Speech-language pathologists (SLPs) play a critical role in promoting inclusive education, but they often have limited training on how to support students who use augmentative and alternative communication (AAC) in general education settings. The purpose of this exploratory study was to describe the perceptions of 17 SLPs regarding the inclusion of students who use AAC in general education settings and their recommendations for supporting students in these settings. Overall, SLPs indicated inclusion in the general education setting is important, benefits students who use AAC and their peers, and requires administrative support. SLPs also identified several essential resources to support students who use AAC in general education settings (i.e., professional learning opportunities for staff, access to appropriate curriculum materials, teaming and collaboration, dedicated planning time, appropriate class size, adequate classroom space). Additional reported areas of need included providing professional learning related to special education and AAC, improving knowledge about AAC programming, addressing challenging behavior, and implementing peer supports in school. This study contributes important insights about the perceptions of SLPs who support students who use AAC in general education settings.
augmentative and alternative communicationinclusive educationspeech-language pathologists
One core aspect of the Individuals with Disabilities Education Improvement Act (2004) is the consideration of the general education setting as the least restrictive environment. However, access to the general education setting continues to be limited for students with intellectual and related developmental disabilities, including those who use augmentative and alternative communication (AAC; Andzik et al., 2018; U.S. Department of Education, 2023). In general, students who use AAC benefit from support from skilled communication partners (Kent-Walsh & McNaughton, 2005) and opportunities to use AAC during motivating interactions that are contextually relevant (Binger et al., 2011). For students with intellectual and developmental disabilities who have complex communication needs, inclusive education requires aligning assessment and instructional practices with content standards (Henneberry et al., 2012), interprofessional collaborative practice (Erickson, 2017), and effective strategies to support AAC use (e.g., peer support, modeling, literacy development; Kearns et al., 2018).
Although students who use AAC can experience a range of benefits within the general education setting (e.g., increased relationships with peers, increased learning opportunities, reduced challenging behaviors, improved communication/language skills; Alquraini & Gut, 2012; Iacono et al., 2022), a number of barriers have been reported. The Participation Model for AAC as outlined by Beukelman and Mirenda (2013) provides a helpful framework for identifying and addressing barriers related to AAC implementation. The model includes opportunity (e.g., partner knowledge/skill, attitude, policy) and access barriers (e.g., motor, AAC system, sensory). Within the literature, specific barriers that align with this framework have been identified in general education settings, including: (a) difficulty coordinating meetings to support team collaboration, (b) adapting curriculum to support individual learning needs, (c) funding professional learning for educational teams, and (d) supporting and facilitating peer relationships (Alquraini & Gut, 2012; Iacono et al., 2022). To address these barriers, various supports can be utilized to promote self-determination for students who use AAC as well as access to and meaningful participation in general education settings (e.g., regular on-going communication with families, supportive administrators, educators and related services providers who believe in the value of inclusion, and peers who are willing to support and welcome the student in the classroom; Alquraini & Gut, 2012; Beukelman & Mirenda, 2013; Iacono et al., 2022; Kim et al., 2025).
Support from an interdisciplinary educational team is critical to ensuring appropriate education for students who use AAC within general education settings, and speech-language pathologists (SLPs) play a key role in this support (Andzik et al., 2018). This support may include facilitating training for educational team members related to the student’s AAC system (Chung & Stoner, 2016), working with the educational team to promote peer relationships (Biggs et al., 2017; Biggs & Rossi, 2021), or assisting in making adaptations to curriculum or educational materials (Chung & Stoner, 2016). However, SLPs have noted AAC coursework is often not required within pre-service training programs (Costigan & Light, 2010) and these skills must be learned on the job (Gohsman & Johnson, 2023). It comes as no surprise, then, that SLPs report varying levels of knowledge and confidence in their ability to support students who use AAC in educational settings (Sanders et al., 2021). Emerging research suggests a number of factors can impact an SLP’s ability to support AAC use in classroom settings, including professional knowledge, team collaboration, and administrative support (Quinn et al., 2023). Yet, research has not addressed SLP support in general education settings for students who use AAC.
Given the critical role SLPs have in supporting students who use AAC and the limited research on how SLPs support students who use AAC in the general education setting, there is a need to understand how to best support students who use AAC within general education settings from the perspective of SLPs. To address this important research area, we conducted an exploratory pilot study to investigate the following research questions: (a) What are SLPs’ perceptions regarding the inclusion of students who use AAC in general education settings? and (b) What recommendations do SLPs have for supporting students who use AAC in general education settings?
Method
We conducted an exploratory study using an anonymous online survey (with qualitative and quantitative items) to understand the perceptions of SLPs supporting students who use AAC in general education settings.
Participants and Procedures
Following research board approval, we used purposive sampling to recruit participants from preschool to Grade 12 schools across the United States that had a reputation for including students who use AAC in general education settings. We reached out to members of several AAC listservs and social media sites to obtain nominations for these inclusive schools. Subsequently, we identified and recruited SLPs from these nominated schools by exploring the websites of the schools and obtaining emails for SLPs. When these details were not provided, we emailed or called administrators at the school to obtain emails of SLPs. Nominations resulted in emails sent to 121 SLPs, 21 of whom consented to participate in this study and started the survey. Of these, 17 completed the survey in its entirety. We suspect spam filters blocked some emails from reaching potential participants, but we were unable to verify how many SLPs received an invitation or whether email addresses we collected were current. Table 1 provides details of participants who completed the survey. All SLP participants were female, worked in public schools, had a master’s degree, and worked full time (at least 30 hr per week). SLP participants provided educational support to a wide range of students as shown in Table 1. All SLPs supported students with intellectual and developmental disabilities, including students receiving services under the categories of developmental delay, autism, intellectual disability, and multiple disabilities.
Table 1: Participant Characteristics.
CHARACTERISTIC
n
%
CHARACTERISTIC
n
%
Race/Ethnicity
IEP categories*
White non-Hispanic/Latinx
16
94%
Autism
17
100%
Hispanic/Latinx
1
6%
Deaf-blindness
4
24%
Developmental delay
11
65%
Age
Hearing impairment
5
29%
20–29
3
18%
Intellectual disability
12
71%
30–39
6
35%
Multiple disabilities
12
71%
40–49
4
24%
Orthopedic impairment
5
29%
50–59
3
18%
Other health impairment
8
47%
60–69
1
6%
Specific learning disability
1
6%
Speech/language impairment
4
24%
State
Traumatic brain injury
2
12%
Colorado
1
6%
Visual impairment/blindness
5
29%
Florida
1
6%
Current grade levels*
Illinois
1
6%
Preschool/Kindergarten
12
71%
Maryland
3
18%
Elementary (1–5)
12
71%
Michigan
3
18%
Middle (6–8)
7
42%
New York
1
6%
High School (9–12)
7
42%
Oregon
1
6%
Number of students who use AAC
Virginia
3
18%
1–5
11
65%
Washington
1
6%
6–10
3
18%
Wisconsin
2
12%
Years as an SLP
11–15
2
12%
0–5
5
29%
16+
1
6%
6–10
4
24%
11–19
3
18%
20+
5
29%
Years in current position
0–5
8
47%
6–10
3
18%
11–19
2
12%
20+
4
24%
Note. Percentages are rounded up and may not equal 100%. *SLPs indicated all grade levels/IEP categories they support so percentages do not equal 100%.
Data Collection and Analysis
Prior to survey distribution, we obtained expert feedback from four researchers with expertise in survey design, AAC, inclusion, speech-language pathology, and special education and adjusted the survey accordingly. We also conducted cognitive interviews with two SLPs using a think aloud approach (Willis, 2015) to determine whether additional edits were required. Adjustments based on expert feedback and cognitive interviews included revisions to formatting, minor rewording for clarity, breaking down longer survey items into multiple items, and adding additional response options to some items. The final survey consisted of five sections: (a) consent; (b) demographics; (c) SLP experiences with AAC and inclusion; (d) SLP views on inclusion; and (e) open-ended questions related to SLPs’ perceptions regarding benefits, challenges, and recommendations to support students who use AAC in general education settings. A copy of the survey is provided in the supplementary materials.
Within the survey, we asked SLP participants to indicate their level of agreement with statements related to supporting students who use AAC in general education settings and identify areas in which they felt most confident supporting students who use AAC in general education settings using a 5-point scale (1 = strongly agree, 2 = agree, 3 = neither agree nor disagree, 4 = disagree, 5 = strongly disagree). They were also asked to list and rank order resources they felt were important to support students who use AAC in general education settings and the perceived benefits and challenges of doing so via open-ended narrative responses. At the end of the survey, they were able to provide recommendations for educational teams supporting students with AAC in general education settings via an open-ended narrative response.
We calculated basic descriptive statistics (i.e., count, percentage) for closed-ended items and conducted a qualitative content analysis for open-ended items to identify patterns within narrative responses (Krippendorff, 2018). This process included an initial review of open-ended responses, initial identification of coding categories that encompassed data for each open-ended response, organization of all open-ended responses into coding categories, revision of coding categories as needed, and a debriefing session with the whole research team to reach consensus on coding and the final categories.
Results
In this section, we provide a summary of survey results, including SLP beliefs about educational inclusion of students who use AAC and their professional preparedness for supporting inclusion of students who use AAC. SLPs also provided insights into the perceived benefits and barriers for students who use AAC in general education settings. We also gained insights from SLPs related to the critical resources required and recommendations to support students who use AAC in general education settings. We present results from quantitative and qualitative survey data in each of these areas next.
SLP Beliefs about Including Students who Use AAC in General Education Settings
SLPs rated their level of agreement with eight statements related to supporting students who use AAC in general education settings (see Table 2). Overall, SLPs strongly agreed or agreed inclusion in general education settings is important (all SLPs indicating strongly agree or agree), benefits students who use AAC and their peers (all SLPs indicating strongly agree or agree), and requires administrative support to be effective (15 of 17 SLPs indicating strongly agree or agree). SLPs also strongly agreed or agreed that, without programs focused on inclusion in general education settings, the rights of students who use AAC can be jeopardized (all SLPs indicating strongly agree). SLPs were somewhat split regarding planning for students who use AAC in general education settings (10 of 17 SLPs indicating disagree or strongly disagree), as well as the resources necessary to support students who use AAC in general education settings (split between agreement, neutral, and disagreement; see Table 2). Most SLPs disagreed or strongly disagreed that inclusion detracts from instruction in general education settings (16 of 17 SLPs indicating disagree or strongly disagree).
Table 2: SLP Perceptions about Including Students Who Use AAC in General Education Settings.
ITEM
STRONGLY AGREE
AGREE
NEITHER AGREE NOR DISAGREE
DISAGREE
STRONGLY DISAGREE
Students who use AAC benefit from inclusion in the general education setting.
14
3
0
0
0
Supporting students who use AAC in the general education setting requires too much planning.
0
2
5
8
2
Supporting students who use AAC in the general education setting is important.
16
1
0
0
0
Supporting students who use AAC in the general education setting detracts from instructional time.
0
0
1
7
9
Supporting students who use AAC in the general education setting benefits all students.
9
8
0
0
0
Without programs to support students who use AAC in the general education setting, students’ rights are violated.
15
2
0
0
0
Supporting students who use AAC in the general education setting cannot be effective without administrative support.
7
8
2
0
0
Schools do not have the resources necessary to support students who use AAC in the general education setting.
1
4
6
5
1
SLP Preparedness for Supporting Students who Use AAC in General Education Settings
SLPs reported high confidence and skills to support students who use AAC in general education settings in numerous areas. For example, 15 of 17 SLPs indicated comfort supporting communication development, while 13 of 17 SLPs indicated comfort with collaboration and teaming. Less than half of the SLPs indicated comfort in AAC programming (n = 9), adapting materials (n = 9), and adapting curriculum (n = 7). Few SLPs indicated comfort supporting social/emotional development of students (n = 5), facilitating peer supports (n = 4), and addressing challenging behavior (n = 2). Across these same areas, SLPs reported needs for additional training to address challenging behavior (n = 10), adapt curriculum (n = 9), program AAC (n = 6), and adapt materials (n = 6). Some SLPs also indicated a need for training to facilitate peer supports (n = 6) and support social/emotional development of students (n = 6). Few SLPs indicated a need for training related to collaborating and teaming (n = 2) and supporting communication development (n = 3).
Benefits and Barriers of Supporting Students who Use AAC in General Education Settings
Thematic analysis of open-ended qualitative responses resulted in three themes focused on the perceived benefits of and barriers to supporting students who use AAC in general education settings (see Figure 1). Most SLPs (16 of 17) described social/emotional advantages, including opportunities for students who use AAC to develop friendships and increased access to peer models. One SLP indicated that access to AAC supported learning and peer relationships: “Students with AAC devices are more engaged and take owner of their devices and want to talk to their peers.” Another SLP noted peers in the general education setting “become valued communication partners.” Approximately half of SLPs also reported benefits related to communication (e.g., varied and authentic communication opportunities; n = 11) and academics (e.g., access to age-appropriate and general education curriculum, increased student engagement; n = 9). One SLP emphasized the importance of generalization: “[inclusion in the general education setting] provides more opportunities to practice communication skills that are worked on during speech therapy sessions.”
Figure 1: Themes from open-ended items.
SLPs noted numerous barriers to supporting students who use AAC in general education settings. Structural barriers were noted by 12 of the 17 SLPs and included negative attitudes of staff, poor classroom structure, and limited self-efficacy. One SLP noted “attitudinal barriers from classroom teams” and provided the following example: “people who think students don’t belong in their rooms.” Staff knowledge and training was also noted as a barrier by 9 of 17 SLPs. One SLP noted, “I have no idea how to adapt [the] curriculum to the AAC user’s level, and teachers don’t seem to either, so I don’t think they’re getting much academic benefit.” Several SLPs (n = 6) also indicated a lack of “time for planning” and “adapting materials” served as a barrier.
Critical Resources to Support Students who Use AAC in General Education Settings
SLPs also identified critical resources to support students who use AAC in general education settings (see Figure 1). The majority of SLPs reported access to relevant professional development and training opportunities (n = 16), access to appropriate curricula and materials (n = 15), collaboration with educational teams (n = 15), dedicated time to plan AAC supports (n = 14), administrative support (n = 12), appropriate class size (n = 12), and adequate classroom space (n = 10) as important resources. One SLP who supported students in preschool to eighth grade stated “school culture of staff who understand and support inclusion” was essential.
Recommendations for Supporting Students who Use AAC in General Education Settings
Thematic analysis of open-ended survey responses resulted in two themes in relation to SLP recommendations for supporting students who use AAC in general education settings (see Figure 1). First, 16 out of 17 SLPs offered recommendations related to training and professional development. Specifically, SLPs described a need for more “time to train staff” including training across a range of school members (e.g., general education teacher, special education teacher, general education peers, SLPs), and “undergraduate education on special education topics including AAC”. Second, over half of SLPs (n = 11) identified recommendations concerning school culture. In particular, SLPs identified a significant need for administrative support, dedicated time for planning, and a shared vision for the inclusion of students who use AAC in general education settings. One SLP stated: “the most important thing is that the people supporting the student truly believe that they belong there and are willing to do what it takes to help them succeed.”
Discussion
Findings from this pilot study provide important insights into the perceptions of SLPs supporting students who use AAC in general education settings. Several key findings indicate potential areas of need within the field, including a need for training related to special education and AAC, AAC programming, implementing peer supports, and addressing challenging behavior. Although many of these areas of need have been noted in other studies (e.g., need for training in AAC; see Costigan & Light, 2010), our findings offer additional information about SLP perspectives. For example, we found it interesting that several SLPs noted limited skills and confidence related to AAC programming. A robust vocabulary is critical to accessing the general education curriculum and promoting meaningful engagement in general education classroom activities, and SLPs most often carry out the role of AAC programming within educational settings (Thistle et al., 2023). This led us to wonder if not SLPs, who is supporting AAC programming – the general education teacher, paraeducator, assistive technology specialist, family?
We also thought the need for knowledge related to implementing peer supports and addressing challenging behavior are highly relevant for SLPs supporting students in general education settings. Peer supports are an evidence-based practice that has been known to support students with intellectual and developmental disabilities in general education settings, including students who use AAC (Biggs & Rossi, 2021). Similarly, inclusion in general education settings can be extremely difficult without behavioral support for students with intellectual and developmental disabilities (Walker et al., 2022), a common area of need among students who require AAC. Knowledge and skill development in these areas should be addressed in SLP pre-service and in-service training.
Limitations and Future Research Directions
Although this initial exploratory study provides important contributions to the existing literature, we recognize the small number of participants and the purposive nature of sampling from inclusive schools may limit conclusions that can be drawn from our findings and have introduced some potential response bias into the findings. Due to the limited research in this area, this study was intended to be exploratory in nature. Nonetheless, future research should examine the inclusion of students who use AAC in general education with a larger sample of SLPs and additional participant groups, including other relevant team members such as general and special education teachers to build upon the findings of this study. There is still much to learn on this topic to inform efforts to support students who use AAC within these inclusive environments, especially related to the needs of students based on grade level and IEP category.
Implications for Practice
Findings from this exploratory study and previous research highlight that inclusion of students who use AAC in the general education setting requires a number of important components. Pre-service preparation in AAC is vital for all SLPs entering educational settings. Although debates exist regarding SLP specializations related to AAC (Gohsman, 2023), a basic understanding of AAC is essential for SLPs supporting students in educational settings. Given that SLPs in this study reported a lack of knowledge related to AAC programming and peer supports, school teams might consider training specifically related to these areas of identified need. Such training may provide SLPs with the knowledge and skills necessary to ensure communication supports promote full and meaningful participation in the general education setting and allow opportunities for peer engagement. Administrative support is critical to ensuring time for teams to meet and adequate training for team members (Quinn et al., 2023). Administrators can advocate for funding within school budgets to set aside money for team training and funding to support meeting time for educational teams who are supporting students who use AAC in general education settings. Administrators can also influence school culture and create a culture of inclusivity and belonging for students who use AAC.
Summary
Given the benefits of inclusive education for students who use AAC, it is critical to explore best practices for supporting the communication needs of these students in general education settings. SLPs play an important role in planning and implementing these supports for students who have complex communication needs. In this exploratory study, SLPs reported varied skills and confidence across AAC implementation in the inclusive environment, identified critical resources necessary to promote inclusive education, and offered several notable recommendations. We encourage continued work to explore best practice for school personnel supporting students who use AAC in these settings.
Supplementary Files
Supplementary materials. AAC Inclusion Study Survey. https://doi.org/10.25894/rise.2770.s1
Competing Interests
The authors have no competing interests to declare.
Author Contributions
Sarah Nathel Douglas: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Original Draft; Virginia Walker: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Supervision, Validation, Writing – Review and Editing; Lauren Bonnet: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Validation, Writing – Review and Editing.
Alquraini, T., & Gut, D. (2012). Critical components of successful inclusion of students with severe disabilities: Literature review. International Journal of Special Education, 27(1), 42–59.Andzik, N. R., Schaefer, J. M., Nichols, R. T., & Chung, Y.-C. (2018). National survey describing and quantifying students with communication needs. Developmental Neurorehabilitation, 21(1), 40–47. 10.1080/17518423.2017.1339133Beukelman, D. R., & Mirenda, P. (2013). Augmentative and alternative communication: Supporting children and adults with complex communication needs. Brookes.Biggs, E. E., Carter, E. W., & Gustafson, J. (2017). Efficacy of peer support arrangements to increase peer interaction and AAC use. American Journal on Intellectual and Developmental Disabilities, 122(1), 25–48. 10.1352/1944-7558-122.1.25Biggs, E. E., & Rossi, E. B. (2021). Supporting inclusion through peer support. In Handbook of Effective Inclusive Elementary Schools (pp. 322–347). Routledge.Binger, C., Maguire-Marshall, M., & Kent-Walsh, J. (2011). Using Aided AAC Models, recasts, and contrastive targets to teach grammatical morphemes to children who use AAC. Journal of Speech, Language and Hearing Research, 54(1), 160. 10.1044/1092-4388(2010/09-0163)Chung, Y. C., & Stoner, J. B. (2016). A meta-synthesis of team members’ voices: What we need and what we do to support students who use AAC. Augmentative and Alternative Communication, 32(3), 175–186. 10.1080/07434618.2016.1213766Costigan, F. A., & Light, J. (2010). A review of preservice training in augmentative and alternative communication for speech-language pathologists, special education teachers, and occupational therapists. Assistive Technology, 22(4), 200–212. 10.1080/10400435.2010.492774Erickson, K. A. (2017). Comprehensive literacy instruction, interprofessional collaborative practice, and students with severe disabilities. American Journal of Speech-Language Pathology, 26(2), 193–205. 10.1044/2017_AJSLP-15-0067Gohsman, M. (2023). AAC specialty certification for speech language pathologists. SpeakUp. https://ussaac.org/speakup/articles/aac-specialty-certification-for-speech-language-pathologists/Gohsman, M. K., & Johnson, R. K. (2023). Reported barriers to augmentative and alternative communication service delivery and learning preferences among speech-language pathologists. American Journal of Speech Language Pathology, 32, 1595–1609. 10.1044/2023_AJSLP-22-00036Henneberry, S., Kelso, J., & Soto, G. (2012). Using standards-based instruction to teach language to children who use AAC. Perspectives on Augmentative and Alternative Communication, 21(3), 92–98. 10.1044/aac21.3.92Iacono, T., Goldbart, J., Douglas, S. N., & Melgar, A. G. (2022). A scoping review and appraisal of AAC research in inclusive education settings. Journal of Developmental and Physical Disabilities, 34, 963–985. 10.1007/s10882-022-09835-yIndividuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. § 1400.Kearns, J., Kelienert, J., & Erickson, K. (2018). Strategies for supporting AAC use in inclusive general education classrooms. Impact, 31(2). https://ici.umn.edu/products/impact/312/Supporting-AAC-Use/#Supporting-AAC-UseKent-Walsh, J., & McNaughton, D. (2005). Communication partner instruction in AAC: Present practices and future directions. Augmentative and Alternative Communication, 21(3), 195–204. 10.1080/07434610400006646Kim, G., Kurth, J. A., & Andzik, N. R. (2025). Supporting self-determination for students with complex support needs using augmentative and alternative communication. Inclusive Practices, 4(3), 42–48. 10.1177/27324745251338211Krippendorff, K. (2018). Content analysis: An introduction to its methodology. Sage.Quinn, E. D., Atkins, K., & Cook, A. (2023). Exploring classroom factors and augmentative and alternative communication use in qualitative interviews. American Journal of Speech-Language Pathology, 32(5), 2158–2177. 10.1044/2023_AJSLP-23-00041Sanders, E. J., Page, T. A., & Lesher, D. (2021). School-based speech-language pathologists: Confidence in augmentative and alternative communication assessment. Language, Speech, and Hearing Services in Schools, 52(2), 512–528. 10.1044/2020_LSHSS-20-00067Thistle, J. J., Thiessen, A., & Hart, J. (2023). “I don’t think you can really understand it until you put it to action”: School-based SLPs’ reflections on graduate and continuing education in AAC. Augmentative and Alternative Communication, 39(4), 270–281. 10.1080/07434618.2023.2220794U. S. Department of Education. (2023). 44th annual report to congress on the implementation of the Individuals with Disabilities Education Act, 2022. https://sites.ed.gov/idea/files/44th-arc-for-idea.pdfWalker, V. L., & Loman, S. L. (2022). Strategies for including students with extensive support needs in SWPBIS. Inclusive Practices, 1(1), 23–32. 10.1177/2732474521100030Willis, G. B. (2015). Analysis of the cognitive interview in questionnaire design. Oxford University Press.