for example
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severely unintelligible speech
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strategies that require learning by the partner (e.g. eye-gaze, partner assisted scanning, etc.)
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devices with output that is not useful with strangers (e.g. devices with poorly intelligible speech output or screens that are unreadable outdoors).
Other Characteristics:
The individual may or may not have:
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significant motor impairments
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cognitive abilities at age-level
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language abilities at age-level
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What might limit someone to only "context-dependent" communication skills?
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Limited spelling ability
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Vocabulary - for only particular contexts
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Vocabulary - not personal or useful
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Limited experience with new partners
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Limited opportunity to practice communication in natural contexts
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Hidden hearing impairment
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Hidden vision impairment
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Mismatch of device and motor control
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Fear of AAC techniques
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Low expectations of other people
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Lack of opportunities to communicate
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Lack of AAC services
INDEPENDENT COMMUNICATION
So, by now, you see where I am going. Independent Communicators are not limited in what they can talk about or whom they can talk to. They can communicate with both familiar and unfamiliar partners. And if they don't have the right vocabulary preprogrammed, then they can use spelling to communicate exactly what they want to say.
Definition of independence:
"the ability to communicate anything on any topic to anyone in any context"
Case Examples of Independent Communicators:
Independent communication means that these real AAC users can do these things:
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Bob Williams can talk politics and shape policy in the government
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Peg Johnson can be a librarian in Minneapolis
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Toby Churchill can develop a product and market it
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Michael Williams can write and publish a newsletter for AAC users
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Rick Hohn can deliver sermons to people with addictions
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Snoopi Botten can be a recording artist with his own label
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Sharon King can discuss her art or advocate for policy changes in Olympia
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David Chapple can write computer code
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Mick Joyce can express frustration with government
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Scott Palm can sing Karaoke or lobby the legislature
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And all of these individuals can still make their daily needs known, communicate with family and caregivers as necessary.
What might prevent someone very capable from becoming independent?
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Never taught to spell
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No access to techniques that permit novel messages via spelling
SUMMARY OF THE MODEL
Now it is time to bring this model together for you. Below you will see a table showing the transition from "Emerging" to "Context-Dependent" to "Independent". You can see that the difference between Emerging Communication and Context-Dependent is the development and use of a reliable means of symbolic communication.
The Context-Dependent Communicator uses symbolic language reliably, but he or she is limited in terms of the vocabulary available or the partners who understand. We have to work on expanding vocabulary and expanding the partners for these individuals.
The Independent Communicator is no longer dependent on others to provide vocabulary; they have the spelling skills to communicate about anything they wish to. These individuals are also not dependent on familiar partners; they have the ability and the means of communication (the AAC system) that works for any listener, familiar or not.
How does this model relate to intervention?
As you can see, this model begins to describe some of the goals of intervention for different types of communicators.
The primary goal for emerging communicators:
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identify that 1st method of symbolic communication.
The primary goal for the context-dependent communicator:
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expand vocabulary and partners and contexts
The primary goal for the independent communicator:
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their goals and desires for improved communication
What the model is NOT:
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a reflection of cognitive ability
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a description of how someone understands (receptive language)
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a prediction of potential
A very capable individual with excellent cognition and receptive language can be held back by poor services. Conversely, a different individual, with good AAC services and education, can become an independent communicator despite cognitive and language delays