We open this issue of Topics in Language Disorders (TLD) by quoting the editor/author of a newly published text, R.W. Schlosser (2003), The Efficacy of Augmentative and Alternative Communication Toward Evidence-Based Practice. Although there is some risk in abstracting quotes of an author without the full context surrounding the quote, we believe that Schlosser's comments are relevant to the central direction of this issue of TLD. Schlosser states that "just because something is written or printed does not mean that it is accurate or to be taken at face value" (p. 1). He goes on to state that in the course of his professional career, he was "drawn to exploring whether AAC interventions really work (i.e., efficacy) and to methodological questions and issues related to such efficacy studies" (p. 2). The co-editors of this issue of TLD found Schlosser's text to be an excellent high-quality resource.
The idea of the articles in this issue of TLD has been developed around the concept of evidence-based practice (EBP) in augmentative and alternative communication (AAC) as well as the idea of best practices in AAC. The questions that continue to be asked by young new practitioners in the field of AAC, by users of AAC, and by many of our experts in the field of AAC are:
* What works?
* How do you know it works?
* What do we do in the field of AAC that really makes a difference?
* How do we help users of AAC learn to communicate, develop language, and develop literacy skills?
* Will we get the same results when we do the same thing the second time?
The co-editors for this issue of TLD offer a challenge to the readers to look for the missing link(s) in their article. The needs of the research community should provide the clinical community with strong models that allow the AAC user to have functional communication and opportunities for literacy. Higdon and Higdon believe that the picture of the AAC user too often does not support EBP. The disconnection between research and clinical practice, as well as the meaning of treatment efficacy and clinical practice guidelines is presented. The article concludes with 10 suggested steps that are necessary, in the eyes of the authors, to blend research and practice in an EBP model.
The authors believe that EBP practitioners, as stakeholders, must become better consumers of research and must take more active roles in the research process. To do so, practitioners must understand how AAC users communicate, the role of listening and listening environments for individuals with communication disorders, the perspective of parents (and other caregivers) in the AAC process, considerations of differences among AAC users of culturally and linguistically diverse populations, and the role of language and literacy in the classroom. These are some of the "missing links" the contributing authors address in their articles is this issue of TLD.
The goal of AAC is to develop the most effective communication possible. Speech-language pathologists should be collecting data, measuring communication, and applying the principles of EBP. The author of the second article in this issue, Hill, presents a model for EBP that represents how collecting and evaluating performance data support clinical decisions. Language activity monitoring or data logging is offered as one approach of collecting performance data. Software tools (e.g., AAC Performance Report Tool) and clinical examples are included in this article.
A slightly different perspective in discussing EBP is taken in the next article by Marttila, an audiologist who is the coordinator of Assistive Technology, Audiology, and Vision Services for the Mississippi Bend Area Educational Agency in Iowa. She discusses the importance of assistive technology as a component of individual educational plans, focusing on classroom acoustics and classroom amplification systems. EBP is important and relevant to many parties of the AAC enterprise. Too often, in the quest for the "better" or "best" AAC, we forget the necessity for a strong commitment on the part of audiologists and educators to improve the acoustic environment of AAC users. Readers should find the Quality Indicators in Assistive Technology Matrices (QIAT Consortium, 2002) very useful.
As Cress notes in her article, research and clinical experience both indicate that parents are excellent observers of communication in their children who rely on AAC. Parents and professionals, however, may find themselves in conflict about how to interpret and support children's communication. Cress outlines strategies for family-centered AAC services that support parents in implementing their communication goals with their children.
Bridges confirms in her article the importance of understanding the quality and type of AAC services that are needed for consumers and families who are culturally and linguistically diverse. Bridges presents the historical perspective of multicultural research in AAC, concluding with guidelines for engaging in culturally relevant and valid investigation critical to the identification of best practices.
Sturm and Clendon discuss language and communication relationship and needs essential to active literacy learning. The authors describe language literacy development of children who use AAC, highlighting intrinsic and extrinsic learning challenges, the communication-based literacy learning experiences of these children, and the important role of language and communication in the literacy curricula of classroom settings. Readers will find the authors' ideas for fostering AAC, language, and literacy connections useful in their day-to-day clinical and educational settings.
Readers of this issue, as noted previously, are challenged to accept the responsibility for developing EBP as best (clinical) practice. Readers must question, consider, listen, and continually evaluate while looking for the "missing link." Once found, missing links must be connected to reduce precarious research and to produce stronger research designs and reliable clinical programs.
The issue editors thank each author for their professional and insightful contribution to furthering best practices in AAC. The issue editors would be remiss if they did not thank journal editor, Dr. Katharine Butler, for advice, support, and help in developing this issue of TLD. Having the opportunity to work with her is, without question, an opportunity to work with one of the great leaders and writers in communication disorders!
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