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Communication Partners' Perceptions of Their Roles and Responsibilities in the Design, Planning and Use of Augmentative and Alternative Communication with Individuals with Severe or Profound Intellectual Disability: A Qualitative Descriptive Study

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Title: Communication Partners' Perceptions of Their Roles and Responsibilities in the Design, Planning and Use of Augmentative and Alternative Communication with Individuals with Severe or Profound Intellectual Disability: A Qualitative Descriptive Study
Language: English
Authors: Edina Hanley (ORCID 0000-0001-7453-3668), Caroline Dalton (ORCID 0000-0003-4396-2800), Elaine Lehane, Anne-Marie Martin (ORCID 0000-0001-6446-7791)
Source: British Journal of Learning Disabilities. 2025 53(1):74-86.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 13
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Interpersonal Communication, Augmentative and Alternative Communication, Severe Intellectual Disability, Role, Attitudes, Parents, Professional Personnel
DOI: 10.1111/bld.12620
ISSN: 1354-4187
1468-3156
Abstract: Background: This study explores communication partners' perceptions of their roles and responsibilities in the design, planning and use of augmentative and alternative communication (AAC) with individuals with severe/profound intellectual disability. Methods: A qualitative descriptive approach was used. Purposive sampling, data collection and qualitative content analysis were undertaken simultaneously. Data were collected from nine participants, four parents and five professionals over 4 months through audio or video-recorded, semi-structured, open-ended interviews. Findings: An overarching theme 'Maximising Communication through AAC' emerged, capturing participants' unanimous agreement that their shared goal was to optimise individuals' communication through AAC. This was influenced by three themes: 'Developing a Communicative Environment', 'The Act of Communicating; Attempting to Realise the Individuals' Ability' and 'Living with Uncertainty'. Conclusions: These findings contribute to enhancing understanding of AAC use with individuals with severe/profound intellectual disability and their communication partners.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1460599
Database: ERIC
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  Value: <anid>AN0183915469;f0401mar.25;2025Mar24.06:32;v2.2.500</anid> <title id="AN0183915469-1">Communication Partners' Perceptions of Their Roles and Responsibilities in the Design, Planning and Use of Augmentative and Alternative Communication With Individuals With Severe or Profound Intellectual Disability: A Qualitative Descriptive Study </title> <p>Background: This study explores communication partners' perceptions of their roles and responsibilities in the design, planning and use of augmentative and alternative communication (AAC) with individuals with severe/profound intellectual disability. Methods: A qualitative descriptive approach was used. Purposive sampling, data collection and qualitative content analysis were undertaken simultaneously. Data were collected from nine participants, four parents and five professionals over 4 months through audio or video‐recorded, semi‐structured, open‐ended interviews. Findings: An overarching theme 'Maximising Communication through AAC' emerged, capturing participants' unanimous agreement that their shared goal was to optimise individuals' communication through AAC. This was influenced by three themes: 'Developing a Communicative Environment', 'The Act of Communicating; Attempting to Realise the Individuals' Ability' and 'Living with Uncertainty'. Conclusions: These findings contribute to enhancing understanding of AAC use with individuals with severe/profound intellectual disability and their communication partners.</p> <p>Summary: Augmentative and alternative communication includes peoples' gestures, facial expressions, body movements and supports such as pictures, objects, signing systems and eye‐gaze devices. Augmentative and alternative communication can help people to communicate.People in the everyday life of a person with intellectual disability have an important role in helping them to use augmentative and alternative communication. This can be hard for many reasons including time and workloads.We asked people who communicate with individuals with severe/profound intellectual disability about their experiences of using augmentative and alternative communication.This is important because we can understand why they use it and try to help them to use it more.</p> <p>Keywords: augmentative and alternative communication; communication; communication partners; severe or profound intellectual disability</p> <hd id="AN0183915469-2">Introduction</hd> <p>Communication is a fundamental human right (Brady et al. [<reflink idref="bib4" id="ref1">4</reflink>]). Individuals with severe/profound intellectual disability experience communication difficulties (van der Gaag [<reflink idref="bib42" id="ref2">42</reflink>]). They tend to function at the earlier stages of communication development (Coupe O'Kane and Goldbart [<reflink idref="bib8" id="ref3">8</reflink>]). Individuals with severe intellectual disability have limited language abilities (11th revision of the International Classification of Diseases [ICD‐11]). Individuals with profound intellectual disability have limited communication abilities (ICD‐11). They demonstrate subtle communication behaviours such as eye gaze, body language and facial expressions (Grove et al. [<reflink idref="bib14" id="ref4">14</reflink>]), which can be unique to the individual and the context (Brady et al. [<reflink idref="bib4" id="ref5">4</reflink>]; Stillman and Siegel‐Causey [<reflink idref="bib38" id="ref6">38</reflink>]). They require additional support to secure their right to communication.</p> <p>This study focuses on communication partners of individuals who communicate at the earlier stages of communication development as per the ICD (World Health Organization [<reflink idref="bib46" id="ref7">46</reflink>]) definitions of severe/profound intellectual and/or multiple disabilities.</p> <p>Individuals with severe/profound intellectual and/or multiple disabilities quality of life (QoL) may differ from others (Petry, Maes, and Vlaskamp [<reflink idref="bib31" id="ref8">31</reflink>]). Communication is deemed a fundamental subdomain of QoL for individuals with profound multiple disabilities (Petry, Maes, and Vlaskamp [<reflink idref="bib31" id="ref9">31</reflink>]). They may experience motor and/or sensory impairments (ICD‐11). They typically require daily support in a supervised environment (ICD‐11). Supporting communication to promote both the development and maintenance of social relationships may help individuals meet their needs and attain their rights (Brady et al. [<reflink idref="bib4" id="ref10">4</reflink>]). Lundy ([<reflink idref="bib25" id="ref11">25</reflink>]) outlined the importance of realising the right to communicate '... since, when it is implemented effectively, other rights fall into place naturally' (p. 940). Strategies must be provided to support individuals with severe/profound intellectual disability to communicate.</p> <p>Augmentative and alternative communication (AAC) has the potential to support communication for individuals with severe/profound intellectual and multiple disabilities (Roche et al. [<reflink idref="bib33" id="ref12">33</reflink>]). AAC requires a collaborative approach including multiple stakeholders (Binger et al. [<reflink idref="bib3" id="ref13">3</reflink>]; Uthoff et al. [<reflink idref="bib41" id="ref14">41</reflink>]) who have different roles and responsibilities. Adopting an individually tailored approach to designing AAC is required to ensure it is responsive to individuals' strengths and needs (Wilkinson et al. [<reflink idref="bib44" id="ref15">44</reflink>]). Speech and language therapists (SLTs) recognise the importance of considering individuals' needs and capabilities when designing an AAC system (Thistle and Wilkinson [<reflink idref="bib39" id="ref16">39</reflink>]). Moreover, the importance of having family members' input when choosing concepts or vocabulary to include in an AAC system has been outlined by SLTs (Thistle and Wilkinson [<reflink idref="bib39" id="ref17">39</reflink>]; Thistle and Wilkinson [<reflink idref="bib40" id="ref18">40</reflink>]).</p> <p>Communication partners are the people who engage with the individual in an interaction. They may be family, friends and support workers (Johnson et al. [<reflink idref="bib20" id="ref19">20</reflink>]). Both the individual and their communication partners are fundamental to the success of AAC (Kent‐Walsh et al. [<reflink idref="bib22" id="ref20">22</reflink>]). Communication partners must become familiar with the AAC system (McNaughton et al. [<reflink idref="bib28" id="ref21">28</reflink>]), model AAC and respond to the individual using AAC (Shire & Jones [<reflink idref="bib37" id="ref22">37</reflink>]). Moreover, they must listen to the individual (McCormack, Baker, and Crowe [<reflink idref="bib27" id="ref23">27</reflink>]). Skilled communication partners are deemed important within the individual's communicative environment (Wilder, Magnusson, and Hanson [<reflink idref="bib43" id="ref24">43</reflink>]).</p> <p>Despite their fundamental roles and responsibilities in supporting the success of AAC, the literature suggests that there is a disconnect between communication partners' perceptions of their roles and responsibilities in supporting AAC implementation with individuals with severe/profound intellectual disability (Hanley et al. [<reflink idref="bib16" id="ref25">16</reflink>]; Wormnæs and Abdel Malek [<reflink idref="bib47" id="ref26">47</reflink>]). SLTs' uncertainty about providing support to individuals with complex communication needs (Wormnæs and Abdel Malek [<reflink idref="bib47" id="ref27">47</reflink>]) may result in restricted provision and use of AAC with individuals with severe/profound intellectual disability (Hanley et al. [<reflink idref="bib16" id="ref28">16</reflink>]). Therefore, it is important for all AAC team members to be aware of their own and others' roles and responsibilities when supporting individuals who communicate using AAC (Hanley et al. [<reflink idref="bib16" id="ref29">16</reflink>]). Thus, this study explored communication partners' perceptions of their roles and responsibilities when implementing AAC with individuals with severe/profound intellectual disability. The following questions were posed:</p> <p></p> <ulist> <item> 1. What are communication partners' perceptions of their roles and responsibilities in the use of AAC when communicating with individuals with severe/profound intellectual disability?</item> <p></p> <item> 2. Who do they believe should be involved in the design, planning and coordination of AAC with individuals with severe/profound intellectual disability?</item> </ulist> <hd id="AN0183915469-3">Methods</hd> <p></p> <hd id="AN0183915469-4">Study Design</hd> <p>An interpretivist paradigm following a naturalistic methodology underpinned the study. Therefore, a qualitative descriptive approach was followed (Sandelowski [<reflink idref="bib35" id="ref30">35</reflink>], [<reflink idref="bib36" id="ref31">36</reflink>]). The Standards for Reporting Qualitative Research (Supporting Information) were used to report the study (O'Brien et al. [<reflink idref="bib29" id="ref32">29</reflink>]).</p> <hd id="AN0183915469-5">Participant Recruitment</hd> <p>Purposive sampling, specifically typical case sampling, was adopted to ensure that communication partners of individuals with severe/profound intellectual disability communicating with AAC were represented in the final sample (Robinson [<reflink idref="bib32" id="ref33">32</reflink>]). To be eligible, communication partners were required to be either paid or familial partners, communicate with a individual with severe/profound intellectual disability using AAC and have known the individual for at least 6 months.</p> <p>The first author liaised with the service provider's gatekeeper to identify eligible participants. The service provides support to individuals with intellectual disability and autism and their family members. Potential participants were sent an information sheet and consent form. Ten potential participants were approached and nine participated. Once the signed consent forms were received, interviews were scheduled.</p> <p>Participants included four familial partners whose children attended the service and five professional partners working in the service. Of the familial partners, three mothers and one father participated. Their children ranged between 8 and 20 years of age, including two males and one female. Two children attended school and a young adult attended a training centre for individuals who have left school. The familial partners discussed multiple types of AAC that they used, which differed at times. Examples include Lámh (a key word signing system in Ireland), Picture Exchange Communication Systems (PECS), eye‐gaze devices and iPads with AAC apps and pictures.</p> <p>The professional partners included a teacher working in an educational day service, a healthcare assistant (HCA) who was an activity co‐ordinator and a clinical nurse specialist (CNS) who was working in the service with adults. Two SLTs were included as they have a fundamental role in implementing AAC. SLTs are a support to communication partners and people who use AAC. It is in this context that they were included in this article as they were identified as a facilitator in the literature (Hanley et al. [<reflink idref="bib16" id="ref34">16</reflink>]). The SLTs had experience in both early intervention and adult services. The teacher discussed his use of an eye‐gaze device with a young adult with severe intellectual disability. The remainder of the professional partners discussed their use of AAC with multiple individuals with severe/profound intellectual disabilities that they supported. Examples of AAC used include Lámh, PECS, pictures of reference, board maker pictures and eye‐gaze devices.</p> <hd id="AN0183915469-6">Data Collection</hd> <p>Data were collected using semi‐structured interviews with open‐ended questions between November 2020 and March 2021. The findings from a systematic review (Hanley et al. [<reflink idref="bib16" id="ref35">16</reflink>]) informed the topic guide (Appendix 1). Two pilot interviews were conducted, and one question was rephrased. Interviews were conducted online via Microsoft Teams due to public health guidelines about COVID‐19. The interviews were recorded with the participants' consent to allow the interviewer to build rapport rather than being distracted with note‐taking (Edwards and Holland [<reflink idref="bib10" id="ref36">10</reflink>]). Interviews lasted between 27 and 45 min. The sample included nine participants. Two participants were interviewed together as they were more comfortable with this. Both participants were asked about their individual perspectives. Supports were in place throughout the process, and participants were debriefed.</p> <hd id="AN0183915469-7">Data Analysis</hd> <p>The interviews were transcribed verbatim and anonymised by the first author. Transcripts were checked by a second author. Data were analysed using inductive content analysis, including three phases: preparing, organising and reporting (Elo and Kyngäs [<reflink idref="bib12" id="ref37">12</reflink>]). Both manifest and latent data were analysed to take note of silences, sighs and so on (Burns and Grove [<reflink idref="bib5" id="ref38">5</reflink>]). The written material was read and re‐read, and the recordings were listened to and watched multiple times (Grove, Burns, and Gray [<reflink idref="bib15" id="ref39">15</reflink>]). Notes and headings were written down to describe the content (Hsieh and Shannon [<reflink idref="bib17" id="ref40">17</reflink>]). Meaning units were generated and condensed further. Both the meaning units and their condensed versions were transferred to open coding sheets.</p> <p>Subcategories and categories were generated. Categories were grouped under headings (McCain [<reflink idref="bib26" id="ref41">26</reflink>]). Results were described by the content of the categories describing the phenomenon (Elo et al. [<reflink idref="bib11" id="ref42">11</reflink>]). The analysis was undertaken by the first author. All authors reviewed the codes and analysis (Elo et al. [<reflink idref="bib11" id="ref43">11</reflink>]) and engaged in continuous dialogue to reach an agreement on the labelling of the data (Graneheim and Lundman [<reflink idref="bib13" id="ref44">13</reflink>]). An example of this process is represented in Table 1.</p> <p>1 Table Example of analysis.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th>Meaning unit</th><th>Condensed meaning unit</th><th>Code</th><th>Subcategory</th><th>Category</th><th>Subtheme</th><th>Theme</th><th>Overarching theme</th></tr></thead><tbody valign="top"><tr><td>'So, I always try to look at what they have and then build on that' (Interview 3)</td><td>Look at what they have and build on that</td><td>Build on the individuals' communication</td><td>Building on the individuals' existing ability</td><td>Recognising Individuality</td><td>Enhancing the Individuals' Potential for Success</td><td>Developing a Communicative Environment</td><td>Maximising Communication through AAC</td></tr></tbody></table> </ephtml> </p> <p>1 Abbreviation: AAC, augmentative and alternative communication.</p> <p>Member checking was not undertaken. The interviewer verified the participants' answers during the interviews through feedback.</p> <hd id="AN0183915469-8">Trustworthiness</hd> <p>The authors aimed to remain mindful of their influence (profession removed for anonymous draft). The authors were cognisant that their professional experience and knowledge may shape their perspective and influence the interpretation of data.</p> <p>Continuous self‐reflection and a reflexive approach helped to identify and articulate their positionality (Darwin Holmes, [<reflink idref="bib9" id="ref45">9</reflink>]). Critical reflection was undertaken to question their assumptions and how their experiences may impact interactions with participants. The interviewer wrote reflective entries (Connelly [<reflink idref="bib6" id="ref46">6</reflink>]) and memos. Credibility was enhanced by taking field notes after every interview (Elo et al. [<reflink idref="bib11" id="ref47">11</reflink>]). All authors reviewed the codes and analysis to enhance credibility and confirmability. Confirmability was enhanced further by including quotes (Cope [<reflink idref="bib7" id="ref48">7</reflink>]). Dependability was enhanced by using audit trails (Cope [<reflink idref="bib7" id="ref49">7</reflink>]) and debriefings with all authors (Connelly [<reflink idref="bib6" id="ref50">6</reflink>]). Data collection was described in detail to enhance transferability (Graneheim and Lundman [<reflink idref="bib13" id="ref51">13</reflink>]), and information was provided about the participants and research context (Connelly [<reflink idref="bib6" id="ref52">6</reflink>]; Cope [<reflink idref="bib7" id="ref53">7</reflink>]).</p> <hd id="AN0183915469-9">Findings</hd> <p>Following an in‐depth analysis, the overarching theme 'Maximising Communication through AAC' emerged, and it was influenced by (<reflink idref="bib1" id="ref54">1</reflink>) 'Developing a Communicative Environment', (<reflink idref="bib2" id="ref55">2</reflink>) 'The Act of Communicating: Attempting to Realise the Individuals' Ability' and (<reflink idref="bib3" id="ref56">3</reflink>) 'Living with Uncertainty'. The theme 'Developing a Communicative Environment' comprises two subthemes: (i) 'Creating the Context' and (ii) 'Enhancing the Individuals' Potential for Success' (Figure 1).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/F04/01mar25/bld12620-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="bld12620-fig-0001.jpg" title="1 Visual representation of the themes and subthemes. AAC, augmentative and alternative communication." /> </p> <p></p> <p>Each theme comprises categories and subcategories (Table 2).</p> <p>2 Table Summary of subcategories, categories and themes.</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th /><th>Response count</th><th /><th /><th /><th /></tr><tr valign="bottom"><th>Subcategory</th><th>Prof. partner</th><th>Fam. partner</th><th>Category</th><th>Subtheme</th><th>Theme</th><th>Overarching theme</th></tr></thead><tbody valign="top"><tr><td>Assessing the environment and the communication partners within it</td><td>n = 3</td><td>__</td><td>Creating opportunities for communication</td><td>Creating the Context</td><td>Developing a Communicative Environment</td><td>Maximising Communication through AAC</td></tr><tr><td>Training communication partners</td><td>n = 5</td><td>n = 2</td></tr><tr><td>Availability of AAC</td><td>n = 4</td><td>n = 3</td></tr><tr><td>Sharing information about the individuals' communication methods</td><td>n = 4</td><td>__</td></tr><tr><td>Building a relationship of trust</td><td>n = 2</td><td>n = 1</td><td>Maximising collaboration and cooperation</td></tr><tr><td>Regular communication is required</td><td>n = 2</td><td>n = 4</td></tr><tr><td>A reciprocal relationship</td><td>n = 5</td><td>n = 4</td></tr><tr><td>Knowledge of the individual</td><td>n = 4</td><td>n = 1</td><td>Recognising individuality</td><td>Enhancing the Individuals' Potential for Success</td></tr><tr><td>Selecting AAC informed by individuality</td><td>n = 5</td><td>n = 4</td></tr><tr><td>Trialling AAC</td><td>n = 2</td><td>n = 1</td><td>Techniques to facilitate individuals' use of AAC</td></tr><tr><td>Training the individual to use AAC</td><td>n = 3</td><td>__</td></tr><tr><td>Identifying the individuals' progress</td><td>n = 4</td><td>n = 2</td></tr><tr><td>Repetitive and consistent use</td><td>n = 5</td><td>n = 2</td><td>Facilitating continuity of communication</td><td /><td>The Act of Communicating: Attempting to Realise the Individuals' Ability</td></tr><tr><td>Multiple forms of AAC</td><td>n = 3</td><td>n = 2</td></tr><tr><td>Consistency of staff</td><td>n = 1</td><td>__</td></tr><tr><td>Offering time and space</td><td>n = 5</td><td>__</td></tr><tr><td>High workloads</td><td>n = 2</td><td>n = 1</td></tr><tr><td>Offering choice</td><td>n = 2</td><td>n = 1</td></tr><tr><td>Communication partners' investment</td><td>n = 2</td><td>__</td><td>Communication partners' characteristics</td></tr><tr><td>Communication partners' expectations</td><td>n = 3</td><td>n = 1</td></tr><tr><td>Communication partners' assumptions</td><td>n = 2</td><td>n = 3</td></tr><tr><td>Uncertainty of individuals' potential</td><td>__</td><td>n = 1</td><td>Uncertainty is common among communication partners</td><td /><td>Living with Uncertainty</td></tr><tr><td>Uncertainty about funding</td><td>__</td><td>n = 3</td></tr><tr><td>Uncertainty about individual's communication technique in school</td><td>__</td><td>n = 1</td></tr><tr><td>Communication partners may be uncertain if they are using AAC correctly</td><td>n = 1</td><td /></tr></tbody></table> </ephtml> </p> <p>2 Abbreviations: AAC, augmentative and alternative communication; Fam., familial; Prof., professional.</p> <hd id="AN0183915469-11">Maximising Communication Through AAC</hd> <p>Participants' roles and responsibilities varied between the different types of communication partners and the nature of their relationship with the individual. Both SLTs and the CNS identified their roles and responsibilities primarily in the provision of training, assessment, selection of AAC and review of the system. The CNS discussed her role in running regular groups with individuals who used AAC. These groups were disrupted by the COVID‐19 lockdown. A teacher, HCA and parents identified their roles and responsibilities in implementing AAC, ensuring it was used, reporting issues to the individual who introduced the system and providing feedback. Although roles and responsibilities differed, there was unanimous agreement that they shared the role of supporting individuals to communicate to the best of their ability. Therefore, the shared goal, regardless of roles, was to maximise communication through AAC. Seven participants mentioned this as their role. 'Being a SLT it's communication, it's empowering that individual and everyone around them so they can communicate ...' (SLT, I4).</p> <p>My role is to give her the best opportunity that we can ... that she can try to communicate in the best way that she can ... So my role is to give her the best we can so that you know she feels like she can be heard .... (Mother, I6)</p> <p>Participants witnessed the potential of AAC to support individuals to communicate. Participants discussed the progress that individuals can and did make through AAC, where their voices were being heard. However, participants stated that their voices need to be heard more. '... people that I supported accessed their meetings with their board maker pictures and they had their voice heard which I think they don't get enough of their voice being heard ...' (CNS, I3). Participants were hopeful that AAC would further support individuals to communicate. This hope was reflected in their attempts to realise the shared goal.</p> <hd id="AN0183915469-12">Theme 1: Developing a Communicative Environment</hd> <p>This theme outlines a preparatory phase to develop an optimal communication environment, compromising two subthemes: (i) 'Creating the Context' and (ii) 'Enhancing the Individuals' Potential for Success'.</p> <hd id="AN0183915469-13">Subtheme 1: Creating the Context</hd> <p>'Creating the Context' outlines the steps taken to create the context for a communicative environment, comprising factors that were extrinsic to the AAC user. It relates to preparatory work involving creating opportunities for communication and maximising collaboration and cooperation.</p> <hd id="AN0183915469-14">Creating Opportunities for Communication</hd> <p>Both the SLTs and the CNS assessed the environment to identify communication opportunities. They discussed the importance of assessing partners' understanding of communication and AAC to ensure that they could provide opportunities for communication within the environment.</p> <p>... work around what is your communication environment at the moment and how was it today? ... so yeah I think that's kind of focusing peoples mind on, on how they can set up their environment for them to become communication partners within this environment and the two are kind of linked really, the environment that you work in and then your role as a communication partner. (CNS, I3)</p> <p>Both SLTs and the CNS discussed their role in training communication partners to ensure they were prepared to support the individual to communicate. They tried to increase partners' awareness and understanding of individuals' communication attempts. They recognised that AAC may be difficult to use so partners needed to be trained to use it. Training was valued by a number of participants who received it from either the SLTs or the CNS. In addition, one SLT identified that all communication partners had the responsibility to be trained in AAC to support the individual.</p> <p>Both SLTs and the CNS highlighted the importance of drawing communication partners' attention to subtle, non‐verbal communication cues to ensure that they recognise more subtle or nuanced non‐verbal communication.</p> <p>... they might not be speaking or using gestures to communicate but like kind of drawing their attention to those real subtle nonverbal cues that the client is using ... showing them that even though they might seem absolutely tiny but that's really important to that individual, that's them communicating what they want .... (SLT, I4)</p> <p>Similarly, an HCA stated that there are different ways to communicate, outlining the importance of recognising communication techniques to provide support.</p> <p>Communication partners' attitudes towards AAC and training were discussed by one participant. They discussed the importance of invested communication partners who were willing to learn. In the past, the participant had met partners who had received training but did not apply it in practice, stating that sometimes people have a way of communicating that is difficult to change. In contrast, both SLTs stated that if there was an incidence where AAC was not being used, it may be due to limited knowledge. Therefore, they would offer support or further training.</p> <p>Communication partners having previous education and knowledge in communication and AAC were reported to facilitate teamwork, as there was recognition that the role was not just the SLTs. Government bodies and policy documents were recognised for such developments. One mother also believed that Lámh was easier to use due to her existing knowledge of Irish Sign Language.</p> <p>Some participants stated that they were not aware of AAC before meeting with the SLTs, highlighting the value of training in increasing their awareness and knowledge of AAC.</p> <p>The impact of knowledge gaps was indicated when communication supports were discarded as it was not understood that they could be updated. Additionally, one participant seemed unaware of the types of AAC they were using, stating that they were not currently using AAC. However, they were using Lámh and PECS. Furthermore, an HCA identified the need for education for communication partners to increase their confidence and awareness of the time it takes to implement AAC with this population. '... sometimes people feel like they're not using it properly and just it takes time. So more education around that part of it for staff ...' (HCA, I5). She discussed other staff members who used AAC a few times and felt it did not work. This participant also highlighted the need for education on different syndromes to enable communication partners to provide more individualised support.</p> <p>The provision of Lámh training by the service provider was discussed by six participants. Lámh training was provided to two mothers of individuals where one individual could not form signs independently and the second did not understand Lámh and, therefore, did not sign. Alternative AAC strategies were then implemented. Training communication partners in AAC that are not individualised to the users' needs may limit communication opportunities as the individual may not be able to use the system.</p> <p>Two participants discussed the need to look at where individuals were networked to ensure that the network members were trained and had suitable skills. Staff transitions resulted in further monitoring of the network to ensure new members had suitable skills. Larger areas with more members resulted in a longer time to provide training.</p> <p>Four participants identified the importance of sharing information about how the individual communicates. This is an extension of recognising communication. Similar to training, it acted as a strategy to increase communication partners' understanding of individuals' communication. Information was shared through spoken word, communication passports and profiles. '... that's the problem, I might have all the information but if I retired it would be lost so the communication profiles are great then' (HCA, I5).</p> <p>Availability of AAC was discussed by seven participants. AAC has become more available in recent years: '... it's brilliant they wouldn't have had this 20 years ago so it's great to have it' (Teacher, I8). However, four participants discussed the challenges of securing funding and investment in high‐tech AAC. Insufficient funding hindered the availability of AAC at home for two individuals with severe intellectual disability. Further, although a device was physically available to an individual, software issues resulted in delays and interruptions, which sometimes led to frustration for the user. A teacher discussed that he was able to fix these issues, but the individual may not be able to rectify them himself.</p> <hd id="AN0183915469-15">Maximising Collaboration and Cooperation</hd> <p>Collaboration and cooperation between communication partners through teamwork were deemed important to create the context for a communicative environment. Trust was considered foundational to facilitate collaboration and cooperation among communication partners, 'I'm just there to kind of progress things and you know I find that building a relationship with the staff that I work with is really, really important' (CNS, I3).</p> <p>Collaborative and cooperative work was demonstrated in regular communication between the individual's communication partners and communication partners' reciprocal relationship to facilitate teamwork. Regular communication was important to ensure everyone was up to date and informed of the targets and plans. Teachers were seen to have a liaison role, which was valued by parents and an SLT.</p> <p>During COVID‐19 restrictions, one parent stated that she communicated with communication partners through email and WhatsApp. Another participant stated that the lockdown had a negative impact on communication with SLTs. She discussed the need for more regular and structured communication to progress towards the AAC goals.</p> <p>Participants held different expertise and experience, both with the individual they supported and in AAC. They took ownership of their roles and responsibilities and respected the roles and responsibilities of the other partners involved. They helped each other, whereby the SLTs and CNS shared their professional experience and expertise in AAC, and familiar partners shared their personal experience with the AAC user. This collaborative approach was highlighted by seven participants. '... I was working with Paul for the device ... but then Mom and Dad were working on the picture at home as well, so we're kind of all working on the same goal together' (SLT, I4).</p> <p>A teacher, HCA and parents acknowledged the SLTs and CNS expertise in communication and AAC. They acknowledged the SLTs' role in the provision of training, selecting AAC, making it available and reviewing an issue. Conversely, the SLTs and the CNS acknowledged the role of partners such as teachers, nurses, HCAs and parents in sending referrals for assessments, helping them to get to know the individual, selecting pictures for the systems used, using AAC and providing feedback.</p> <p>The CNS also identified her role in reviewing issues with AAC and stated that she would contact the SLT for advice on devices. Both the SLTs and the CNS also discussed their positive relationship with the AAC providers (the company and their reps.) and their importance when implementing AAC and reviewing issues they could not rectify themselves.</p> <p>Multidisciplinary team involvement was deemed important. The behaviour support team, occupational therapists, physiotherapists, nurses, special needs assistants, visiting teachers and dual sensory impairment practitioners were mentioned outside of the team members that were interviewed.</p> <hd id="AN0183915469-16">Subtheme 2: Enhancing the Individuals' Potential for Success</hd> <p>The second subtheme includes the factors intrinsic to the AAC user, relating to engagement with the individual when developing a communicative environment.</p> <hd id="AN0183915469-17">Recognising Individuality</hd> <p>Each person's individuality was identified by gaining knowledge of the individual through assessment and gathering information from their familiar partners. Individuality was related to their ability, needs, motivators and preferences. Participants discussed the importance of knowing individuals when selecting, using and reviewing AAC.</p> <p>Yeah so I suppose the first step usually I would do would be an assessment, so kind of seeing okay is this individual at object level or are they at visual level... and that kind of for me differentiates like if it's going to be like objects of reference, is it a device, is it picture level like to see what they're able for .... (SLT, I4)</p> <p>Applying this knowledge was beneficial when selecting AAC, where partners built on the individuals' existing ability, supported their understanding and selected ACC that matched their individual needs: 'Every single child is an individual ... And what works for one might not work for another' (Mother, I6). AAC tailored to the users' individuality was reported to have been successful. For example, eye‐gaze devices were selected for two individuals who had a limited range of movement in their arms and could eye‐point. The SLTs selected AAC that built on their existing ability. 'He has limited movement of his arms, so it gives him more freedom of choice which is good' (Teacher, I8).</p> <p>Similarly, three participants discussed AAC use with older adults who preferred gestures and pictures as opposed to technology. This was due to previous exposure to these forms of AAC as opposed to technology. Objects of reference were introduced to an individual as he preferred to feel and touch items. His preference was included in the selection of AAC and was reported as successful.</p> <p>Not considering each person's individuality may potentially lead to introducing AAC that does not match their needs or abilities. Two mothers discussed the introduction of Lámh to their children. One mother stated that her son required physical assistance to use Lámh as he has abducted thumbs and found using Lámh difficult. Although this mother continued to use Lámh, she displayed a level of uncertainty about her child's understanding of Lámh. This suggests that introducing AAC that the individual cannot use may have led to feelings of uncertainty. A second mother stated that her child did not understand Lámh and therefore, did not sign. A different type of AAC was then introduced. An SLT stated that Lámh was introduced to supplement individuals' understanding to promote total communication.</p> <p>AAC was reported to support individuals' communication needs. It was stated that AAC helped supplement users' understanding and helped them to make choices and requests and express themselves. However, three participants identified the need for further supports for individuals to express themselves and have their voices heard. There was a need to support both their receptive and expressive communication.</p> <p>Professionals introducing AAC discussed their role in including parents and familiar staff from the start as their input is essential for the selection process: 'You have to have them involved ...that's their field' (SLT, I4). SLTs highlighted the need to manage expectations. They had worked with parents who sometimes wanted to start by supporting their children to speak as opposed to communicate. With time, parents accepted using AAC that built on the individual's ability, which was to support communication as opposed to speech.</p> <hd id="AN0183915469-18">Techniques to Facilitate Individuals' Use of AAC</hd> <p>A number of techniques were discussed to prepare individuals with severe/profound intellectual disability to use AAC and facilitate their continued use of AAC. Techniques involved trialling AAC, training the individual to use it and documenting their progress.</p> <p>When the AAC strategy was trialled, participants felt the right AAC was selected. This suggests the value of trialling possible types of AAC before making a final decision.</p> <p>Participants discussed the need to train the individual to use AAC. One participant stated that she trained the individual first so their partners could see the individuals' ability.</p> <p>A number of participants discussed the AAC progress made by individuals they supported. An SLT and teacher discussed documenting progress made by an individual who used an eye‐gaze device.</p> <p>... we were working on the word more...the support worker was recording how many times he was functionally communicating more so it was really lovely to look back then and see okay he wasn't actually doing it at all at the start whereas now he's actually requesting more 10 times for his favourite activity. (SLT, I4)</p> <p>The teacher documented the individual's daily progress to monitor his overall progression. 'I was doing an eye gaze monitoring sheet, recording different stages. And I make my own notes after about observations, where he might be looking if he found it hard or the dwell time, things like that' (Teacher, I8).</p> <p>The SLT identified it as encouraging for communication partners to see individuals' progress. Four participants identified witnessing individuals' ability to communicate as positive. It was stated that people sometimes think individuals with severe/profound intellectual disability do not make much progress. If their ability is not recognised, then it cannot be maximised. Therefore, documenting progress could act as a strategy for feedback. '... when parents see okay, their son or daughter is actually able to use this device, they kind of get pulled in then and get a bit of knowledge about it and then everyone's able to use it together' (SLT, I4). '... I think if staff see that people are actually able to use it, they use it a little bit more' (CNS, I3).</p> <hd id="AN0183915469-19">Theme 2: The Act of Communicating: Attempting to Realise the Individuals' Ability</hd> <p>Theme 2 outlines participants' attempts to realise individuals' ability through the act of communicating.</p> <hd id="AN0183915469-20">Facilitating Continuity of Communication</hd> <p>Repetitive, consistent use, using multiple forms of AAC, consistency of communication partners and providing the individual with sufficient time and space to communicate through AAC were important to facilitate continuity of communication through AAC.</p> <p>Repetitive, consistent AAC use was important to ensure all partners implemented the same plan. The significance of using multiple forms of AAC was discussed during an interview with a mother of a child with severe intellectual disability. Her child had become more mobile and, therefore, more independent. As she became more mobile, she was less interested in using PECS to communicate. They tried other types of AAC strategies that had already been introduced, which provided the individual with a choice.</p> <p>Consistency of communication partners was discussed by one participant who outlined a case where an individual's keyworker was transferred, but there did not seem to be a reason for the move. This was thought to have negatively impacted the individual's communication. The need to move staff was recognised, but the importance of discussing the communication partnership when making such decisions was highlighted: 'But you know if you're managing a group of people then the communication partner aspect of it needs to be taken into account' (CNS, I3).</p> <p>Time and space were important to support individuals' communication needs: 'And like it does take time like it's not going to be a week or two like these things take time' (SLT, I4). An HCA stated that when she had one‐to‐one time with an individual, she was better able to support their expressive communication.</p> <p>High workloads were reported to have had a negative impact on the provision of time for assessment and AAC use. In addition, staffing levels limited time. Within an adult residential setting, there were individuals with various needs. Two participants spoke about the relationship between staffing levels and workload within this setting. The CNS highlighted the need to have sufficient staffing levels to support a variety of individual needs.</p> <hd id="AN0183915469-21">Communication Partners' Characteristics</hd> <p>Communication partners' characteristics were deemed important to reach the shared goal. These characteristics included investment, attitudes, expectations and assumptions based on presuming to know what the individual was communicating.</p> <p>Participants discussed their experiences with other people who had a generic view of individuals with severe/profound intellectual disability and their abilities. The CNS outlined the importance of communication partners expecting that the individual can communicate, where low expectations could result in limitations for maximising individuals' ability: '... nobody believes that the individual that has been referred is going to change, nobody has an expectation that this is going to get better ... she is always doing this, she will never do that ...' (CNS, I3). A second participant thought that the individual could not use AAC. However, this participant stated that she continued to try to use AAC. This highlights a sense of hope in AAC. The participant's expectation stemmed from her uncertainty in AAC, thus posing as a limitation to maximising the individual's communication.</p> <p>Individuals' right to choices and the importance of offering choices were highlighted. However, assumptions about what the individual was communicating were identified as a potential limitation for the provision of choice. Such assumptions were evident in discussions with three participants. The CNS discussed the need to work with the individual as well as their partners to ensure partners understood that environmental cues may supplement such understanding.</p> <p>Such assumptions could limit the continuity of communication with other people and environments. One mother discussed her awareness of the importance of using AAC more with her child, to ensure that her child could communicate with other people in different environments. To maximise individuals' ability to communicate with others, consistency and continuity of use are important.</p> <hd id="AN0183915469-22">Theme 3: Living With Uncertainty</hd> <p>The key finding represented in this theme relates to the overall feeling of uncertainty and living with this uncertainty.</p> <p>A mother discussed her uncertainty about her son's ability to understand and use Lámh. The mother's uncertainty was related to her son having a severe intellectual disability and being unable to sign as he had abducted thumbs. This participant's uncertainty in her son's ability resulted in further uncertainty about reaching the shared goal. 'I keep trying but I don't know if it will happen' (Mother, I1).</p> <p>Three participants discussed uncertainty about funding. Furthermore, they discussed their uncertainty of accessing AAC at home, which stemmed from the cost of the device and the funding available.</p> <p>A mother was uncertain as to how her child communicated in school. She expressed her feelings of needing to do more and felt this was a characteristic of mothers. She stated that she plans to speak to the class teacher in the future to find out how her child communicates in school. This suggests that there is potential to reduce such uncertainty through communication between partners in different settings.</p> <p>Furthermore, an HCA spoke about communication partners' uncertainty in their use of AAC. Such uncertainties may hinder the ability to reach the shared goal of maximising communication through AAC.</p> <hd id="AN0183915469-23">Discussion</hd> <p>The current study provides nuanced insights into communication partners' perceptions of their roles and responsibilities in the design, planning and use of AAC in supporting individuals with severe/profound intellectual disability. Such knowledge could be beneficial when planning and implementing AAC support. Also, it identifies the potential barriers and facilitators to maximising this population's communication through AAC.</p> <p>The overarching theme 'Maximising Communication through AAC' captures participants' agreement that their shared goal was to maximise the individuals' communication, where they were hopeful that AAC would help them realise their goal. Three factors influencing this shared goal included: (<reflink idref="bib1" id="ref57">1</reflink>) 'Developing a Communicative Environment', (<reflink idref="bib2" id="ref58">2</reflink>) 'The Act of Communicating: Attempting to Realise the Individuals' Ability' and (<reflink idref="bib3" id="ref59">3</reflink>) 'Living with Uncertainty'.</p> <p>AAC helped to support individuals' communication needs. The positive impacts of AAC are echoed by other studies (Roche et al. [<reflink idref="bib33" id="ref60">33</reflink>]). However, individuals' voices need to be heard more. Participants' hope in AAC was reflected in their attempts to reach and realise this shared goal. However, such attempts were made within a context of uncertainty.</p> <p>The shared goal encouraged teamwork. AAC is a collaborative approach requiring teamwork among stakeholders for successful use (Uthoff et al. [<reflink idref="bib41" id="ref61">41</reflink>]). Effective and efficient teamwork must be developed (Lund and Light [<reflink idref="bib24" id="ref62">24</reflink>]). The importance of establishing trust to facilitate collaboration is reiterated by Jansen, Van der Putten, and Vlaskamp ([<reflink idref="bib19" id="ref63">19</reflink>]). Trust was established in the present study by listening to communication partners, including them in the assessment and intervention and having knowledge of both the AAC user and AAC.</p> <p>Communication partners must work together to maximise the individuals' communication and establish a individual‐centred approach. A collaborative approach involving communication partners increases the likelihood of positive outcomes for individuals (Lund and Light [<reflink idref="bib24" id="ref64">24</reflink>]). Each partner's unique contributions were respected and shared in the current study. Responsibilities can vary and be shared when a collaborative relationship has been developed (Beukelman, Ball, and Fager [<reflink idref="bib1" id="ref65">1</reflink>]). The importance of collaborative, family‐centred AAC decision‐making is documented within the literature (Ogletree [<reflink idref="bib30" id="ref66">30</reflink>]). Not seeking parents input when selecting AAC may lead to negative outcomes (McNaughton et al. [<reflink idref="bib28" id="ref67">28</reflink>]). Moreover, not considering families perspectives could result in the abandonment of AAC (Johnson et al. [<reflink idref="bib21" id="ref68">21</reflink>]). Parents of children who use AAC recommended that professionals need to be sensitive to the unique needs of both the individual using AAC and their family members (McNaughton et al. [<reflink idref="bib28" id="ref69">28</reflink>]).</p> <p>The impact of effective and efficient teamwork on maximising individuals' communication and providing individualised support was highlighted. Gathering information about the AAC user from familiar partners and selecting AAC informed by the users' individuality resulted in a better 'fit' (Johnson et al. [<reflink idref="bib21" id="ref70">21</reflink>]) of the AAC with the user. This led to more consistent AAC use by communication partners in the current study. Communication partners may be hesitant to use AAC as they may think it does not match the individual's needs and when AAC enables communication successes they are more likely to consistently implement it (Johnson et al. [<reflink idref="bib21" id="ref71">21</reflink>]). AAC must be individualised for each person's needs (Williams, Krezman, and McNaughton [<reflink idref="bib45" id="ref72">45</reflink>]). Therefore, each person's individuality needs to be identified collaboratively, and the selected AAC should be tailored accordingly.</p> <p>The findings indicate that the 'fit' between the users' individuality and selected AAC impacts the use of AAC. In addition, expectations and attitudes were also deemed key factors impacting consistent use. Attitudes can impact the success of AAC (Johnson et al. [<reflink idref="bib21" id="ref73">21</reflink>]). Attitude barriers can result in reduced expectations of individuals with disabilities which can limit opportunities for participation (Beukelman et al. [<reflink idref="bib2" id="ref74">2</reflink>]). There were differing expectations and attitudes between partners towards both individuals and AAC. A participant in this study discussed working with communication partners who had negative attitudes. Despite having received AAC training, they did not implement AAC, thus limiting opportunities (Beukelman et al. [<reflink idref="bib2" id="ref75">2</reflink>]). This is a key consideration given communication partners fundamental role in developing opportunities for communication (Huer and Threats [<reflink idref="bib18" id="ref76">18</reflink>]). Both SLTs discussed the need for further training if such a situation arose, although additional training may not necessarily alter communication partners' attitudes. These findings raise the question of how to positively affect partners' beliefs and attitudes towards AAC and individuals with severe/profound intellectual disability. Light and McNaughton ([<reflink idref="bib23" id="ref77">23</reflink>]) state that 'the persistent focus on deficits alone may cloud recognition of the unique characteristics of the individual and important strengths that may be leveraged to maximise outcomes' (p. 90). Therefore, steps need to be taken to ensure individuals' abilities are recognised and potential fulfilled. Documenting individuals AAC progress could further highlight their small improvements and ability to their partners.</p> <p>Optimal AAC use was also influenced by factors outside of the communication partners' control. The findings from this study and others (Rombouts, Maes, and Zink [<reflink idref="bib34" id="ref78">34</reflink>]) indicate that communication partners may need to choose between tasks. Therefore, one task was prioritised over the other. Communication is fundamental for individuals' well‐being. There needs to be time to incorporate AAC into the daily lives and activities of AAC users. Technical issues with an eye‐gaze device were also discussed and limited individuals' access to the AAC system. Similarly, parents discussed technical issues with devices, which led to frustrations (McNaughton et al. [<reflink idref="bib28" id="ref79">28</reflink>]). Sufficient investment in developing and maintaining AAC device software is required to reduce such challenges and ensure continuous access for the individual who uses AAC to communicate.</p> <hd id="AN0183915469-24">Conclusions and Implications</hd> <p>Participants had differing roles and responsibilities. Both SLTs and the CNS identified their roles and responsibilities primarily in the provision of training, assessment, selection of AAC and review of the system. Familiar partners included both familial and professional partners. Professional partners who spent regular time with the individual were considered familiar partners. Familiar partners identified their roles and responsibilities in sharing the information and experience they had with the individual with professionals, using AAC, reporting issues to the individual who introduced the system and providing feedback. Although roles and responsibilities varied, participants believed that multiple partners should be involved in the design planning and use of AAC, with each partner having distinct yet important roles and responsibilities to optimise the outcomes for the individual. Roles and responsibilities can and do vary. The key finding is the importance of respecting the roles and responsibilities of each partner and working together to optimise the outcomes.</p> <p>The findings highlight the importance of employing strategies both intrinsic and extrinsic to the AAC user to optimise their communication. Teamwork is essential for AAC success (Uthoff et al. [<reflink idref="bib41" id="ref80">41</reflink>]) and must be developed (Lund and Light [<reflink idref="bib24" id="ref81">24</reflink>]). Trust is an underlying principle of teamwork and was developed through multi‐way communication and participation in decision‐making. Communication partners have different expertise and experience in AAC and with the individual, the recognition and respect of the various contributions of each partner aided teamwork. It is recommended that teamwork is developed and fostered by including diverse team members with distinct roles and responsibilities, fostering open communication, listening to each partner involved and sharing decision‐making where the individual AAC user is central to those decisions.</p> <p>Introducing AAC that is not compatible with the individual's current ability poses a barrier to optimising the individual's communication. Each communication partner has a fundamental role in identifying the person's individuality. Therefore, collaboration must be promoted to ensure a thorough assessment is undertaken, which aids in selecting AAC that is individual to each user.</p> <p>Communication partners must provide communication opportunities that promote participation. Training communication partners in methods of AAC not tailored to the individual may limit such opportunities. It is recommended to train partners in AAC that supports the user's individuality, explicitly inform them of their roles and responsibilities and prepare them for what to expect in terms of progress and timelines.</p> <p>There were differing expectations and attitudes towards individuals with severe/profound intellectual disability and AAC. It was deemed encouraging for partners to see individuals' abilities and progress in AAC. It is recommended that intervention plans include a method of objectively recording progress with regular feedback and updates to the individual's network.</p> <p>Uncertainty was common among participants. It is recommended to acknowledge uncertainty and encourage partners to share their experiences.</p> <hd id="AN0183915469-25">Acknowledgements</hd> <p>The authors would like to thank the Service Provider and the participants for their time and openness. This research was undertaken as part of the first author's PhD, which was supported by a studentship granted by the Catherine McAuley School of Nursing and Midwifery, University College Cork. Open access funding provided by IReL.</p> <hd id="AN0183915469-26">Ethics Statement</hd> <p>Ethical approval was gained from the Social Research Ethics Committee, University College Cork (Log 2020‐131) and the Service‐Providers Research Committee. All participants received an information sheet detailing the study and signed a consent form. Interviews were scheduled when the first author received the signed consent forms. This article has not been published and is not under review/consideration anywhere else. A segment of the findings focused on family members' roles and responsibilities was presented at the online conference of the SIRG‐PIMD of IASSIDD, titled 'The strengths of families for individuals with Profound Intellectual and Multiple Disabilities', on 3 March 2022.</p> <hd id="AN0183915469-27">Conflicts of Interest</hd> <p>The authors declare no conflicts of interest.</p> <hd id="AN0183915469-28">Data Availability Statement</hd> <p>The data are not publicly available due to privacy or ethical restrictions.</p> <p>GRAPH: Supporting information.</p> <p>GRAPH: Supporting information.</p> <ref id="AN0183915469-29"> <title> References </title> <blist> <bibl id="bib1" idref="ref54" type="bt">1</bibl> <bibtext> Beukelman, D. R., L. J. Ball, and S. Fager. 2008. " An AAC Personnel Framework: Adults With Acquired Complex Communication Needs." 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  Label: Title
  Group: Ti
  Data: Communication Partners' Perceptions of Their Roles and Responsibilities in the Design, Planning and Use of Augmentative and Alternative Communication with Individuals with Severe or Profound Intellectual Disability: A Qualitative Descriptive Study
– Name: Language
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  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Edina+Hanley%22">Edina Hanley</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-7453-3668">0000-0001-7453-3668</externalLink>)<br /><searchLink fieldCode="AR" term="%22Caroline+Dalton%22">Caroline Dalton</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-4396-2800">0000-0003-4396-2800</externalLink>)<br /><searchLink fieldCode="AR" term="%22Elaine+Lehane%22">Elaine Lehane</searchLink><br /><searchLink fieldCode="AR" term="%22Anne-Marie+Martin%22">Anne-Marie Martin</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-6446-7791">0000-0001-6446-7791</externalLink>)
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  Label: Source
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  Data: <searchLink fieldCode="SO" term="%22British+Journal+of+Learning+Disabilities%22"><i>British Journal of Learning Disabilities</i></searchLink>. 2025 53(1):74-86.
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  Label: Availability
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  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
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  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
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  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Interpersonal+Communication%22">Interpersonal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Augmentative+and+Alternative+Communication%22">Augmentative and Alternative Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Severe+Intellectual+Disability%22">Severe Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Role%22">Role</searchLink><br /><searchLink fieldCode="DE" term="%22Attitudes%22">Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Parents%22">Parents</searchLink><br /><searchLink fieldCode="DE" term="%22Professional+Personnel%22">Professional Personnel</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/bld.12620
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  Label: ISSN
  Group: ISSN
  Data: 1354-4187<br />1468-3156
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: This study explores communication partners' perceptions of their roles and responsibilities in the design, planning and use of augmentative and alternative communication (AAC) with individuals with severe/profound intellectual disability. Methods: A qualitative descriptive approach was used. Purposive sampling, data collection and qualitative content analysis were undertaken simultaneously. Data were collected from nine participants, four parents and five professionals over 4 months through audio or video-recorded, semi-structured, open-ended interviews. Findings: An overarching theme 'Maximising Communication through AAC' emerged, capturing participants' unanimous agreement that their shared goal was to optimise individuals' communication through AAC. This was influenced by three themes: 'Developing a Communicative Environment', 'The Act of Communicating; Attempting to Realise the Individuals' Ability' and 'Living with Uncertainty'. Conclusions: These findings contribute to enhancing understanding of AAC use with individuals with severe/profound intellectual disability and their communication partners.
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  Data: 2025
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  Data: EJ1460599
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      Pagination:
        PageCount: 13
        StartPage: 74
    Subjects:
      – SubjectFull: Interpersonal Communication
        Type: general
      – SubjectFull: Augmentative and Alternative Communication
        Type: general
      – SubjectFull: Severe Intellectual Disability
        Type: general
      – SubjectFull: Role
        Type: general
      – SubjectFull: Attitudes
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      – SubjectFull: Parents
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      – TitleFull: Communication Partners' Perceptions of Their Roles and Responsibilities in the Design, Planning and Use of Augmentative and Alternative Communication with Individuals with Severe or Profound Intellectual Disability: A Qualitative Descriptive Study
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