INT J LANG COMMUN DISORD, JANUARY–FEBRUARY VOL.

2014,

49, NO. 1, 1–14

Review ‘Communicative competence’ in the field of augmentative and alternative communication: a review and critique Gail Teachman† and Barbara E. Gibson‡ †Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada ‡Department of Physical Therapy, Bloorview Research Institute, University of Toronto, Toronto, ON, Canada

(Received January 2013; accepted July 2013) Abstract Background: Understandings of ‘communicative competency’ (CC) have an important influence on the ways that researchers and practitioners in augmentative and alternative communication (AAC) work toward achieving positive outcomes with AAC users. Yet, very little literature has critically examined conceptualizations of CC in AAC. Following an overview of the emergence of the concept of CC and of the field of AAC, we review seven conceptualizations of CC identified in the literature. Aims: To consider the contributions and potential shortcomings of conceptualizations of CC in AAC. Methods & Procedures: We use a critical theoretical approach to review, critique and synthesize conceptualizations of CC in AAC, with a particular focus on uncovering ‘taken for granted’ assumptions. By historically situating the reviewed literature, we examine the shifting boundaries and tensions among theoretical conceptualizations of CC in AAC and their potential impacts on practice. Main contributions: We suggest ways that revisiting past scholarly work, alongside emergent, innovative conceptualizations of CC might shift ways of thinking about CC in AAC which tend to focus on the individual who communicates differently, toward (re)location of CC as a shared, socially incorporated and performed communication construct. Conclusion & Implications: We propose that emerging critical perspectives drawn from AAC and other interdisciplinary literatures offer innovative ways of theorizing communication difference, which might inform evolving conceptualizations of CC in AAC. Keywords: communicative competence, augmentative and alternative communication, communication impairment, critical conceptual review.

What this paper adds? Conceptualizations of ‘communicative competency’ (CC) in the field of augmentative and alternative communication (AAC) have not been critically examined in the literature. It is crucial that researchers and clinicians query takenfor-granted assumptions that underpin AAC practice and directly impact people with communication impairments. This paper uses a critical theoretical approach to review, critique, and synthesize conceptualizations of CC in AAC. The reviewed works are situated historically to contextualize and trace the evolution of understandings of CC in AAC. The paper offers perspectives that encourage reflection and (re)consideration of understandings of CC, and that support emerging, innovative ways to theorize communication difference.

Introduction In this paper, we consider the contributions and potential shortcomings of conceptualizations of communicative competence (CC) over the quarter

century since the discipline of augmentative and alternative communication (AAC) was founded. We examine the shifting boundaries and tensions among theoretical conceptualizations of CC in AAC, considering the

Address correspondence to: Gail Teachman, Department of Occupational Science & Occupational Therapy, University of Toronto, 160–500 University Avenue, Toronto, ON M5G 1V7, Canada; e-mail: [email protected] International Journal of Language & Communication Disorders C 2013 Royal College of Speech and Language Therapists ISSN 1368-2822 print/ISSN 1460-6984 online  DOI: 10.1111/1460-6984.12055

2

Gail Teachman and Barbara E. Gibson

interplay among conceptualizations by situating the reviewed literature historically. We then examine opportunities to shift ways of thinking about CC in AAC, which tend to focus on the individual who communicates differently, toward consideration of CC as a shared, socially incorporated and performed communication construct. Currently, the concept of CC pervasively underpins AAC intervention. Yet, very little literature has critically examined conceptualizations of CC in AAC. CC in the broadest sense is equated with the ability to communicate effectively. Originally introduced by Dell Hymes (1972), it has become a core construct in sociolinguistic theory. CC is a concept that both grounds and situates the study of language mastery specifically and social communication practices more generally. Understandings of CC have an important influence on the ways that researchers and practitioners in AAC work toward achieving positive outcomes with AAC users. Ongoing critique of the theories and assumptions that dominate AAC and rehabilitation more generally is important. As noted by Blackstone et al. (2007: 194): theoretical constructs (whether explicitly stated or not) impact modes of operation in research, development, and practice, they often determine what constitutes relevant human factors, what is considered relevant evidence, and how that evidence will be interpreted.

One of the central goals in AAC intervention is focused on increasing the CC of individuals with communication impairments (Hill 2004, Light 1997, Lund and Light 2006). An assortment of potentially confusing conceptualizations and terminologies exist in relation to CC, AAC and communication difference more broadly (Alant et al. 2006). This can hamper knowledge creation and dissemination, and ultimately impede progress toward the goal of improving life chances for people who communicate differently. Because so much of the focus of research and practice in the field of AAC has been directed toward increasing the CC of individuals who have little or no speech, it is important to understand and critique ways that CC has been conceptualized within this field. In this paper, we review literature that has specifically conceptualized CC in AAC with particular attention made to uncovering ‘taken for granted’ assumptions that underpin these conceptualizations. Additionally, we suggest ways that revisiting past scholarly work, alongside emergent, innovative conceptualizations of CC, might usefully inform considerations of how AAC research and practice has evolved and might continue to transform. Following a description of the methodological approach, we provide a brief, but by no means comprehensive, contextual overview of the emergence of the concept of CC, and the development of the field of AAC. We acknowledge that within the scope of this paper it is not feasible

to outline the many seminal works that formed a foundation of knowledge about communicative interaction in AAC (for example, for a very comprehensive ‘state of the art’ review, see Kraat 1985). We then review, synthesize and critique conceptualizations of CC extracted from the AAC literature and specific to communication impairments. Our review is framed by two queries:

r How is ‘communicative competence’ conceptualized in the AAC literature?

r What are the taken-for-granted assumptions that underlie these conceptualizations and influence how they have been ‘put to work’ in AAC research and practice? In addressing these questions, we highlight emergent critical ways of thinking about communication difference that, we argue, can inform a shift in understandings of CC in the field. Using exemplars, we suggest ways to revisit and relocate CC which would favour more critical, reflexive rehabilitation practices and attend to issues of power that impact AAC practice and the daily lives of people who use AAC. Methodological approach Critical social science approaches In this review, we draw on critical perspectives to question assumptions or ideologies that underpin everyday practices; consider power relations that are at play; and acknowledge contradictions (Eakin et al. 1996). In critical work, dialectical relationships are acknowledged between the micro-level of the individual and their macrolevel social, political and economic contexts (Eakin et al. 1996). Kincheloe and McLaren (2005: 304) outline some of the basic assumptions that inform critical research approaches: all thought is mediated by power relations that are socially and historically constituted; certain groups in any society are privileged over others; and mainstream research practices are generally, though often unwittingly, implicated in the reproduction of systems of oppression. Critical research is thus explicitly concerned with identifying and addressing marginalization and exclusion (Kincheloe and McLaren 2005). Critical perspectives can be used to uncover possible unintended sources of marginalization in healthcare practices. Literature examining implicit assumptions in rehabilitation practices has provided opportunities for consideration of ‘how things might be otherwise’. For example, Gibson and Teachman (2012) examined ways that dominant social assumptions about the value of walking contributed toward negative self-identities for children with cerebral palsy; and explored ways that rehabilitation professionals might better support parents

‘Communicative competence’ in AAC: a review Table 1. Search strategy for locating conceptualizations of ‘communicative competency’ (CC) in the augmentative and alternative communication (AAC) literature Keywords: communicat∗ competence, augmentative and alternative communication, augmentative communication, nonverbal communication Electronic databases searched: 1. CINAHL 2. Combined searches in Scholars Portal (specific databases selected): Arts & Humanities Citation Index (1975 to present) ASSIA: Applied Social Sciences Index and Abstracts Conference Papers Index Digital Dissertations @ Scholars Portal ERIC CSA Linguistics and Language Behavior Abstracts MEDLINE Proquest Education Journals @ Scholars Portal PsycINFO Science Abstracts @ Scholars Portal Social Sciences Abstracts @ Scholars Portal Social Sciences Citation Index (1956 to present) R

R

Search dates: 1980 to current (a period that spans the development of the field of AAC) Other limits: human, English language

and children through open discussion of their changing values and goals around walking and mobility options (see also Duchan and Leahy 2008, Hammell 2006, Simmons-Mackie and Damico 2008). However, underlying assumptions in the field of AAC remain, for the most part, unexamined. Searching for conceptualizations of CC in the AAC literature The methods used in this review were both procedural and philosophical. A structured critical conceptual review of the literature (Grant and Booth 2009) was integrated with a philosophical critique grounded in a critical social science perspective (Eakin et al. 1996). Critical reviews do not provide definitive answers. Instead, they provide opportunities to build on the strengths of the existing literature and suggest possibilities for new or alternative approaches (Grant and Booth 2009). Because of the interdisciplinary nature of the field of AAC, literature is scattered across numerous sources in a variety of larger fields (e.g. linguistics, rehabilitation, engineering, education) and is inconsistently indexed (Schlosser et al. 2005). For this paper, advanced electronic search strategies were supplemented by handsearching to identify key works specifically conceptualizing CC in relation to communication disabilities. In February 2011, an electronic search strategy was developed and implemented as outlined in table 1. The search strategy was based on recommendations for-

3 warded by Schlosser et al. (2005) for locating the AAC literature across a variety of larger disciplinary fields. The searches covered a period from 1980 forward because this period spans development of the field of AAC. Keywords included communicat∗ competence, augmentative and alternative communication, augmentative communication, and nonverbal communication. These searches yielded 84 sources, including books, peer-reviewed articles, conference presentations and dissertations. Abstracts were reviewed to determine whether a conceptualization of CC in AAC was presented. Works that referred to CC but did not theorize a model of CC or elaborate on an existing conceptualization were excluded. Six peer-reviewed articles and one book chapter were identified conceptualizing CC in relation to AAC. Ancestry hand-searching (Schlosser et al. 2005), which involved searching reference lists of those six key works, yielded one additional paper. Thus, the literature included in the review was comprised of seven peer-reviewed papers and one book chapter. To aid the iterative process of analysing, synthesizing and critiquing the literature, the text of each work was imported into NVivo 8, a qualitative analysis software program. This software was used to organize, extract, compare and contrast data in order to identify relationships and patterns among those data. In our analysis, adapted from Dixon-Woods et al.’s (2006) method of ‘critical interpretive synthesis’, an initial coding scheme was developed reflecting the review aims and critical approach. Initial codes included: description of CC, conceptualizing communication differences, underpinning assumptions, theories attributed in development of the conceptualization, and how the conceptualization might act on AAC research and practice. Some codes allowed for extraction of descriptive information (e.g. theories being attributed), while others were used to organize our critical interpretation (e.g. underpinning assumptions). The first author coded the text across all the reviewed papers. Following procedures for iterative critical analysis (Willis 2007), multiple meetings were held with the second author, over multiple analytic cycles, to discuss alternate interpretations, develop new codes, and converge codes to identify patterns discerned across the conceptualizations. Extensive memoing (Birks et al. 2008) aided in capturing connections, relationships and interpretations across the texts. Contextualizing the review Emergence of the concept communicative competence (CC) The term ‘communicative competence’ is generally attributed to Hymes (1972), a sociolinguist who, in the early 1970s, wrote a seminal essay outlining a theory

4

Gail Teachman and Barbara E. Gibson

of CC. Hymes refuted the views of Chomsky (1965) who had earlier proposed that competence and performance were dichotomous. In Chomsky’s view, any study of linguistic performance would necessarily involve examination of interactions among a variety of factors, the CC of the individual who is either speaking or listening (the ‘hearer–speaker’) being only one of these factors. Chomsky (1965: 4) asserted that there is a fundamental distinction between competence (the speaker– hearer’s knowledge of their language) and performance (the actual use of language in concrete situations) and he specified that only in an idealized world would performance be a direct reflection of competence. Hymes criticized Chomsky’s theory for having virtually omitted any consideration of socio-cultural aspects of linguistic competence. He countered Chomsky by proposing a theory of CC that articulated ‘competence for use’; a construct intended to transcend the Chomskyan competence/performance dichotomy. Hymes posited that CC is a construct that incorporates performance. Effective communication, he argued, is produced through the integration of linguistic competence with pragmatic knowledge, and the ability to perform communicatively within specific speech communities to accomplish a purpose. Hymes’s model of CC was well received in the emerging field of sociolinguistics, and had considerable influence on the development of pedagogical approaches to language instruction, for example, teaching a new or second language. A later elaboration on Hymes’s conceptualizing of CC was put forward by Canale and Swain (1980), who are attributed with both clarifying and extending Hymes’s work. Canale and Swain proposed a theoretical model where CC was constituted by three sub-competencies: ‘grammatical competence’: knowledge of lexical items and of rules of morphology, syntax, sentence–grammar semantics and phonology (Canale and Swain 1980: 29); ‘sociolinguistic competence’: sociocultural rules of use and rules of discourse (p. 30); and ‘strategic competence’: verbal and nonverbal communication strategies to compensate for communication breakdowns or insufficient competence (p. 30). In later iterations of the model, Canale (1983) included ‘discourse competence’, which describes overall cohesion and coherence, as a fourth sub-competency. As we discuss below, Canale and Swain’s model has had considerable influence on conceptualizations of CC in the field of AAC.

began among previously disparate disciplines involved with research aimed at developing knowledge, tools and strategies to assist non-speaking individuals to communicate (Vanderheiden 2002, Zangari et al. 1994). By 1983, an international group of engineers, therapists, teachers and researchers along with individuals who used communication aids coined the term ‘augmentative and alternative communication’ and founded the International Society for Augmentative and Alternative Communication. The first peer-reviewed journal dedicated to the field of AAC appeared in 1985. Currently, AAC is a well-established international field that has retained its interdisciplinary composition. People who use AAC range in ages from toddlers to older persons. They may have communication impairments related to developmental neurological disorders such as cerebral palsy or autism; acquired brain injuries, stroke or neurological degenerative diseases; and/or have limited or no speech because of tracheotomy, intubation or ventilation. An overwhelming array of AAC tools and strategies has been developed, ranging from simple alphabet boards, pictures and symbolsets to highly complex and costly integrated speechgenerating computer technologies. Typically, at least in developed countries, multidisciplinary teams (including speech–language pathologists, occupational therapists, educators and engineers) provide assessment and intervention. Therapists providing clinical assessment, consultation and intervention are commonly required to act as technology gatekeepers within complex regulated funding systems. Access to AAC services is often limited by a variety of socio-political factors including limited funding, waitlists, geographical distribution of services favouring larger metropolitan areas, and limited numbers of pre-service trained professionals (Hodge 2007, Lindsay 2010). It is important to acknowledge that people who communicate differently are not a homogenous group. In this paper, the term ‘AAC users’ includes not only people who use devices and technologies to communicate, but also those who have little or no functional speech who may not use specific systems but who communicate using alternatives such as non-speech vocalizations, nonverbal gestures, eye-gaze and facial expressions.

Tracing ‘communicative competence’ in AAC Emergence of the field of augmentative and alternative communication (AAC) The field of AAC is relatively young and has been marked from the beginning by a distinctly interdisciplinary identity. In the 1960s and 1970s, a convergence

A summary of the eight reviewed works is provided in table 2. This section will review and critique each conceptualization, tracing the development of ‘CC’ over time in the field of AAC. It then compares and contrasts the models, discussing ways that CC, as an evolving construct, has been taken up in AAC research and practice.

‘Communicative competence’ in AAC: a review

5

Table 2. Summary of ‘communicative competency’ (CC) conceptualizations in augmentative and alternative communication (AAC) Author(s) Dunst and Wortman Lowe (1986)

Wilbert and Albritton (1986)

Theoretical underpinnings

Conceptualizing CC in AAC

Based on Goldberg’s (1977) readability hypothesis about social–communicative competence Elaboration and synthesis of theorists in psycholinguistics and developmental psychology, within a framework by Baltes, Reese & Nesselroade (1977). Various developmental, social and learning theories

Developmental model of early childhood CC Seven levels: behaviour state, recognitory, contingency, instrumental, triadic, verbal (context-bound), and verbal (decontextualized) Six rating criteria: awareness, goal-directed, culturally defined, intentional, linguistic, and symbolic All individuals have different topographies of communication

Sutton (1989)

Wiig’s (1982) ‘Let’s Talk Inventory for Adolescents’: a compendium of speech acts standardized for normal communication development

Light (1989, 2003)

Adaptation to AAC of sociolinguistic CC models of Hymes (1972), Canale and Swain (1980), and Canale (1983)

Granlund et al. (1995)

Schundt and McFall’s (1985) model of social competence

Hetzroni and Harris (1996)

Kagan (1998)

Nordenfelt’s (1991) logical analysis of health promotion and (1993) notions of disability and handicap. Socio-cultural theory in relation to language development Light’s (1989) model of CC Lyon’s (1992) emerging theory of communicative partners Parr’s (1996) application of the social model of disability to aphasia

Dunst and Wortman Lowe (1986) The earliest conceptualization of CC in relation to AAC was forwarded by Dunst and Wortman Lowe (1986). Dunst was a researcher in the fields of child development and linguistics who was collaborating on a developmental model of CC (Holdgrafer and Dunst 1986). Dunst and Wortman Lowe drew on developmental psychology, especially Goldberg’s (1977) model of social competence in infancy as well as emerging psycholinguistic theories. Their goal was to outline a model of early (birth to 2 years) CC in infants with speech or language impairments. They identified seven developmental and progressively more complex levels of CC along with behavioural criteria for scoring each level. The model was underpinned by assumptions that communication skill

Rough ‘sketch’ of CC related to verbal and nonverbal skills Four systems of nonverbal skills: kinesic, proxemic, chronemic and paralinguistic Attention paid to interactive, shared aspects of communication. Social–verbal competency conceptualized as an inventory of 40 speech acts organized against four categories (ritualizing, controlling, informing, feeling) Competency in performing these acts is tested in two contexts (peer, authority) CC involves being functionally adequate in daily communication; having sufficient knowledge, judgement and skill to communicate Four sub-competencies: linguistic, operational, social and strategic Each sub-competency is integral to overall CC, attainment is achieved through performed integration of the sub-competencies Three-factor relation among agents (the persons), the goal of an action (the mission) and the circumstances surrounding this action (the environment) Change in outcomes can occur through change in any of the variables Socio-cultural elaboration on Light’s (1989) model of CC where: ‘bicultural’ linguistic competence of AAC users is explicated; and other competencies (operational, social and strategic) are considered against clients’ own culture and culturally based world views CC is conceptualized in relation to ‘conversational success’ and concomitant experiences of participation, i.e. communication access Three factors contributing toward success in a conversational equation: skills and experience aphasic partners, skills and experience of non-aphasic partner, and availability of appropriate resources Intervention approach termed: supported conversation for adults with aphasia (SCA)

development proceeds along a predictable continuum during childhood. Dunst and Wortman Lowe’s model was innovative in that it introduced the notion of communication difference as opposed to communication deficiency. Differences in ways of communicating were to be ‘expected’ and ‘accepted’ as variations that were evocatively termed ‘topographies of communication’. The authors argued for recognition of sign language, or use of a symbol board, as valid demonstrations of CC, equal to speech. This early critique of difference-deficiency, however, conflicted with the authors’ simultaneous treatment emphasis on encouraging conventional, socially recognized, nonverbal and verbal communication practices (e.g. nonverbal gestures such as nodding or

6

Gail Teachman and Barbara E. Gibson

smiling that closely approximated typical, recognizable gestures produced by non-disabled children, or the use of voice synthesized language to approximate more recognizable speech.) The authors rationalized that this type of communication ‘par excellence’ would more easily be recognized across environments and communication partners. Thus, Dunst and Wortman Lowe’s conceptualization of CC, while innovative, included unresolved tensions between a nascent acceptance of communication differences and ongoing valorization of normative mainstream communication practices. Wilbert and Albritton (1986) Later in 1986 at the International Society of Augmentative and Alternative Communication conference, Wilbert and Albritton (1986) presented a paper where they cited the work of Dunst and Wortman Lowe (1986), but made significant departures. They expressed concern about the emphasis on devices and technologies reflected in the early AAC literature of the time. They argued for greater consideration of the person and the complexities of communicative interaction. To frame these considerations, Wilbert and Albritton identified a grouping of skills deemed necessary to achieve CC and to participate in ‘normal’ communicative interaction (quotation marks in the original) (Wilbert and Albritton 1986). Their model was underpinned by a diverse range of psycholinguistic, learning and social theories, and was premised on the underlying assumption that removing barriers encountered by people with communication impairments would lead to effective communication interactions. The focus was on bringing together verbal and nonverbal competencies with emphasis placed on the value added to communication by nonverbal signals. The nonverbal system was framed as a composition of (1) the kinesic system (postures and bodily movement including facial expressions related to a communication act); (2) the proxemic system (interpersonal distance or proximity); and (3) the paralinguistic system (vocal aspects of communication such as articulation control, pitch height and range, stress and intonation). A fourth ‘chronemic’ dimension (temporal aspects such as rhythm, rate, silence and stillness) was noted but not expanded on. Wilbert and Albritton put forth the aim of enabling people with communication impairments to ‘fully participate in and interact with the environment’ (Wilbert and Albritton 1986: 4). In this sense, they foreshadowed current theoretical and empirical work (Balandin and Duchan 2007, Cooley Hidecker 2010, Kovarsky et al. 2001, Yorkston et al. 2007) exploring participation, and more specifically communicative participation (an emerging construct in the field), which will be discussed briefly below. The authors provided a reflec-

tive critique of AAC practices, suggesting an overemphasis on communication aid technologies in isolation from social considerations. However, Wilbert and Albritton’s work, alongside Dunst and Wortman Lowe’s (1986), was located historically in assumptions that normative communication interactions provide a suitable foundation on which to premise considerations of CC in AAC. As a result, these two models implicitly guided intervention practices aimed to teach people with communication impairments to approximate the communication patterns and behaviours of non-disabled people. CC among AAC users was considered and measured against mainstream normative standards, which were taken for granted as appropriate to target. Both models assumed that as individuals’ CC increased, successful communication interactions and participation would follow.

Sutton (1989) The next paper contributing toward conceptualizing CC in AAC was by Sutton (1989) who reflected on the appropriateness of using ‘normal’ models of communication in AAC practice, noting potential benefits but also harms. In her relatively early critique of existing AAC assumptions, Sutton cautioned: ‘The normal model should be kept in mind not as a goal to strive for but as a perspective to be questioned when setting goals for intervention with an AAC user’ (p. 161). Sutton based this recommendation on a study where she had tested the applicability of a standardized assessment of social–verbal competence for use with four young adults who communicated using Blissymbols. The assessment she used was the ‘Lets’ Talk Inventory for Adolescents’, developed in 1982 by Wiig (as cited in Sutton 1989). The inventory was designed to elicit 40 selected speech acts categorized under four communicative functions: ritualizing (e.g. greeting and introducing self ), informing (e.g. reason question and content question), controlling (e.g. requesting assistance and negotiating), and feeling (e.g. endearment and exclamation). Sutton concluded that although Wiig’s inventory was somewhat useful in describing the social–verbal competence of individuals who use AAC, it was not suitable for capturing CC in AAC. For example, she noted that AAC users develop and apply different rules to guide communication interactions, based on their unique communication experiences. In fact, the main contribution of Sutton’s study was empirical evidence of fundamental communication differences among AAC users. This provided a foundation and a rationale for developing new models and measures of CC specifically designed for AAC practice that would not be based on ‘normal’ models of communication.

‘Communicative competence’ in AAC: a review Light (1989, 2003) We move next to the conceptualization forwarded by Light (1989), which became a seminal paper in the AAC literature. This paper appeared in the same year in which Sutton (1989) published her study and called for a move away from using normative models to underpin understandings of CC in AAC. Light (1988) had in the previous year published a comprehensive review of the AAC literature focused on communication interaction. In concluding the review, Light framed her agenda by calling for future research directed toward establishing a clear definition of CC in relation to AAC. The definition of CC forwarded by Light (1989) is the one most frequently cited in the AAC literature and is arguably the dominant model of CC influencing AAC research and practice to this day. Light challenged assumptions that were taken for granted in rehabilitation generally and in AAC practice specifically. Like Sutton (1989), Light called for a move beyond automatically evaluating the CC of individuals who use AAC against benchmarks and standards of normal spoken communication. She questioned whether clinic-based rehabilitation interventions would necessarily improve clients’ communication interactions in everyday life situations. She foregrounded the scarcity of socio-relational interventions in AAC. Her model of CC in AAC identified the need for intervention to occur within natural communication contexts, i.e. settings where people live, work and play. CC was positioned as an interpersonal, relative and dynamic construct. Light’s conceptualization of CC was organized by three central constructs: (1) functionality of communication, (2) adequacy of communication and (3) sufficiency of knowledge, judgment and skill to communicate. It built on the work of other key researchers in the developing field of AAC as well as the fields of sociolinguistics and rehabilitation more generally. In particular, the four sub-competencies of CC developed by linguists Canale and Swain (Canale 1983, Canale and Swain 1980) were reflected and adapted in Light’s model where they are termed: linguistic competency, operational competency, social competency and strategic competency. We briefly outline these four sub-competencies as they were defined by Light in order to ground our critique. Linguistic competence involved adequate mastery of linguistic codes, not only in relation to an individual’s native language (the language of their family or home), but also in relation to the linguistic codes used in their AAC system. This might include, for example, symbols, picture symbols or combinations of symbols that communicate meaning. To convey the communication difficulties encountered by a person with limited linguistic competence, Light used the analogy of visiting a for-

7 eign country with no knowledge of the language. Operational competence referred to the technical skills required for communication using an AAC system, e.g. operating device features and controlling the device; retrieving stored symbols or messages. Social competence included the sociolinguistic (pragmatic) and socio-relational aspects of the knowledge, i.e. judgement and skills related to social rules of communication. Strategic competence allowed an individual to communicate effectively, skilfully adapting their own communication to suit best the demands imposed by variable communication partners and contexts. Light noted research would be needed to operationalize variables related to her modeling of CC and to develop valid and psychometrically sound outcome measures to assess the CC of individuals using AAC. These issues have been one focus of Light’s subsequent research agenda, evidenced by her considerable contributions to literature on the subject (e.g. Light et al. 1999, Light 1997, 1999, 2003). More than a decade after Light’s seminal work, she co-edited with Beukelman and Reichle, a textbook entitled Communicative Competence for Individuals Who Use AAC (Light 2003) where she elaborated on her conceptualization of CC in AAC. In a dedicated chapter, she extended her model by describing CC ‘mitigating’ psychosocial factors intrinsic to the AAC user such as motivation, attitude, confidence and resilience. She also further described the contribution of external barriers and supports in the attainment of CC. This later elaboration on conceptualizing CC suggested a tightening of the focus on the individual using AAC as central to the model. For example, no mention was made of additional mitigating factors that might be intrinsic to communication partners. Communication partners were positioned as external supports and barriers. The added elements in Light’s elaboration on her modeling of CC in AAC are reflective of influential changes in rehabilitation models more generally during that time, catalysed by the introduction in 2001 of the newly conceptualized International Classification of Functioning, Disability and Health (ICF) (World Health Organization (WHO) 2001). The ICF conceptualized relationships among function, disability and health using a ‘biopsychosocial’ approach in order to frame classification of disabilities. The ICF placed a central focus on the individual (Baylies 2002). It was innovative in its integration of intrinsic factors (personal factors), and external barriers and supports (environmental factors). Light’s (2003) elaborated model of CC similarly focuses on the individual AAC user and incorporates terminology that parallels terms in the ICF. However, the ICF has its own limitations and, we suggest, may not offer the best fit with Light’s earlier theorizing of CC as a dynamic, relational, interpersonal

8

Gail Teachman and Barbara E. Gibson

construct. The ICF has been critiqued for its emphasis on ‘classificatory practices’ in relation to disabled people (Hammell 2004). As well, it has been suggested that the ICF is weak in its conceptualizing of participation. While acknowledging the importance of context, the ICF only partially addresses measurement of contextual variables such as governments, systems and social situations (Baylies 2002) that may support or obstruct participation. For these reasons, the ICF may not adequately guide the way forward in evolving conceptualizations of CC in AAC. Light’s model advanced the field in very significant ways; however, in foregrounding the CC of individuals who use AAC, it did not fully address the issue of how communication is created in partnership and in context. Just as Hymes (1972) conceptualized communication performance as an integral aspect of CC, expressed as ‘competence for use’, Light’s model integrated knowledge (of linguistics and of AAC tools) with more performance-related competencies expressed as demonstrated skills and social judgment in interaction. Although she clearly called attention to interpersonal aspects of CC, noting that AAC intervention should extend to communication partners, her model did not incorporate competencies at the level of dyads or groups. Instead, Light’s model was predicated on assumptions that the individual with communication impairments develops CC whilst others in their environment act as supportive facilitators. In the absence of more explicit consideration of the CC of communication partners, the door was left open for AAC practices that disproportionately focus on ‘intrapersonal’ aspects of CC. Given that dominant rehabilitation discourses place a high value on individual independence (Hammell 2006), it followed then that Light’s model was often taken up and integrated into practice with a predominant focus on improving the CC of individual AAC users. Granlund et al. (1995) Granlund et al. (1995) proposed a model of CC in AAC that explicitly incorporated communication partners and environments into their conceptualization. CC was proposed as a ‘three-place relation’ (p. 50) among agents (the persons), the goal of an action (the mission), and the circumstances surrounding this action (the environment). The authors suggested that a change in CC outcomes could occur through change in any one of the variables. Citing the work of Light (1989), Granlund et al. agreed on the importance of defining CC as an interpersonal, dynamic construct, but also drew on theories of health promotion and social competence in their conceptualization. They contended that models of CC found in the literature were either ‘trait oriented’ (lo-

cating CC within the person, as assessed by normreferenced and criterion-referenced measures) or ‘outcome oriented’ (where CC is judged in relation to the extent that an individual succeeds in important roles, within specific contexts). Just as Sutton (1989) had expressed the need to move away from tools and goal-setting based on normal developmental achievement, Granlund et al. asserted that both trait- and outcome-oriented approaches were inadequate. Instead, they recommended that researchers and clinicians explore individualized tools such as goalattainment scaling to guide interventions. Furthermore, in line with their conceptualization of CC, they recommended that AAC intervention strategies be refocused to consider the CC of communication partners as well as the CC of the AAC user. Hetzroni and Harris (1996) Hetzroni and Harris (1996) outlined a ‘cultural perspective’ on CC in relation to AAC. These authors aligned their work closely to Light’s (1989) model, but included socio-cultural considerations that were previously missing or underdeveloped. Culture, in their work, was defined as ‘ways of thinking, perceiving, believing and evaluating within a particular group of people’ (p. 53). An ‘Inventory of Guidelines for Cultural Assessment Intervention’ (table 1, p. 57) was included that mapped specific questions about cultural contexts to behaviours identified in Light’s (1989) model of CC. Hetzroni and Harris stressed the importance of considering professional cultural influences on CC. For example, rehabilitation professionals working in the field of AAC may judge ‘adequate’ communication differently than might lay individuals who are not part of the culture of rehabilitation. They suggested that in the absence of explicit attention to a client’s own cultural perspectives, professionals’ cultural views would dominate AAC practices from assessment through to the design and implementation of communication systems. Kagan (1998) The final conceptualization of CC found in the reviewed literature was termed ‘supported conversation for adults with aphasia’ (SCA) and was described by Kagan (1998). This conceptualization explicitly shifted focus from the CC of the individual toward the CC of communication dyads. The paper has been highly cited in literature concerning aphasia, which is a specialized area within the broader field of AAC. Kagan drew on Parr’s (1996) work that applied the social model of disability to aphasia. Consistent with the primary tenets of the social model (Oliver 1996), Parr positioned ‘communication disability’, not as an

‘Communicative competence’ in AAC: a review individual attribute, but as a socially constructed and imposed category. Kagan concurred with this view of disability and called for a shift away from intervention practices that aimed to reduce, repair and normalize personal communication impairments towards addressing environmental communication access. The right to communicate was a key assumption underpinning her work. In the same way that a wheelchair ramp can provide a more inclusive physical environment, Kagan conceptualized a model of CC where communication partners create ‘communication ramps’ as necessary elements of an inclusive communication environment. Kagan proposed three factors related to successful communication interactions: the CC of the aphasic partner, the CC of the non-aphasic partners and the availability of appropriate AAC resources. She argued that all three factors warranted equal attention. As a result, she suggested, interventions would have relatively less focus on the CC of the individual and relatively more focus on CC at the level of the communication dyad. This was a significant departure from Light’s (1989) work, in which she had acknowledged that communication occurred in dyads or groups but did not put them on equal footing. Kagan acknowledged the important role of intervention directed at improving the CC of the person with aphasia but noted that having the skills to communicate did not necessarily result in actually having fulfilling communication experiences. Because of this discrepancy between skills and performance, the SCA model aimed to create more opportunities for fulfilling communication. Another key innovation in Kagan’s model was the value placed on generic communication skills training for persons without communication impairments. Following this model, non-disabled people develop their own CC so that they might be more skilled and competent in ‘shared communication partnerships’. Discussion Critiquing ‘communicative competence’ in AAC This review has considered the development of conceptualizations of CC in AAC, beginning with two models predicated on normative communication development (Dunst and Wortman Lowe 1986, Wilbert and Albritton 1986). The underpinnings of those conceptualizations were contested by Sutton (1989), who queried the appropriateness of aiming toward ‘normal’ communication, and instead built the case for development of models of CC unique to AAC. Light’s (1989) work addressed this call with a clearly articulated model of CC focused on the individual AAC user. Built on scholarly AAC research and using familiar AAC terminology, her model was quickly taken up and applied widely in

9 AAC research and practice. It was further elaborated by Hetzroni and Harris (1996) who forwarded previously missing socio-cultural perspectives; and by Light (2003) herself who expanded the model to account for intrinsic psychosocial factors and extrinsic supports and barriers. The final two models reviewed, by Granlund et al. (1995) and by Kagan (1998), proposed an equal weighting among relational factors comprising CC, expanding the boundaries of CC to include communication partners and environmental resources. There is much to commend in the work of these scholars, each of whom has pushed boundaries and challenged assumptions in order to build theory and knowledge to inform AAC practice. By tracing the development of these models, it is possible to see the evolution of an emphasis on the interpersonal, dynamic and relational aspects of CC, along with a move away from setting goals and gauging success against the measurement stick of ‘normal’ communication patterns. In Light’s (1989) work there is unresolved tension between theorizing CC as a relational, interpersonal construct and the stated goal of defining CC for individual AAC users. After all, Light did not set out to model CC for each of the communicators in an AAC dyad. Perhaps it was this tension that Light alluded to when she characterized the ‘hazy delineation’ and ‘difficult to locate’ boundaries of CC in AAC (p. 142). In conceptualizing the equal importance of both conversation partners’ CC, Kagan’s (1998) model expanded the boundaries of CC. Likewise, Granlund et al.’s (1995) work departed from Light’s model by weighting communication partners and environmental circumstances equally with the AAC user’s CC. Thus, both these later models explicitly emphasize the shared social production of communication. As noted above, Light’s (1989) model of CC was developed in the context of her in-depth review (Light 1988) of interpersonal communicative interaction in everyday life for AAC users. Why, then, did intrapersonal aspects of CC remain as the focus of so many intervention approaches moving forward? Political, economical or cultural influences might account for the ongoing focus on intrapersonal aspects of CC, or it might simply be because interventions directed at the interpersonal sphere were not a ‘fit’ with normative clinical practice (Skeat and Perry 2008). In the context of pressures to produce evidence of treatment efficacy, which rose during the 1990s, Light (1997) noted that a disproportionate percentage of interventions continued to focus on teaching individuals to express their needs and wants, as opposed to setting goals to achieve social closeness. High value was placed on interventions that demonstrated increased skills on the part of individuals who use AAC, and in particular, on their operational competencies related to using communication technologies.

10 Generally, in rehabilitation, discourses that privilege normalization and independence have predicated goal setting directed primarily toward ‘fixing’ impairment (Hammell 2006). The field of AAC has been informed by these same, often unexamined, assumptions where, for example, communication differences are constructed as ‘communication disorders’ (Kovarsky et al. 1999). There is a risk AAC practices may unwittingly reinforce these discourses and contribute towards AAC users identifying themselves as ‘incompetent communicators’. Deeply ingrained social assumptions about communicating normally could unintentionally be reproduced. We suggest that for many individuals who use AAC, ‘normal’ standards of communication are not attainable or feasible, whereas being listened to and acknowledged as a person who is communicating differently can and should be a goal. When CC is primarily considered at the level of the AAC user, then the responsibility for achieving ‘adequate’ CC rests with that individual, who is expected constantly and continually to ‘work’ on improving their CC. In relation to her own modeling of CC, Light conceded that learning to master CC sub-competencies and integrate them in performance might present very difficult challenges for AAC users, and acknowledged that some individuals might require ongoing support from a communication assistant. We query whether realization of this ideal of integrated CC is achievable for many individuals who use AAC, and whether it is necessary for participation in fulfilling communicative interactions. Instead of assuming that AAC users require continual intervention, we suggest that judgements about adequacy of CC might best be made by AAC users from their own perspectives. The implication that ultimate achievement of communication competency for an individual using AAC would parallel broader normative conceptions of CC is problematic in the sense that is does not take into account power inequalities (where people who use AAC often are in positions of relatively less power than those who use speech, or AAC professionals) and the marginalization of people who communicate differently. Light’s (1989) vision of integrated mastery was aligned with the notion of ‘competence for use’ conceptualized by Hymes (1972) as described above, but it failed to resolve the dilemma of idealized competency theorized by Chomsky (1965). The unattainability of idealized competence underpinned his dualistic conception of competenceperformance that has been shown to be deeply problematic in relation to AAC use. Kagan (1998) similarly differentiated between communicative ability and actual opportunities for fulfilling ‘performed’ communicative interactions. In locating CC more broadly, Granlund et al. (1995) along with Kagan (1998) suggested ways

Gail Teachman and Barbara E. Gibson to take into account all individuals in communication interactions. Looking forward: (re)locating communicative competency In what follows, we consider emerging perspectives that point to the need to (re)visit and (re)locate understandings of CC in AAC, shifting the inherent locus of power and responsibility. In AAC, a shift has emerged away from a predominant focus on (re)habilitating communication ‘deficiencies’ toward advocacy and interventions aimed to increase ‘communicative access’ in societies, creating opportunities for ‘communicative participation’ and increased life chances for individuals. Recent work has conceptualized ‘communicative participation’, defined as ‘taking part in everyday life situations where knowledge, ideas, information or feelings are exchanged’ (Eadie et al. 2006: 309; see also Baylor et al. 2010, Dalemans et al. 2010, Mackie et al. 2007, Yorkston et al. 2007). Conceptualizations of communicative access (Mirenda 1990, Parr et al. 2006) embrace the notion of provision of resources that support people who communicate differently to exchange information in ways that are accessible to them; and to receive necessary supports to ensure that their voice is included in civic institutions and deliberations in order to address power inequities and reduce marginalization. Links between these emerging constructs of communicative participation and communicative access with evolving conceptualizations of CC in AAC warrant further exploration. For example, in Kagan’s (1998) work, the boundaries of CC overlap with communicative access. Kagan clearly explicated links between reduced communicative access and negative impacts on psychosocial well-being and quality of life. Woll and Barnett (1998) published an invited paper in the journal Augmentative and Alternative Communication that applied a critical theoretical perspective to the issues. Based in the social model of disability and drawing from work within deaf culture, Woll and Barnett challenged prevailing AAC practices. They agreed that CC was a dynamic construct and asserted the need for more attention to the impact of frequent changes in communication systems and contexts experienced by AAC users. Indeed, the poor reliability and frequent turnover of speech-generating technologies continues to be a problem (Shepherd et al. 2009). Woll and Barnett critiqued the ongoing replacement of broken or defective communication technologies, which when combined with a continuous cycle of technology evolution and abandonment by industry, necessitated ongoing investments in learning new systems by AAC

‘Communicative competence’ in AAC: a review users. They poignantly highlighted the communication challenges implicit in life-long transitions between school, work and community contexts which combined to create a pattern of continual losses of familiar communication partners, and concluded with a call for (re)framing research questions and clinical interventions to address more socially situated interventions. Some AAC clinicians and researchers have taken up this challenge. For example, in Australia and Canada the innovative ‘Libraries for All’ project developed interventions aimed to provide AAC resources and train librarians across public library systems in order to increase communicative access in libraries for people who use AAC (Shepherd and McDougall 2008). Others have advocated for social acceptance of human communication assistants (similar to human assistants who guide people with visual impairments) to increase communicative access (Beukelman et al. 2008, Collier et al. 2010). The use of communication assistants had been viewed as interfering with the ‘true’ independent voice of AAC users; however, these authors argued AAC users’ preferences in relation to supported versus independent communication should be recognized and respected. In these innovative exemplars, CC is (re)located at the level of dyads, groups and systems. Coming full circle to our introductory discussion of linguistic theories, we return to the Chomskyan debate on CC and performance. The meaning of ‘competence’ as a term on its own remains controversial in the field of linguistics (Bagaric and Djigunovic 2007), in part because of its association with Chomsky’s provocative theorizing. These debates about how CC is conceptualized, incorporated and performed, which still resonate in the field of linguistics, are reflected in similar dilemmas that have been highlighted throughout this review and in other AAC literature. For example, it has been demonstrated that assessments of an individual AAC user’s CC within the context of clinical settings or familiar environments are unlikely to predict ‘performances’ of communicative interaction in day-to-day contexts (Cooley Hidecker 2010, Light 1989, Raghavendra et al. 2007). Future research exploring interventions that target communication partners, groups and communities is indicated in order to determine whether these sites might offer routes to CC that reduce the burden on individuals. Tools are needed to evaluate CC at the level not only of an individual using AAC, but also of specific dyads, groups, social settings or environments. Ongoing research focused on communication interaction points out potential approaches toward these ends (e.g. Clarke and Bloch 2013, Clarke and Wilkinson 2013). Most pressing, however, we suggest that conceptualizations of CC be revisited, drawing on the important contributions of AAC scholars highlighted above, as well as emerging critical perspectives.

11 Conclusion In this paper we used a critical social science approach to review and critique conceptualizations of CC in AAC by examining underlying assumptions and situating the works historically alongside the development of the field of AAC. We have not suggested that there is one ‘right’ way to conceptualize CC. Instead, we highlighted opportunities to continue to move away from conceptualizing communication deficiencies toward conceptualizing communication difference. We have queried assumptions that people who communicate differently should strive continuously toward ‘improved’ CC, pointing out ways that some of the original emphasis on the interdependence of CC has been obscured by practice models that impose pressures to demonstrate outcomes at the level of individual AAC users. We proposed revisiting the work of AAC scholars, alongside emerging perspectives, to (re)locate conceptualizations of CC from a tight focus on individuals to broader interpersonal contexts where connections are formed and performed. Examples from the emerging AAC and interdisciplinary literature were used to suggest ways to move forward, learning from past scholarly work while reimagining and reframing desirable outcomes in AAC research and practice. Further interdisciplinary critical scholarship has the potential to contribute to positive change in the lives of people with communication impairments by contributing to conceptualizations of CC in AAC that are focused at the level of dyads, families, communities and society at large. This paper has combined a structured critical conceptual review with a philosophical critique, and the intention has been to provide opportunities to build on the strengths of the existing literature and suggest possibilities for new or alternative approaches. Thus, a potential limitation of this work is that the analysis was limited to the few papers located where CC was specifically conceptualized, and we are not able to include commentary about the much broader body of literature that addresses CC in AAC without specifically conceptualizing the term. Because of the difficulties noted in searching for the AAC literature, it is possible that we failed to include all conceptualizations of CC in AAC. It is also possible that works in languages other than English might have contributed novel conceptualizations of CC in AAC which are not reviewed here. Finally, we have not provided an overview of the literature on communication interaction, or AAC more generally, on which conceptualizations of CC in AAC were founded. Light (1988: 71) likened knowledge creation in AAC to assembling a puzzle, where some of the puzzle pieces are lost or not visible:

12

Gail Teachman and Barbara E. Gibson Although our theories generally take into account the dynamics of the reciprocal behaviours of the dyad, our methodology has tended to center on individual behaviours. With only the pieces of the puzzle reported, valuable information is lost and the data are difficult to interpret meaningfully.

Certainly, more pieces of that puzzle have since been revealed and there has been no shortage of insightful, dedicated researchers and clinicians in the field. Yet, it is worth revisiting Light’s analogy in order to observe that the puzzle remains far from complete. We propose that emerging critical perspectives drawn from AAC and other interdisciplinary literatures offer innovative ways of theorizing communication difference, which might inform evolving conceptualizations of CC in AAC. Acknowledgements Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

References ALANT, E., BORNMAN, J. and LLOYD, L. L., 2006, Issues in AAC research: how much do we really understand? Disability and Rehabilitation, 28(3), 143–150. BAGARIC, V. and DJIGUNOVIC, J. M., 2007, Defining communicative competence. Metodika, 8(1), 94–103. BALANDIN, S. and DUCHAN, J., 2007, Communication: Access to inclusion. Journal of Intellectual and Developmental Disability, 32(4), 230–232. BALTES, P. B., REESE, H. W. and NESSELROADE, J. R., 1977, Lifespan developmental psychology: Introduction to research methods (Monterey, CA: Brooks/Cole). BAYLIES, C., 2002, Disability and the notion of human development: questions of rights and capabilities. Disability and Society, 17(7), 725–739. BAYLOR, C., YORKSTON, K., BAMER, A., BRITTON, D. and AMTMANN, D., 2010, Variables associated with communicative participation in people with multiple sclerosis: a regression analysis. American Journal of Speech–Language Pathology, 19(2), 143– 153. BEUKELMAN, D. R., BALL, L. J. and FAGER, S., 2008, An AAC personnel framework: adults with acquired complex communication needs. Augmentative and Alternative Communication, 24(3), 255–267. BIRKS, M., CHAPMAN, Y. and FRANCIS, K., 2008, Memoing in qualitative research: probing the data and processes. Journal of Research in Nursing, 13(1), 68–75. BLACKSTONE, S. W., WILLIAMS, M. B. and WILKINS, D. P., 2007, Key principles underlying research and practice in AAC. Augmentative and Alternative Communication, 23(3), 191–203. CANALE, M., 1983, From communicative competence to communicative language pedagogy. In J. Richards and R. Schmidt (eds), Language and Communication (New York, NY: Longman Press), pp. 2–27. CANALE, M. and SWAIN, M., 1980, Theoretical bases of communicative approaches to second language teaching and testing. Applied Linguistics, I(1), 1–47.

CHOMSKY, N., 1965, Aspects of the Theory of Syntax (Cambridge, MA: MIT Press). CLARKE, M. and BLOCH, S. (eds), 2013, AAC Practices in Everyday Interaction. Augmentative and Alternative Communication, 29(1) [Special Issue], 1–103. CLARKE, M. and WILKINSON, R., 2013, Realizations of communicative competence in children’s peer interaction. In N. Noren, C. Samuelsson and C. Plejert (eds), Aided Communication in Dialogical Perspectives: Augmentative and Alternative Communication as Action and Participation within Embodied Social Worlds (Guildford: J & R Press). pp. 23–57. COLLIER, B., MCGHIE-RICHMOND, D. and SELF, H., 2010, Exploring communication assistants as an option for increasing communication access to communities for people who use augmentative communication. Augmentative and Alternative Communication, 26(1), 48–59. COOLEY HIDECKER, M. J., 2010, Communication activity and participation research. Developmental Medicine and Child Neurology, 52(5), 408–409. DALEMANS, R. J. P., DE WITTE, L., WADE, D. and VAN DEN HEUVEL, W., 2010, Social participation through the eyes of people with aphasia. International Journal of Language and Communication Disorders, 45(5), 537–550. DIXON-WOODS, M., CAVERS, D., AGARWAL, S., ANNANDALE, E., ARTHUR, A., HARVEY, J., HSU, R., KATBAMNA, S., OLSEN, R., SMITH, L., RILEY, R. and SUTTON, A. J., 2006, Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 6(35), 27–44. DUCHAN, J. F. and LEAHY, M. M., 2008, Hearing the voices of people with communication disabilities. International Journal of Language and Communication Disorders, 43(S1), 1–4. DUNST, C. and WORTMAN LOWE, L., 1986, From reflex to symbol: describing, explaining, and fostering communicative competence. Augmentative and Alternative Communication, 2(1), 11–18. EADIE, T. L., YORKSTON, K. M., KLASNER, E. R., DUDGEON, B. J., DEITZ, J. C., BAYLOR, C. R., MILLER, R. M. and AMTMANN, D., 2006, Measuring communicative participation: a review of self-report instruments in speech–language pathology. American Journal of Speech–Language, 49(4), 307–320. EAKIN, J., ROBERTSON, A., POLAND, B., COBURN, D. and EDWARDS, R., 1996, Towards a critical social science perspective on health promotion research. Health Promotion International, 11(2), 157–165. GIBSON, B. E. and TEACHMAN, G., 2012, Critical approaches in physical therapy research: investigating the symbolic value of walking. Physiotherapy Theory and Practice, 28(6), 474–484. GOLDBERG, S., 1977, Social competence in infancy: A model of parent-infant interaction. Merrill-Palmer Quarterly of Behaviour and Development, 23(3), 163–177. ¨ -A˚ KESSON, E., BRODIN, J. and OLSSON, C., GRANLUND, M., BJORCK 1995, Communication intervention for persons with profound disabilities: a Swedish perspective. AAC: Augmentative and Alternative Communication, 11, 49–59. GRANT, M. J. and BOOTH, A., 2009, A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information and Libraries Journal, 26(2), 91–108. HAMMELL, K. W., 2004, Deviating from the norm: a sceptical interrogation of the classificatory practices of the ICF. British Journal of Occupational Therapy, 67(9), 408–411. HAMMELL, K. W., 2006, Perspectives on Disability and Rehabilitation (Edinburgh: Elsevier). HETZRONI, O. and HARRIS, O., 1996, Cultural aspects in the development of AAC users. Augmentative and Alternative Communication, 12(1), 52–58.

‘Communicative competence’ in AAC: a review HILL, K., 2004, Augmentative and alternative communication and language. Topics in Language Disorders, 24(1), 18–30. HODGE, S., 2007, Why is the potential of augmentative and alternative communication not being realized? Exploring the experiences of people who use communication aids. Disability and Society, 22(5), 457–471. HOLDGRAFER, G. and DUNST, C., 1986, Communicative competence: from research to practice. Topics in Early Childhood Special Education, 6(3), 1–22. HYMES, D., 1972, On communicative competence. In J. Pride and J. Holmes (eds), Sociolinguistics (Harmondsworth: Penguin), pp. 269–293. KAGAN, A., 1998, Supported conversation for adults with aphasia: methods and resources for training conversation partners. Aphasiology, 12(9), 816–830. KINCHELOE, J. L. and MCLAREN, P., 2005, Rethinking critical theory and qualitative research. In N. K. Denzin and Y. S. Lincoln (eds), Handbook of Qualitative Research, 3rd edn (Thousand Oaks, CA: Sage), pp. 303–342. KOVARSKY, D., CULATTA, B., FRANKLIN, A. and THEADORE, G., 2001, ‘Communicative participation’ as a way of facilitating and ascertaining communicative outcomes. Topics in Language Disorders, 22(1), 1–20. KOVARSKY, D., DUCHAN, J. F. and MAXWELL, M. (eds), 1999. Constructing (In)Competence: Disabling Evaluations in Clinical and Social Interaction (Mahwah, NJ: Lawrence Erlbaum Associates). KRAAT, A., 1985, Communication Interaction Between Aided and Natural Speakers: A State of the Art Report (Toronto, ON: Canadian Rehabilitation Council for the Disabled). LIGHT, J., 1988, Interaction involving individuals using augmentative and alternative communication systems: state of the art and future directions. Augmentative and Alternative Communication, 4(2), 66–82. LIGHT, J., 1989, Toward a definition of communicative competence for individuals using augmentative and alternative communication systems. Augmentative and Alternative Communication, 5(2), 137–144. LIGHT, J., 1997, ‘Communication is the essence of human life’: reflections on communicative competence. Augmentative and Alternative Communication, 13(2), 61–70. LIGHT, J., 1999, Do augmentative and alternative communication interventions really make a difference?: the challenges of efficacy research. Augmentative and Alternative Communication, 15(1), 13–24. LIGHT, J. C., 2003, Shattering the Silence: development of communicative competence by individuals who use AAC. In J. C. Light, D. R. Beukelman and J. Reichle (eds), Communicative Competence for Individuals Who Use AAC: From Research to Effective Practice (Baltimore, MD: Brookes), pp. 3–38. LIGHT, J. C., BINGER, C., AGATE, T. L. and RAMSAY, K. N., 1999, Teaching partner-focused questions to individuals who use augmentative and alternative communication to enhance their communicative competence. Journal of Speech, Language, and Hearing Research, 42(1), 241–255. LINDSAY, S., 2010, Perceptions of health care workers prescribing augmentative and alternative communication devices to children. Disability and Rehabilitation: Assistive Technology, 5(3), 209–222. LUND, S. K. and LIGHT, J., 2006, Long-term outcomes for individuals who use augmentative and alternative communication: Part I—what is a ‘good’ outcome? Augmentative and Alternative Communication, 22(4), 284–299. LYON, J. G., 1992, Communication use and participation in life for adults with aphasia in natural settings: the scope of the

13 problem. American Journal of Speech Language Pathology, 1(3), 7–14. MACKIE, N. N., O’NEILL CHRISTIE, C., HUIJBREGTS, M., MCEWEN, S. and WILLEMS, J., 2007, Communicative access and decision making for people with aphasia: implementing sustainable healthcare systems change. Aphasiology, 21(1), 39–66. MIRENDA, P., 1990, Communication options for persons with severe and profound disabilities: state of the art and future directions. Journal of the Association for Persons with Severe Handicaps, 15(1), 3–21. NORDENFELT, L., 1991, Towards a theory of health promotion—a logical analysis. Health Service Studies, 5, 1–50. NORDENFELT, L., 1993, On the notions of disability and handicap. Scandinavian Journal of Social Welfare, 2(1), 17–24. OLIVER, M., 1996, Understanding Disability: From Theory to Practice (New York, NY: St. Martin’s). PARR, S., 1996, Everyday literacy in aphasia: radical approaches to functional assessment and therapy. Aphasiology, 10(5), 469– 479. PARR, S., POUND, C. and HEWITT, A., 2006, Communication access to health and social services. Topics in Language Disorders, 26(3), 189–198. ¨ RAGHAVENDRA, P., BORNMAN, J., GRANLUND, M. and BJORCK A˚ KESSON, E., 2007, The World Health Organization’s international classification of functioning, disability and health: implications for clinical and research practice in the field of augmentative and alternative communication. Augmentative and Alternative Communication, 23(4), 349–361. SCHLOSSER, R. W., WENDT, O., ANGERMEIER, K. L. and SHETTY, M., 2005, Searching for evidence in augmentative and alternative communication: navigating a scattered literature. Augmentative and Alternative Communication, 21(4), 233–255. SCHLUNDT, D. G. and MCFALL, R. M., 1985, New directions in the assessment of social competence and social skills. In M. A. Millan, L. L. L’Abate (eds), Handbook of social skills training and research (New York: Pergamon Press), pp. 22–49. SHEPHERD, T. A., CAMPBELL, K. A., RENZONI, A. M. and SLOAN, N., 2009, Reliability of speech generating devices: a 5-year review. Augmentative and Alternative Communication, 25(3), 145–153. SHEPHERD, T. A. and MCDOUGALL, S., 2008, Communication access in the library for individuals who use augmentative and alternative communication. Augmentative and Alternative Communication, 24(4), 313–322. SIMMONS-MACKIE, N. and DAMICO, J. S., 2008, Exposed and embedded corrections in aphasia therapy: issues of voice and identity. International Journal of Language and Communication Disorders, 43(S1), 5–17. SKEAT, J. and PERRY, A., 2008, Exploring the implementation and use of outcome measurement in practice: a qualitative study. International Journal of Language and Communication Disorders, 43(2), 110–125. SUTTON, A. C., 1989, The social–verbal competence of AAC users. Augmentative and Alternative Communication, 5(3), 150–164. VANDERHEIDEN, G. C., 2002, A journey through early augmentative communication and computer access. Journal of Rehabilitation Research and Development, 39(suppl. 6), 39–54. WILBERT, K. M. and ALBRITTON, E. G., 1986, Communication Interaction and implications for handicapped individuals. Paper presented at the Biennial International Conference on Augmentative and Alternative Communication, Cardiff, UK, September 1986. WIIG, E., 1982, Let’s talk inventory for adolescents (Columbus, OH: Charles E. Merrill). WILLIS, J. W., 2007, Foundations of Qualitative Research: Interpretive and Critical Approaches (Thousand Oaks, CA: Sage).

14 WOLL, B. and BARNETT, S., 1998, Toward a sociolinguistic perspective on augmentative and alternative communication. Augmentative and Alternative Communication, 14(4), 200–211. WORLD HEALTH ORGANIZATION (WHO), 2001, International Classification of Functioning, Disability and Health (ICF) (Geneva: WHO). YORKSTON, K. M., BAYLOR, C. R., KLASNER, E. R., DEITZ, J., DUDGEON, B. J., EADIE, T., MILLER, R. M. and AMT-

Gail Teachman and Barbara E. Gibson MANN,

D., 2007, Satisfaction with communicative participation as defined by adults with multiple sclerosis: a qualitative study. Journal of Communication Disorders, 40(6), 433–451. ZANGARI, C., LLOYD, L. and VICKER, B., 1994, Augmentative and alternative communication: an historic perspective. Augmentative and Alternative Communication, 10(1), 27– 59.